Why are we there?
- Armed conflict
- Access to health care
- Natural disaster
Central African Republic: Latest MSF Updates
- CAR: MSF Begins Emergency Intervention in Kouango
- CAR: Ongoing Violence Means Ongoing Health Needs in Bambari Area
- CAR: MSF Begins Vaccination Campaign for 18,000 Displaced by Violence
- CAR: “There’s Not One Single Muslim Left in Bocaranga”
2015 Operational Highlights
- Although violence has now subsided in some parts of Central African Republic (CAR), the security situation in 2015 remains volatile, and armed groups are still active. There are more than 450,000 Central African refugees in Cameroon, Democratic Republic of the Congo (DRC), Republic of the Congo, and Chad, while an estimated of 436,000 persons are internally displaced.
- Persisting insecurity in many areas continues to impede MSF’s ability to reach people in need through its 16 projects. MSF’s mobile clinics have been stopped by armed elements on numerous occasions around cities like Batangafo, Kabo, Bambari, and Boguila, hindering access to people in more remote locations where there are no functioning health facilities.
- Even though the situation seemed calmer by March, there was actually an increase in incidents mostly in the north-west of the country near the Chadian border. The incidents are more directed at civilians than NGOs.
- Towards the end of 2014, armed clashes between rebel groups with the implication of nomadic Peuhl cattle herders drove a growing number of displaced people into the camp in Batangafo. By the end of April 2015, approximately 35,000 people were residing in the camp. Besides running a hospital, MSF has deployed seven health agents to closely monitor the sanitary and health situation of the displaced.
- The two years of political crisis have exacerbated the country’s pre-existing shortage of health services, leaving Central African Republic in a state of a protracted chronic health emergency, or desert sanitaire. In some areas like Kouango, routine vaccinations have not been carried out for two years, and fewer than 50 percent of children in CAR have been vaccinated against infectious diseases. As a result of the conflict, 72.5 percent of the country’s facilities are either destroyed or not functioning. Moreover, epidemiological surveillance in CAR is currently non-existent.
- In February, the government announced measles, rubella, and rabies epidemics. In response, MSF organized three mass measles vaccination campaigns for children under 15 in the town of Bria, at the displaced people camp in Batangafo, as well as in Batangafo town, and the cities of Nzako and Bakouma. By the end of March, 33,000 children had been vaccinated.
- Malaria remains a major killer throughout MSF’s projects in CAR, in some areas accounting for 90 percent of cases, taking the greatest toll on children below the age of five. The protracted conflict and displacement, lack of resources, and access to basic health care are the biggest obstacles to fighting malaria in CAR.
- In February, following reports that around 30,000 people from Kouango province in the south of CAR had fled into neighboring DRC and other parts of CAR, MSF traveled to the area to evaluate humanitarian needs. MSF have put in place mobile clinics, as well as support for the hospital in Kouango, providing secondary health care.
- For more than a year Muslim populations have remained locked within enclaves in cities like Berberati or Carnot, among others. MSF continues to support the enclaves with mobile clinics and referrals to the hospital for both children and adults, and continues to closely monitor the situation and needs.
- January and February saw a lot of tension and recurrent clashes in Bambari (Ouaka), not only between the different armed groups, but also within those groups. In April and May the situation remained highly volatile and the underlying tensions have not improved. People are often afraid to move and MSF has tried to reach the different communities by providing health care to all sides. Local attacks on different villages by various elements occurred, during which the population was harassed.
MSF has been working in CAR since 1997. Since December 2013, in response to the crisis, MSF has doubled its medical assistance in CAR and is running additional projects for Central African refugees in neighboring countries.
This is an excerpt from MSF's 2014 International Activity Report:
MSF Press Briefing on Crisis in the Central African Republic
Current MSF Operations
The health situation in Central African Republic (CAR) is catastrophic, and conflict and displacement prevent people from obtaining the medical services they desperately need.
At the beginning of 2014, most of the Muslim population in the western half of CAR left the country in the space of a few months to escape attacks. Several thousand people remained living in enclaves, fearful for their lives. Intercommunal violence and attacks by armed groups were not limited to the Muslim population though, and all communities in CAR were affected.
By December 2014, some 430,000 people were internally displaced in the country and hundreds of thousands of others had crossed the border into Chad and Cameroon. Although a transitional government was formed in January (elections are anticipated in 2015), many areas remain unsafe and people do not want to return home. Banditry and security incidents are common, and Doctors Without Borders/Médecins Sans Frontières (MSF) has been directly affected by armed attacks, harassment, and robberies. On 26 April, 19 unarmed civilians, including three MSF national staff members, were killed by armed men at the MSF hospital in Boguila.
There is a severe shortage of skilled staff, and of vaccines in the country. Access to care is limited and expensive, and drug supplies are frequently interrupted. MSF remains the main health care provider in CAR, with many longstanding programs offering comprehensive services, as well as emergency projects that are set up as needed. Malaria is rampant, and appalling living conditions are causing health issues such as intestinal infections and diarrheal or skin diseases.
Providing Healthcare in Bangui
In Bangui, the capital city, MSF provides emergency surgery at the general hospital for victims of violence and trauma such as road accidents. From December 2013 to March 2014, MSF supported maternal health activities and surgery in the Castor health center until the situation improved and people could access other health centers in the city. In June, some activities resumed and MSF started to carry out obstetric and other emergency surgery. A program offering medical and psychological care for victims of sexual violence was opened in July.
