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Chad-HEALTH AND MEDICAL SERVICES

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Chad Index

A range of diseases afflicts the populace of Chad. In 1983 infectious and parasitic diseases were the most prevalent ailments, followed by respiratory afflictions and nervous disorders. In 1988 a severe epidemic of meningitis affected N'Djamena, in particular. By 1987 only one case of acquired immune deficiency syndrome (AIDS) had been reported to the World Health Organization; however, it was likely that incidence of the disease was many times higher, especially in the southern areas near Cameroon and Central African Republic.

In the early 1960s, the government made a substantial effort to extend the country's limited health infrastructure. Despite the ensuing civil conflict, the government has attempted to maintain and expand health services. Foreign assistance has allowed the construction of new buildings and the renovation of existing facilities, as well as the laying of groundwork for training health care professionals.

By the early 1980s, health facilities included five hospitals (at N'Djamena, Sarh, Moundou, Abéché, anda locality in Mayo-Kebbi Prefecture). Two polyclinics served the population of the capital region. Medical centers numbered 18, and there were 20 infirmaries and 127 dispensaries. Private medical facilities numbered seventy-five, and twenty social centers administered to the needs of Chadians in all prefectures except Biltine and Borkou-Ennedi-Tibesti.

Despite apparent progress in health care delivery, it is difficult to determine if growth in the number of facilities represented an increased capacity or merely a reorganization and reclassification of health establishments. The only data available in 1988, for example, showed that despite the increase in numbers of units, the hospitals, medical centers, and infirmaries increased the number of beds by only 238 more than the number recorded in 1971. Modern health care was also very unevenly distributed. Such facilities in Chad have long been concentrated in the south and remained so in 1983. For example, eleven of the eighteen medical centers were found there, along with three of the five hospitals, and private care followed the same pattern, with sixty-four of seventy-five centers in the southern prefectures. In theory, therefore, people in the less populated sahelian and Saharan regions had to travel very long distances for modern medical care. In fact, distance, lack of transportation, and civil conflict probably discouraged most people from making the effort.

A continuing shortage of trained medical personnel has compounded the difficulty of providing adequate, accessible health facilities. In 1983 Chad's medical system employed 42 Chadian doctors, 8 pharmacists, a biologist, 87 registered nurses, 583 practical nurses, 59 nurses specializing in childbirth, 22 midwives, 19 health inspectors, and 99 public health agents. Foreign assistance provided another 41 doctors, 103 nurses, and 2 midwives.

More detailed information concerning health care in Chad was unavailable in the late 1980s, largely because of the Chadian Civil War, which had disrupted government services for many years. As a result of this conflict, there were probably fewer health personnel in the late 1980s than earlier in the decade, particularly in the sahelian and Saharan zones, where nurses abandoned rural infirmaries. Mortality levels in Chad have been high for a long time, but the war may have reversed the limited progress made in the 1960s in dealing with the country's many health problems. Although the conflict was far from resolved in the late 1980s, the Habré government had been much more successful than its predecessors in consolidating control over the sahelian and Saharan regions of the country where modern health care has been the least available. Although resources remained scarce, greater international attention to Chad's plight produced more foreign assistance than in the past.

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In the late 1980s, reliable studies on Chad in English remained scarce. For a useful general study of Chad, the reader should consult Jean Chapelle's Le peuple tchadien: ses racines et sa vie quotidienne. A slightly more recent study, Tchad: la genèse d'un conflit by Christian Bouquet, covers some of the same ground but focuses on the context of Chadian underdevelopment and civil conflict. The much drier volume, Le Tchad by Jean Cabot and Christian Bouquet, offers a more detailed survey of the physical environment. In English, Dennis D. Cordell's Dar al-Kuti and the Last Years of the Trans-Saharan Slave Trade analyzes Chad's role in Saharan commerce, the Muslim slave trade, and the expanding Islamic world of the nineteenth century. Finally, Samuel Decalo's Historical Dictionary of Chad is one of the very few general references to the country in English.

