Against this complex and constantly changing humanitarian context in Eastern Chad, malaria presents a great threat to the well fare and lives of IDPs, host communities and refugees. Whilst transmission of malaria is very low in the most northerly areas of the eastern Chad border disease transmission increases significantly from Abeche downwards in all the IDP areas to Am Timan. In this epidemic prone area, all age groups within the population are considered equally vulnerable to malaria as no immunity is acquired during childhood. A part from causing an important number of life-threatening cases throughout the year there is also a significant risk of large scale malaria epidemics amongst the displaced and host communities.
In Southern Chad, the emergency is of a different scale and largely due to instability on the other side of the border in the Central African Republic (CAR). Five refugee camps, of which two are in the health district of Danamadji and three in Gore health district, have been set up to give shelter to refugees from CAR. The epidemiological profile for malaria is different in the South compared to the East: The vector borne disease is endemic in all of Southern Chad and represents more than 60% of the outpatient health burden in national health facilities (and an estimated 30% of inpatient health burden). Children and pregnant women are the main target population for malaria interventions as the adult population originating from this area will have acquired a partial, natural immunity during childhood.
In both Eastern and Southern Chad, the national health infrastructure is in poor condition with frequent stock outs - or no stock at all - of malaria drugs and rapid tests. As a consequence, inefficient and potentially dangerous drugs are bought in local markets