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