There are a number of good regional studies of Chadian society and religion. Basic literature on the Sara of the soudanian zone includes Robert Jaulin's controversial La mort sara, a study of the yondo; Jean-Pierre Magnant's important La terre sara, terre tchadienne; and Françoise Dumas-Champion's Les Masa du Tchad. Annie M.D. Lebeuf's Les principautés Kotoko remains the essential study of the Kotoko. Albert Le Rouvreur's Sahéliens et sahariens du Tchad surveys the northern two-thirds of the country. Within this region, basic reading should include Jean Chapelle's now-classic Nomads noirs du Sahara, a study of the Teda and Daza; Jean-Claude Zeltner's Les Arabes dans la région du Lac Tchad; and Dennis D. Cordell's "The Awlad Sulayman of Libya and Chad," in Canadian Journal of African Studies. In Survivances pré-islamiques en pays zaghawa, Marie-José Tubiana analyzes the retention of pre-Islamic beliefs and practices in eastern Chad. In Pilgrims in a Strange Land, John A. Works, Jr. has written a good study of Hausa communities in Chad and their role in the spread of Islam. (For further information and complete citations, see Bibliography.)

Data as of December 1988

Background		Chad, part of France's African holdings until 1960, endured three decades of civil warfare as well as invasions by Libya before a semblance of peace was finally restored in 1990. The government eventually drafted a democratic constitution, and held flawed presidential elections in 1996 and 2001. In 1998, a rebellion broke out in northern Chad, which has sporadically flared up despite several peace agreements between the government and the rebels. In 2005, new rebel groups emerged in western Sudan and made probing attacks into eastern Chad, despite signing peace agreements in December 2006 and October 2007. Power remains in the hands of an ethnic minority. In June 2005, President Idriss DEBY held a referendum successfully removing constitutional term limits and won another controversial election in 2006. Sporadic rebel campaigns continued throughout 2006 and 2007, and the capital experienced a significant rebel threat in early 2008.
Location		Central Africa, south of Libya
Area(sq km)		total: 1.284 million sq km land: 1,259,200 sq km water: 24,800 sq km
Geographic coordinates		15 00 N, 19 00 E
Land boundaries(km)		total: 5,968 km border countries: Cameroon 1,094 km, Central African Republic 1,197 km, Libya 1,055 km, Niger 1,175 km, Nigeria 87 km, Sudan 1,360 km
Coastline(km)		0 km (landlocked)
Climate		tropical in south, desert in north
Elevation extremes(m)		lowest point: Djourab Depression 160 m highest point: Emi Koussi 3,415 m
Natural resources		petroleum, uranium, natron, kaolin, fish (Lake Chad), gold, limestone, sand and gravel, salt
Land use(%)		arable land: 2.8% permanent crops: 0.02% other: 97.18% (2005)
Irrigated land(sq km)		300 sq km (2003)
Total renewable water resources(cu km)		43 cu km (1987)
Freshwater withdrawal (domestic/industrial/agricultural)		total: 0.23 cu km/yr (17%/0%/83%) per capita: 24 cu m/yr (2000)
Natural hazards		hot, dry, dusty harmattan winds occur in north; periodic droughts; locust plagues
Environment - current issues		inadequate supplies of potable water; improper waste disposal in rural areas contributes to soil and water pollution; desertification
Environment - international agreements		party to: Biodiversity, Climate Change, Desertification, Endangered Species, Hazardous Wastes, Ozone Layer Protection, Wetlands signed, but not ratified: Law of the Sea, Marine Dumping
Geography - note		landlocked; Lake Chad is the most significant water body in the Sahel
Population		10,329,208 (July 2009 est.)
Age structure(%)		0-14 years: 46.7% (male 2,445,841/female 2,381,319) 15-64 years: 50.4% (male 2,386,428/female 2,816,050) 65 years and over: 2.9% (male 126,351/female 173,219) (2009 est.)
Median age(years)		total: 16.5 years male: 15.3 years female: 17.7 years (2009 est.)
Population growth rate(%)		2.069% (2009 est.)
Birth rate(births/1,000 population)		40.86 births/1,000 population (2009 est.)
Death rate(deaths/1,000 population)		16.09 deaths/1,000 population (July 2009 est.)
Net migration rate(migrant(s)/1,000 population)		-4.08 migrant(s)/1,000 population (2009 est.)
Urbanization(%)		urban population: 27% of total population (2008) rate of urbanization: 4.7% annual rate of change (2005-10 est.)
