CAR: MSF is working with the populations, particularly displaced persons, who are victims of spikes of violence
December 4, 2013
After years of political-military instability, the Central African Republic has reached a state of chronic humanitarian and health emergency. The situation has worsened considerably since the last coup d'état in March 2013. The displaced populations now number in the thousands and are even more vulnerable and exposed, particularly to malaria, but also to epidemics and malnutrition. This context has become increasingly complex because of the reigning insecurity, which affects civilians first of all, but also health care workers and aid actors. MSF has been active in the CAR since 1997 and continues to work, adapting its activities and opening new projects to address growing and increasingly urgent needs.
Having faced political-military instability for decades, the Central African Republic (CAR) has now faces a chronic humanitarian and health emergency. Even in "times of peace," mortality rates greatly exceed emergency thresholds, which define a humanitarian crisis. Life expectancy - which averages 48 years - is one of the lowest in the world. Given the chaos, the country's health system has been virtually wiped out. The Ministry of Health has almost no presence outside of Bangui, the capital city. Very few health care facilities operate in the interior of the country. There are few providers, with just one doctor per 55,000 people - most of whom are in Bangui - and one nurse or midwife per 7,000 residents.1 As a result, access to basic care is very limited and, even, non-existent in certain regions. Many women die during pregnancy or childbirth and 1292 out of every 1,000 children die before the age of 5, primarily from malaria, chronic malnutrition, diarrheal illnesses, measles or meningitis.
The situation has worsened since December 2012, when the offensive led by the Séléka, the former rebel coalition, began. Many health care facilities were looted or destroyed and most health care workers left their positions to flee towards Bangui. Since that time, during the annual malaria spike, drugs, vaccines and supplies have been blocked in the capital. Health care facilities have been unable to resume their activities and health monitoring and routine vaccination systems have been halted. Today, the population of the CAR - 4.4 million people – lacks medical care and is increasingly vulnerable.
The security situation has worsened further, particularly in Bangui, with a growing number of warring parties in the field. New clashes are occurring between armed self-defense groups (the anti-Balaka) and former Séléka forces. Intercommunal, ethnic and religious tensions are felt regularly, particularly in the north and northwest. Attacks on villages are reaching unprecedented levels of violence. Since spring 2013, raids, abuses, arbitrary arrests and detentions and summary executions, including of health care and aid workers, have risen. All international NGOs working in the CAR have had vehicles stolen, sometimes in armed robberies. Facilities, offices and living quarters have been looted and robbed and personnel have been threatened.
In this context of fear and violence, thousands of villagers have had to flee, sometimes several times since January. The number of displaced persons is now estimated at 395,0003. They are hiding in the brush, without shelter, food or drinking water, exposed to the weather and mosquitoes, which carry malaria, the leading cause of death in the CAR. The situation is no better in the resettlement sites. Crowding and poor living and health conditions promote the risk of epidemics. One million4 people are estimated to lack adequate food and 1.6 million5 are in immediate need of humanitarian aid. The Central African Republic's authorities cannot currently meet their growing and pressing needs, particularly medical needs. MSF is particularly concerned about the fate of populations living in certain "gray" areas, some of which are inaccessible to aid actors, located primarily in the eastern region of the country. The health and humanitarian situation there is unknown.
Despite this tense and volatile security context, MSF, now a major health actor in the CAR, continues its work, traveling within the country, conducting needs evaluations, launching new programs and treating patients and the wounded, regardless of their affiliation and of the forces controlling the area where we are working. Our teams understand the changing context and are responding to the changing situation and needs. While we have had to temporarily evacuate our staff from certain areas that have become too dangerous in several regions of the country - and will probably have to do so again - MSF has adapted its current activities and has even opened new projects to meet the needs.
MSF has been working in the CAR since 1997 and is currently managing seven regular projects (in Batangafo, Boguila, Carnot, Kabo, Ndéle, Paoua and Zémio) and three emergency projects (in Bossangoa, Bouca and Bria). In addition, a mobile emergency team is covering the areas of Bouar, Mbaiki and Yaloké. By the end of the year, MSF hopes to be able to launch activities in Bangassou and Ouango. We currently offer free medical care to approximately 400,000 people and provide approximately 800 hospital beds. We are working in seven hospitals, two health centers and 40 health posts. The teams are composed of more than 100 expatriate health care workers and around 1,100 Central African Republic staff.
1 United Nations - July 2012
2 WHO - 2013
3 United Nations - October 2013
4 United Nations - October 2013
5 United Nations - October 2013