Faced with deepening gaps in international aid and rising needs, Doctors Without Borders/Médecins Sans Frontières (MSF) is increasingly stepping in to provide life–saving water and sanitation services for hundreds of thousands of refugees and local residents across eastern Chad.
With particularly high temperatures in recent months, the daily search for clean water has become a relentless struggle for most of the 860,000 Sudanese refugees and the communities hosting them. Now, with the rainy season fast approaching, the crisis is only set to worsen. Flood risks, water contamination, and overstretched health services loom large. MSF is working closely with Chadian authorities, who shoulder the response and are being hit hardest by shrinking international support.
More than two years of war creating waves of displacement
After over two years of war between Sudan’s Armed Forces and the Rapid Support Forces, tens of thousands of people continue to flee across the border – with more than 85,000 new arrivals in the provinces of Wadi Fira and Ennedi Est since 23 April 2025, according to UNHCR. Each wave of displacement adds pressure to already fragile water and sanitation systems in the camps and surrounding areas.
Providing large–scale water and sanitation in such conditions is both costly and complex. Few humanitarian organizations have the resources to respond, and recent funding cuts are further eroding their capacity. As a result, MSF – already stretched beyond its core medical mandate – is being forced to take on more of the burden.
Not enough clean water, not enough latrines
In refugee camps scattered across Ouaddai, Wadi Fira, and Ennedi Est provinces, most refugees are still receiving far less than the recommended 20 litres of clean water per day. The water crisis is hardest on women and children. With long queues and limited supply, many spend hours each day under the sun to secure water.
There are also not enough latrines, with many camps failing to meet the minimum 1 per 50 people standard. Both poor sanitation and unsafe water increase the risk of skin infections, and the spread of hepatitis E, typhoid, polio and cholera. They can also lead to diarrheal diseases, which prevent the body from absorbing vital nutrients, ultimately causing or worsening malnutrition. In the last two years, MSF treated 43,908 patients for
acute malnutrition and responded to hepatitis E and typhoid outbreaks in Adré, Aboutengue and Metche.
MSF major provider of water and sanitation amid increasing needs
Since the onset of the crisis, MSF has been a major provider of clean water in three refugee camps in the Ouaddai region – in Adré, Aboutengue and Metche.
In Aboutengue and Metche, MSF initially installed emergency water systems, which were later handed over to partner organizations. Since then, the water supply in Aboutengue has dropped from an average of 12 to 9 litres per person per day. This decline is partly due to geological challenges – boreholes in some areas do not reach deep enough to produce enough water to meet the growing demand.
With water needs still unmet for the 46,000 Sudanese refugees in Aboutengue – and 5,000 more people expected to be relocated to the camp soon – MSF is working with partners to upgrade the water system by installing an additional solar–powered network.
making them self–sufficient and sustainable for the community.
MSF has also distributed soap and jerrycans in Aboutengue camp. It handed out over 26,000 jerrycans in the first week of July alone, along with 400g of soap per person each month.
In Metche, where 41,000 refugees still do not have enough water, no other actor has stepped in to improve the infrastructure. As a result, MSF is preparing a new water network to support both refugees and the host community.
As thousands of Sudanese refugees arrive to the north in the arid Wadi Fira province, where clean water is extremely limited, MSF has built 50 emergency latrines and distributed 60,000 liters of water daily at Tine transit camp, in addition to providing basic health care services. As relocations continue from transit to refugee camps – already lacking adequate water and sanitation – pressure on scarce resources will only increase.
Mounting needs amid climate emergency, mass displacement, and aid cuts
Chad is vulnerable to recurrent cycles of drought and flooding made more extreme by the climate crisis. This year’s forecast of heavy rainfall has raised urgent concerns, with the government and its partners currently considering a national contingency plan.
Meanwhile, Chad’s refugee situation is unfolding against a backdrop of shrinking global funding. In early 2025, the United States cut nearly all foreign aid, followed by reductions from several European countries. UN agencies such as UNHCR and UNICEF– key actors in water and sanitation – are facing budget shortfalls.
The budget reductions faced by other organizations capable of implementing large–scale water services are limiting their ability to respond, placing an increasing burden on MSF to fill the gap.