Sex ratio(male(s)/female)		at birth: 1.04 male(s)/female under 15 years: 1.03 male(s)/female 15-64 years: 0.85 male(s)/female 65 years and over: 0.73 male(s)/female total population: 0.92 male(s)/female (2009 est.)
Infant mortality rate(deaths/1,000 live births)		total: 98.69 deaths/1,000 live births male: 104.72 deaths/1,000 live births female: 92.42 deaths/1,000 live births (2009 est.)
Life expectancy at birth(years)		total population: 47.7 years male: 46.67 years female: 48.77 years (2009 est.)
Total fertility rate(children born/woman)		5.31 children born/woman (2009 est.)
Nationality		noun: Chadian(s) adjective: Chadian
Ethnic groups(%)		Sara 27.7%, Arab 12.3%, Mayo-Kebbi 11.5%, Kanem-Bornou 9%, Ouaddai 8.7%, Hadjarai 6.7%, Tandjile 6.5%, Gorane 6.3%, Fitri-Batha 4.7%, other 6.4%, unknown 0.3% (1993 census)
Religions(%)		Muslim 53.1%, Catholic 20.1%, Protestant 14.2%, animist 7.3%, other 0.5%, unknown 1.7%, atheist 3.1% (1993 census)
Languages(%)		French (official), Arabic (official), Sara (in south), more than 120 different languages and dialects
Country name		conventional long form: Republic of Chad conventional short form: Chad local long form: Republique du Tchad/Jumhuriyat Tshad local short form: Tchad/Tshad
Government type		republic
Capital		name: N'Djamena geographic coordinates: 12 06 N, 15 02 E time difference: UTC+1 (6 hours ahead of Washington, DC during Standard Time)
Administrative divisions		18 regions (regions, singular - region); Batha, Borkou-Ennedi-Tibesti, Chari-Baguirmi, Guera, Hadjer-Lamis, Kanem, Lac, Logone Occidental, Logone Oriental, Mandoul, Mayo-Kebbi Est, Mayo-Kebbi Ouest, Moyen-Chari, Ouaddai, Salamat, Tandjile, Ville de N'Djamena, Wadi Fira
Constitution		passed by referendum 31 March 1996; a June 2005 referendum removed constitutional term limits
Legal system		based on French civil law system and Chadian customary law; has not accepted compulsory ICJ jurisdiction
Suffrage		18 years of age; universal
Executive branch		chief of state: President Lt. Gen. Idriss DEBY Itno (since 4 December 1990) head of government: Prime Minister Youssof Saleh ABBAS (since 16 April 2008) cabinet: Council of State, members appointed by the president on the recommendation of the prime minister elections: president elected by popular vote to serve five-year term; if no candidate receives at least 50% of the total vote, the two candidates receiving the most votes must stand for a second round of voting; last held 3 May 2006 (next to be held by May 2011); prime minister appointed by the president election results: Lt. Gen. Idriss DEBY Itno reelected president; percent of vote - Lt. Gen. Idriss DEBY 64.7%, Delwa Kassire KOUMAKOYE 15.1%, Albert Pahimi PADACKE 7.8%, Mahamat ABDOULAYE 7.1%, Brahim KOULAMALLAH 5.3%; note - a June 2005 national referendum altered the constitution removing presidential term limits and permitting Lt. Gen. Idriss DEBY Itno to run for reelection
Legislative branch		unicameral National Assembly (155 seats; members elected by popular vote to serve four-year terms); note - the 1996 constitution called for a Senate that has never been formed elections: National Assembly - last held 21 April 2002 (next to be held by 2009); note - legislative elections, originally scheduled for 2006, were first delayed by National Assembly action and subsequently by an accord, signed in August 2007, between government and opposition parties election results: percent of vote by party - NA; seats by party - MPS 110, RDP 12, FAR 9, RNDP 5, UNDR 5, URD 3, other 11
Judicial branch		Supreme Court; Court of Appeal; Criminal Courts; Magistrate Courts
Political pressure groups and leaders		rebel groups
International organization participation		ACCT, ACP, AfDB, AU, BDEAC, CEMAC, FAO, FZ, G-77, IAEA, IBRD, ICAO, ICCt, ICRM, IDA, IDB, IFAD, IFC, IFRCS, ILO, IMF, Interpol, IOC, ITSO, ITU, ITUC, MIGA, NAM, OIC, OIF, OPCW, UN, UNCTAD, UNESCO, UNIDO, UNOCI, UNWTO, UPU, WCL, WCO, WFTU, WHO, WIPO, WMO, WTO
Flag description		three equal vertical bands of blue (hoist side), yellow, and red note: similar to the flag of Romania; also similar to the flags of Andorra and Moldova, both of which have a national coat of arms centered in the yellow band; design was based on the flag of France
