Dave was our guide through the refugee camp they'd set up to show us. He had done several tours of duty with MSF, (The acronym is based on the acronym for Doctors Without Borders in French or Spanish. They use that acronym because it is easy to say compared to DWB.) one deployment in Africa, and several in South America. Then he explained that of the 42 million people uprooted by war, the 26 million that never cross an international boundary are referred to as Internally Displaced Persons (IDP).

  

People typically become refugees when insurgents tell them something like "you have ten minutes to leave this house before we burn it down." Usually it happens to quite a few people, and they have to travel cautiously because more soldiers are likely to shoot them on sight. He asked us to put ourselves in the shoes of the refugee, who has crossed many miles fearing for their lives with little food and water. The come upon this checkpoint, and they probably have to approach it because the surrounding fields are mined with bombies. The kid in the guard shack with an AK-47 could easily just shoot you.

 

Once we find a place that is safe enough to stay, MSF tries to help. The first thing they provide is tarps or tents, depending on what is available. Typically, exposure is one of the leading causes of death among refugees. This kind of shelter is enough to drastically reduce that kind of problem.

 


  

For emergency rations these food bricks are handed out. They taste a bit like sweet graham crackers with a lot of milk powder in the recipe. The texture is crackerish, but compressed with no air like crackers usually have. It crumbles in your mouth like a dry cookie. That box is two days minimum rations for an adult.

In more stable situations, where time and utensils for cooking are available, MSF tries to give every refugee 2100 calories every day. Usually this is rice or corn and beans, with a little vegetable oil, salt, and sugar. Dave emphasized that this will keep an adult reasonably healthy, but it doesn't have enough protein to make a child grow healthy and strong.

Fuel to cook this food is a challenge for every refugee. Sometimes they have to walk miles to find the wood for it. Sometimes the women (most refugees are women and children) end up getting raped by soldiers that find them looking for wood.

 

Water is another need that MSF helps refugee camps with. If the situation is dire, each person will be limited to a gallon and a half every day. In more comfortable situations five gallons per person per day is better. (For contrast, a typical American probably uses 100 gallons a day.) Beyond that carrying the stuff becomes an issue. Dave asked us to heft the five gallons in this jug. It was very heavy. Then he explained that refugees probably have to carry it all the way from the source to their homes, which could be half a mile or more.

MSF sets up these huge bladders (this one is just a small demonstration size), pumps them full of water and then treats it with chlorine. They test it with instruments that look a lot like the pool test kits available here. Once the water is known to be okay they pass it out to people who bring their jugs, fill up and carry it home.

   

Dave looked at the picture of a bathroom above and said "that is the ideal case, and must be a posed picture." He explained that in a real refugee camp there would be a long line of people waiting their turn to use the latrine. Soap and water to wash hands is almost a luxury. Usually there are a lot of flies laying their eggs in the crap and generally being a nusince.

To prevent outbreaks of cholera proper disposal of fecal matter is very important. This means the latrine has to be far enough away from the water intake that cross contamination doesn't occur. Also, the drop pit the waste falls into has to be sealed off to keep the fly problem down. This is done by putting a cloth over the top of the vent pipe, and by having lids for the toilets that fit tightly.

 

Once the basics of survival are handled, psychological aspects of getting by become more important. MSF likes to team up with psychologists to work on this. These pictures were drawn by children coming to terms with how they got into the situation the refugee camps are a symptom of.

  

  

After that, we got to the tent that was set up as an immunization station. Dave explained that measles are a huge threat in refugee camps, and if an outbreak occurs a lot of people will die. He reminded us that generally refugees are weaker and more cramped than most populations, making them particularly susceptible to outbreaks. To prevent that immunizations are done as soon as possible after the refugees come in, or when resources are available.

     

Vaccines are delicate, and need to be kept in a certain temperature range to work. The vials are sealed in insulated boxes with blue ice and shipped as fast as possible from the source in France, India, the USA, or wherever to the camp. A temperature memory strip (I forget what he called it) is included that will indicate if the box was heated too much in transit. If the test strip indicates a borderline case, the camp will call the manufacturer for guidance.

If it is okay on delivery they try to use the shipment as soon as possible. Vaccinations are done with single use needles so that thieves won't steal them for black market use. After a day of vaccinations, MSF will have a big box of used needles (or more). Usually these are burned, creating a nasty block of melted plastic and scorched needles that nobody is going to want to steal for any known use.

     

Malnutrition in children is a common problem. MSF has a neat armband thing that makes it easy for an untrained caregiver to diagnose malnutrition. Children who are deeply undernourished are given "plumpy nut". It smells a lot like peanut butter. The ingredients say it is mostly peanuts and milk powder and vitamins and minerals. Children who eat it get better fast. Caregivers call plumpy nut "medicine" so that other people in the same household don't steal it from the patient.

        

The next tent is set up as a doctor's office. It had tools for boiling water, a pharmacy for filling prescriptions, and a number of other doctors tools. This one also had a MSF flag.

     

Prescriptions are sent home with the patient in these plastic bags, with tick marks indicating when and how much of the contents should be eaten. The iconography is easy for even illiterate people to read.

If there is a cholera epidemic in the camp than anybody that has it is taken into a segregated ward and is given all the water with ORS (Oral Rehydration Salts) they can drink. They are expected to drink some, vomit it, drink some, squirt diarrhea, drink some and vomit it. Cholera is essentially an allergic reaction to the toxins produced by the pathogen. The idea is to keep enough liquids going into the patient that what comes out won't leave them dehydrated. The patients are kept on beds that have holes in them for the diarrhea, to exit through so they don't have to get up, which they are usually too weak to do anyhow.

The last exhibit of the tour was a tent with the stories of a few representative samples from different war zones across the planet. Each had a picture of the people and a bit about them.

When the tour was over we just happened to be at the intake end of a tent where they were asking for donations and selling stuff. I got out of there with a booklet that covered the same material as the exhibits, but without the expert who knew the answers, and a shirt. I'm wondering how much to make of the fact that the iconic pair of refugees on the shirt are an eight year old girl in Chad carrying her too thin brother to the feeding station again for more medicine back in 2004. The book explained that they continue to grow up in fear and uncertainty, hanging on with little hope of returning to their home village in Darfur. Gives a whole new meaning to the phrase "Hanging Chad".