Basic health care for children under 15 is available at Mamadou M’Baiki health center in the city’s PK5 district, and MSF ambulances transport emergency patients of all ages to the hospital. Mobile clinics also began visiting displaced people several times a week at the Grand Mosque, Fatima’s Church, and St Joseph’s Parish Centre this year. More than 39,900 consultations were carried out in PK5, nearly a third of them malaria-related.
There were approximately 100,000 displaced people living in and around M’poko airport in makeshift camps at the peak of the violence in 2014, but by the end of the year this number had dropped to 20,000. Two-thirds of patients traveled from Bangui to access the health care offered by MSF at the camps, as services were lacking in the city. People were treated for malaria, births were assisted, and over 80 victims of sexual violence were helped.
When MSF started working in the general hospital in February, the emergency surgery activities at community hospital in the capital were handed over to the International Committee of the Red Cross. The project assisting displaced people at the Don Bosco center closed in March once their number had significantly decreased.
Caring for the Displaced
In January, MSF began activities at Berbérati regional university hospital, responding to the needs of displaced people, victims of violence, pregnant women, and children. Weekly mobile clinics visited some 350 people living in the Berbérati area. In July, teams started outreach activities to support seven health centers providing health care in surrounding villages. Malnutrition, malaria, diarrhea, respiratory tract infections, and measles were the main health concerns. More than 41,900 outpatient consultations and 3,000 surgical interventions were performed. MSF also launched an intervention from Berbérati to Nola, Sangha-Mbaéré prefecture, and 23,000 children were vaccinated there against measles.
From January to April, MSF responded to the health consequences of a spike in violence against enclaves of displaced people and the local population in Bouar, Nana-Mambéré, with mobile clinics and by supporting the emergency room and surgical activities at Bouar Hospital.
Following the attack in Boguila, Ouham prefecture, in April, MSF’s comprehensive health care services were reduced to a health center with an outpatient unit, four health posts, maintenance of malaria testing and treatment sites (‘palu points’), and HIV treatment. The palu points were handed over to the NGO MENTOR Initiative in November. Another long-running project provided basic and specialist health care in Kabo. A series of security incidents resulted in a partial evacuation of the MSF team in February but the situation stabilized in the second half of the year. Staff treated more than 46,000 patients, most of whom had malaria.
MSF also supported the 165-bed Batangafo Hospital and five local health centers. The village became part of the front line in 2014 and there were security incidents during the year. More than 96,000 outpatient consultations were carried out and almost 5,000 patients were admitted. The emergency program that had started in Bossangoa in 2013 for displaced people continued, although activities in the camps ceased in April when people were able to return home.
Following outbreaks of violence and population displacement in Ouaka prefecture, MSF opened projects in Bambari and Grimari in April. Mobile clinics traveled to villages and found many people still living in fear in the bush. MSF supported palu points and health centers and vaccinated 4,000 children in the prefecture against polio and measles in August. The Grimari project closed in October, and the focus was concentrated on Bambari.
In Kémo, MSF started supporting Dekoua parish clinic in May, following clashes that displaced civilians. Activities focused on outpatient consultations, assisting births, and treating malnutrition. MSF also conducted mobile clinics. More than 5,500 consultations were undertaken, mostly for young children. The project closed in August when people left the area.
Teams offered a comprehensive package of health care in Carnot, Mambéré-Kadéï, in a longstanding project, carrying out over 49,000 consultations during the year. Approximately 500 Muslims from Carnot have taken refuge in a church in the city; more than 4,470 consultations were provided to them through a regular mobile clinic.
Access to General Healthcare
MSF opened a hospital-based project in Bozoum, Ouham-Pendé, in January but closed it in March, as people felt safer visiting the nearer health centers. In Bocaranga, MSF ran a project between May and September to treat children under five during the annual malaria peak, and mobile clinics visited the northwest of the country. The comprehensive health care project in Paoua has been operating for many years and the team carried out some 71,400 consultations there in 2014.
In late February, MSF started working at the 80-bed referral hospital in Bangassou, the capital of Mbomou prefecture, where services had been severely disrupted. Basic and specialist health care, including internal medicine, maternity, pediatric, and surgical services, were available. From May, MSF supported the 30-bed hospital in Ouango and rehabilitated its maternity, pediatric, internal medicine, and surgery wards, as well as the operating theater and the laboratory. The Ouango Hospital was supported by MSF temporarily between May and October.
MSF also provided comprehensive health care to children under 15 in the refurbished hospital in Bria, Haute-Kotto, where there are high rates of malaria and malnutrition. More than 48,000 consultations were undertaken, and an average of 80 children were admitted to the hospital each week.
A program of basic and specialist health care at Ndélé Hospital, Bamingui-Bangoran, and four nearby health centers continued. Staff saw a significant increase in patients with violence-related injuries.
MSF remained the main health care provider for those living in the east of the country in Haut Mbomou. Health facilities are scarce in this prefecture and people travel up to 125 miles to reach the main health center in Zémio and four outlying health posts.
At the end of 2014, MSF had 2,593 staff in Central African Republic. MSF has worked in the country since 1997.
Melissa is the mother of a seven-month-old girl who arrived at Batangafo hospital with malaria and anemia, requiring a blood transfusion.
“I had to leave my other children with my family to come to the hospital. My baby had a fever for three days. When she started having convulsions I decided to search for help.
"After two days walking to the health center in Boulam, they referred us to the hospital by motorbike taxi.”
After two days at the hospital, Melissa’s daughter’s condition had improved.