Economy - overview		Chad's primarily agricultural economy will continue to be boosted by major foreign direct investment projects in the oil sector that began in 2000. At least 80% of Chad's population relies on subsistence farming and livestock raising for its livelihood. Chad's economy has long been handicapped by its landlocked position, high energy costs, and a history of instability. Chad relies on foreign assistance and foreign capital for most public and private sector investment projects. A consortium led by two US companies has been investing $3.7 billion to develop oil reserves - estimated at 1 billion barrels - in southern Chad. Chinese companies are also expanding exploration efforts and plan to build a refinery. The nation's total oil reserves are estimated at 1.5 billion barrels. Oil production came on stream in late 2003. Chad began to export oil in 2004. Cotton, cattle, and gum arabic provide the bulk of Chad's non-oil export earnings.
GDP (purchasing power parity)		$15.82 billion (2008 est.) $15.85 billion (2007 est.) $15.82 billion (2006 est.) note: data are in 2008 US dollars
GDP (official exchange rate)		$8.4 billion (2008 est.)
GDP - real growth rate(%)		-0.2% (2008 est.) 0.2% (2007 est.) 0.2% (2006 est.)
GDP - per capita (PPP)		$1,600 (2008 est.) $1,600 (2007 est.) $1,600 (2006 est.) note: data are in 2008 US dollars
GDP - composition by sector(%)		agriculture: 20.5% industry: 48% services: 31.5% (2008 est.)
Labor force		4.293 million (2007)
Labor force - by occupation(%)		agriculture: 80% (subsistence farming, herding, and fishing) industry and services: 20% (2006 est.)
Unemployment rate(%)		NA%
Population below poverty line(%)		80% (2001 est.)
Household income or consumption by percentage share(%)		lowest 10%: NA% highest 10%: NA%
Investment (gross fixed)(% of GDP)		13.7% of GDP (2008 est.)
Budget		revenues: $2.324 billion expenditures: $1.91 billion (2008 est.)
Inflation rate (consumer prices)(%)		10.3% (2008 est.) 4% (2007 est.)
Stock of money		$NA (31 December 2008) $874.5 million (31 December 2007)
Stock of quasi money		$NA (31 December 2008) $55.23 million (31 December 2007)
Stock of domestic credit		$NA (31 December 2008) $82.81 million (31 December 2007)
Market value of publicly traded shares		$NA
Economic aid - recipient		ODA, $379.8 million (2005)
Agriculture - products		cotton, sorghum, millet, peanuts, rice, potatoes, manioc (tapioca); cattle, sheep, goats, camels
Industries		oil, cotton textiles, meatpacking, brewing, natron (sodium carbonate), soap, cigarettes, construction materials
Industrial production growth rate(%)		2% (2008 est.)
Current account balance		-$1.019 billion (2008 est.) -$737.8 million (2007 est.)
Exports		$4.342 billion (2008 est.) $3.674 billion (2007 est.)
Exports - commodities(%)		oil, cattle, cotton, gum arabic
Exports - partners(%)		US 92.8%, Japan 2.2%, France 1.5% (2008)
Imports		$1.927 billion (2008 est.) $1.541 billion (2007 est.)
Imports - commodities(%)		machinery and transportation equipment, industrial goods, foodstuffs, textiles
Imports - partners(%)		France 17.5%, Cameroon 14.8%, China 9.8%, Ukraine 9.5%, US 7.7%, Germany 5.6%, Saudi Arabia 4.7%, Netherlands 4% (2008)
Reserves of foreign exchange and gold		$1.347 billion (31 December 2008 est.) $964.4 million (31 December 2007 est.)
Debt - external		$1.6 billion (2005 est.)
Stock of direct foreign investment - at home		$4.5 billion (2006 est.)
Stock of direct foreign investment - abroad		$NA
Exchange rates		Cooperation Financiere en Afrique Centrale francs (XAF) per US dollar - 447.81 (2008 est.), 480.1 (2007), 522.59 (2006), 527.47 (2005), 528.29 (2004) note: since 1 January 1999, the Central African CFA franc (XAF) has been pegged to the euro at a rate of 655.957 CFA francs per euro; Central African CFA franc (XAF) coins and banknotes are not accepted in countries using West African CFA francs (XOF), and vice versa, even though the two currencies trade at par
Currency (code)		Communaute Financiere Africaine franc (XAF); note - responsible authority is the Bank of the Central African States
Telephones - main lines in use		13,000 (2008)
Telephones - mobile cellular		1.809 million (2008)
Telephone system		general assessment: primitive system with high costs and low telephone density; fixed-line connections for only about 1 per 1000 persons coupled with mobile-cellular subscribership base of less than 20 per 100 persons domestic: fair system of radiotelephone communication stations international: country code - 235; satellite earth station - 1 Intelsat (Atlantic Ocean) (2008)
