Over 290,000 people live in refugee camps in Tanzania's northwestern Kigoma district. Most are from neighbouring Burundi. People cross the border every day – in January, nearly 19,000 Burundians arrived in Tanzania, according to the UN Refugee Agency (UNHCR).
Unsanitary and overcrowded conditions, particularly in the cramped mass shelters that house new arrivals, cause a host of health problems including diarrhoea, respiratory tract infections and skin conditions. Children, as well as expectant or new mothers, are often the most vulnerable. Malaria is one of the biggest risks in the camps, particularly during the rainy season, where stagnant water provides a breeding ground for mosquitoes. In January 2017 alone, MSF tested over 31,200 people and treated the 16,812 diagnosed with the disease.
Below, two MSF patients in Nduta and Nyarugusu camps describe the shelter, water, food and hygiene problems they face, as well as their life in the camps and the health problems they encounter.
"My baby has a life of hardship ahead of him – what hope is there for a child born in a refugee camp?"
Aisha, 23, lives in Nduta camp with her husband and two children. She recently gave birth to her third child at the camp's MSF-run maternity hospital, making her one of the 3,005 women who delivered at MSF facilities in Nduta in 2016. Due to complications during labour, Aisha's baby is being kept in the hospital for ongoing care and observation.
"I'm so happy about the birth of my son but I'm also concerned about his future. He was born after foetal distress. He can't breathe properly, he hasn't been moving, and he still hasn't cried or made any of the noises that babies normally make. He's also unable to feed naturally so he's feeding via a tube. He is only five days old but he has already seen so much suffering. I know that he has a life of hardship ahead of him – what hope is there for a child born in a refugee camp?
When I think of the future, I feel sad. I have no money or way to provide for my baby and two older children. I've been in the camp for 10 months now but food is still a problem – I don't have the ingredients I need to make proper meals and we normally run out of supplies long before we're given our next ration. I try my best to provide for my children but they don't eat well and they don't have enough clothes.
I used to have so many dreams but now I try to block them from my mind – there are no opportunities for me to plan or develop myself anymore. I feel trapped here and wish I could find a peaceful place to escape to but I don't have any other options. When I remember what happened to me back home, I know it's better to stay in Nduta. I will never, ever, go back to my country. Instead I just have to try to find a way to keep going here."
"Refugees never have a good life – it's a struggle to get enough food and water, and living in a tent wears you down. But it's better than living in fear at home, so I will stay in this camp until I die."
Ramadhani, 26, was diagnosed with malaria at one of the three health posts MSF runs at Nyarugusu camp. He is one of the 6,802 people MSF treated for malaria in January in Nyarugusu.
"I've been sick since yesterday evening. I have a headache and nausea and feel very cold. I can't stop shivering and shaking. I came to the MSF clinic today and the doctor here tested my blood and then told me I have malaria. I'm waiting to receive some medicine that will help me get better. I have a mosquito net in my tent in the camp and although I use it, I still got sick. I don't know how I got ill.
I've been living here for six months with my wife and two children, who are aged four and five. My wife is four months pregnant but has been having stomach pains so she was taken to the camp hospital. She's there now and I'm waiting to hear how she is. I'm really worried about her and our baby.
I have spent most of my life as a refugee. I grew up in another camp in Tanzania after my parents and I were forced to flee our country. I'm still not used to the conditions though and life here is difficult. Refugees never have a good life – it's a struggle to get enough food and water, and living in a tent wears you down. But it's better than living in fear at home. I can't and won't go back home – I will stay in this camp until I die."
MSF has worked in Tanzania since May 2015. Currently, teams are working in Nyarugusu and Nduta camps. In Nyarugusu, MSF runs a 40-bed stabilisation unit and three malaria clinics and provides mental health support. In Nduta, MSF is the major medical provider, running a 120-bed hospital and five health posts, and providing mental health support.