This week, Doctors Without Borders/Médecins Sans Frontières (MSF) began a campaign to vaccinate at least 18,000 children under 15 years old against measles and polio in and around the internally displaced persons (IDP) camp near Batangafo, in northern Central African Republic (CAR). This camp is now the largest in the country, with a population of around 35,000 people. The campaign will also provide children with important vitamins and treatment against parasites.
Preparations for the campaign, initially scheduled to begin in March, were accelerated after suspected cases of measles threatened to unleash an epidemic among children in the camp, where the population has not stopped growing since last August. The campaign is targeting more than 16,000 children in the camp and around 2,000 more among the few local families still living in Batangafo.
The lack of security and continued looting and attacks by armed militias have increasingly forced residents of Batangafo to leave their homes in town for rudimentary huts in the camp. In summer 2014, hundreds of people from Batangafo settled in the camp, between the hospital and the headquarters of international peacekeepers, seeking protection after a series of armed clashes. Today most of the town’s neighborhoods appear deserted.
The camp is also home to a growing number of people from surrounding areas, where the population must contend with attacks from nomadic shepherd communities from the north in addition to the ongoing militia violence. The traditional arrival of herdsmen after the end of the rainy season, around November, has always caused some friction with local inhabitants, who are mainly farmers. But the current state of war in CAR has exacerbated the fighting to the point that thousands are now forced to flee armed groups of nomads, who are themselves caught up in the cycle of violence that is devastating the country in the absence of international peacekeeping solutions.
People “Have Virtually Nothing”
MSF maintains five health posts around Batangafo, but the lack of security makes it impossible to manage the outposts and prevents thousands of people from receiving basic health assistance in the region. "These people are in an extremely vulnerable situation, even worse than those in the IDP camp,” says Terradillos. "They have virtually nothing."
"If there is no security on the roads we cannot provide essential medical attention," adds Stella Aprile, MSF deputy head of mission in CAR. She explains that in northern CAR you find "all the typical diseases in the country, such as malaria, respiratory infections, and conjunctivitis, and they all remain undiagnosed and without attention if we cannot intervene."
The unstoppable growth of the Batangafo camp, initially set up to host 12,000 people on a two-square kilometer plot [just 0.75 square miles], is drastically increasing health risks for the already-vulnerable population. "Overcrowding is a major risk factor for the occurrence of diseases in the camp," says Carmen Terradillos, medical coordinator for MSF in Batangafo. "In addition to starting the vaccinations, we are strengthening our hospital resources in case we see an increase of consultations. So far, there has been no large increase, partly because the first priority for many families is to find food for the day, so when someone is sick they don’t bring them to the doctor until their condition is severe." In order to try and avoid that situation, MSF is also enhancing health promotion activities among the displaced, and medical staff will start surveillance visits to the IDP camp.
“We Will Not Move Until Their Weapons Have Been Removed”
Displaced people in Batangafo say the same thing again and again: they will not leave while there is no security for them, even though the rainy season will arrive within a couple months. The huts in the camp are not prepared for rain and many are located in areas where water will gather and stagnate. "We would love to leave, we want to return home,” says Brigitte Befio, a Batangafo resident who has been living in the camp with her husband and five children for months. “But if we do not have our safety granted, we'll stay and do whatever it takes to strengthen the huts. We will not leave."
"We will not move until the militias that attack us incessantly are disarmed," says Lea Nukofio. She is 59 years old and cannot remember having seen such violence in CAR before. She has been fleeing attacks from militias for two years, along with around one hundred people from her village near Kambakota, about 50 kilometers [about 31 miles] west of Batangafo. "We will not move from here until their weapons have been removed.”
MSF has been working in Central African Republic since 1997 and currently has more than 300 international and 2,000 Central African workers in the country. Since December 2013, MSF has increased the number of its medical projects from 10 to 20 in response to the crisis, and is also providing aid to Central African refugees in neighboring Chad, Cameroon, and Democratic Republic of Congo.
In Batangafo, MSF manages the general hospital (165 beds) and supports five health centers in the surrounding area. Between December 2013 and the end of 2014, more than 37,000 people received medical assistance in the area, and more than 500 surgeries were performed.