Internet country code		.td
Internet users		130,000 (2008)
Airports		54 (2009)
Pipelines(km)		oil 250 km (2008)
Roadways(km)		total: 33,400 km paved: 267 km unpaved: 33,133 km (2002)
Military branches		Armed Forces: Chadian National Army (Armee Nationale du Tchad, ANT), Chadian Air Force (Force Aerienne Tchadienne, FAT), Gendarmerie (2008)
Military service age and obligation(years of age)		20 years of age for conscripts, with 3-year service obligation; 18 years of age for volunteers; no minimum age restriction for volunteers with consent from a guardian; women are subject to 1 year of compulsory military or civic service at age of 21 (2004)
Manpower available for military service		males age 16-49: 1,906,545 females age 16-49: 2,258,758 (2008 est.)
Manpower fit for military service		males age 16-49: 1,103,006 females age 16-49: 1,315,620 (2009 est.)
Manpower reaching militarily significant age annually		male: 121,080 female: 121,585 (2009 est.)
Military expenditures(% of GDP)		4.2% of GDP (2006)
Disputes - international		since 2003, Janjawid armed militia and the Sudanese military have driven hundreds of thousands of Darfur residents into Chad; Chad remains an important mediator in the Sudanese civil conflict, reducing tensions with Sudan arising from cross-border banditry; Chadian Aozou rebels reside in southern Libya; only Nigeria and Cameroon have heeded the Lake Chad Commission's admonition to ratify the delimitation treaty, which also includes the Chad-Niger and Niger-Nigeria boundaries
Refugees and internally displaced persons		refugees (country of origin): 234,000 (Sudan); 54,200 (Central African Republic) IDPs: 178,918 (2007)
Trafficking in persons		current situation: Chad is a source, transit, and destination country for children trafficked for the purposes of forced labor and commercial sexual exploitation; the majority of children are trafficked within Chad for involuntary domestic servitude, forced cattle herding, forced begging, forced labor in petty commerce or the fishing industry, or for commercial sexual exploitation; to a lesser extent, Chadian children are also trafficked to Cameroon, the Central African Republic, and Nigeria for cattle herding; children may also be trafficked from Cameroon and the Central African Republic to Chad's oil producing regions for sexual exploitation tier rating: Tier 2 Watch List - Chad is on the Tier 2 Watch List for its failure to provide evidence of increasing efforts to combat human trafficking in 2007; Chad was destabilized during 2007 by civil conflict leading to a declared state of emergency in February 2008, and a steady influx of refugees fleeing Sudan and the Central African Republic; the government demonstrated insufficient overall efforts to combat trafficking; Chad has not ratified the 2000 UN TIP Protocol (2008)
Electricity - production(kWh)		100 million kWh (2007 est.)
Electricity - production by source(%)		fossil fuel: 100% hydro: 0% nuclear: 0% other: 0% (2001)
Electricity - consumption(kWh)		93 million kWh (2007 est.)
Electricity - exports(kWh)		0 kWh (2008 est.)
Electricity - imports(kWh)		0 kWh (2008 est.)
Oil - production(bbl/day)		127,000 bbl/day (2008 est.)
Oil - consumption(bbl/day)		1,000 bbl/day (2008 est.)
Oil - exports(bbl/day)		157,900 bbl/day (2007 est.)
Oil - imports(bbl/day)		1,571 bbl/day (2007 est.)
Oil - proved reserves(bbl)		1.5 billion bbl (1 January 2009 est.)
Natural gas - production(cu m)		0 cu m (2008 est.)
Natural gas - consumption(cu m)		0 cu m (2008 est.)
Natural gas - exports(cu m)		0 cu m (2008)
Natural gas - proved reserves(cu m)		0 cu m (1 January 2009 est.)
HIV/AIDS - adult prevalence rate(%)		3.5% (2007 est.)
HIV/AIDS - people living with HIV/AIDS		200,000 (2007 est.)
HIV/AIDS - deaths		14,000 (2007 est.)
Major infectious diseases		degree of risk: very high food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever vectorborne disease: malaria water contact disease: schistosomiasis respiratory disease: meningococcal meningitis animal contact disease: rabies (2009)
Literacy(%)		definition: age 15 and over can read and write French or Arabic total population: 25.7% male: 40.8% female: 12.8% (2000 est.)
School life expectancy (primary to tertiary education)(years)		total: 6 years male: 7 years female: 4 years (2005)
Education expenditures(% of GDP)		1.9% of GDP (2005)