Central African Republic: Latest MSF Updates

Crisis Update: September 2017

Renewed violence in Central African Republic (CAR) has forced hundreds of thousands of people to flee their homes, leaving them displaced within CAR or seeking refuge across the border in Democratic Republic of Congo (DRC). MSF is responding to the crisis with medical assistance in several areas throughout the country.

Humanitarian Needs

Violence has led to the internal displacement of over 600,000 people nationwide, the highest number since April 2014. The renewed fighting has also forced 60,000 more to cross into DRC since the end of April 2017. The towns of Alindao, Bria, and Bangassou, among others, have seen the overwhelming majority of their populations displaced. (In Alindao, from a population of 18,000, some 16,000 people have been displaced; in Bria, from a population of 47,000, there are 41,000 displaced people.)

In Bangassou, 2,000 displaced people still live on the site of the Catholic church and 7,000 more have sought refuge on the site of Zemio health center since fighting started in June. These sites are not adapted to the needs of displaced people and lack basic services such as water, latrines, and shelters, increasing the risk of epidemics. In addition to seeking refuge in hospitals, churches, and mosques, people are also hiding in the bush for long periods of time, with dire health consequences: children are not able to reach medical facilities during malaria season, regular vaccination campaigns and HIV and tuberculosis (TB) treatment regimens are interrupted, and pregnant women are left without assistance when they deliver.

MSF’s Response

Bria

In November 2016, heavy fighting in Bria—where MSF usually runs a pediatric project—forced thousands of people from their homes. The fighting spread to nearby villages, and civilians were targeted. MSF teams responded by supporting surgical trauma care and setting up mobile clinics. In March, MSF’s pediatric project again shifted to emergency mode to respond to an influx of wounded patients following renewed fighting. The team treated 24 wounded people at Bria hospital and reinforced mobile clinics to better reach communities affected by the violence.

Fighting erupted in Bria again on May 15 between members of the coalition led by the Popular Front for the Central African Renaissance (FPRC) and local "self-defense" forces. The conflict displaced the vast majority of the town’s population, who are now gathered in camps. In the second half of May, MSF teams saw 1,100 people in outpatient consultations and launched mobile clinics in Bria and the surrounding villages, providing 860 consultations to internally displaced people (IDPs). MSF also supplied water to the camp and helped build latrines.

Heavy fighting flared up again in Bria town on June 20—one day after a peace agreement was signed by different parties in Rome, Italy—reportedly causing about 100 casualties. MSF ambulances were able to access the conflict-affected neighborhoods on the same day to take the wounded back to the hospital, where 43 injured patients received care. In July, about 20,000 displaced people remained in the camp, and 3,000 were still in the hospital compound. MSF continued running mobile clinics and water and sanitation activities.

Bangassou

In Bangassou, in mid-May, an armed group supported by local militias attacked the United Nations Multidimensional Integrated Stabilization Mission in the Central African Republic (MINUSCA) base and the predominantly Muslim neighborhood of Tokoyo. MSF’s team provided care to 133 wounded people and consultations to 1,100 patients via mobile clinics in places where displaced people had gathered. Up to two-thirds of the city has since fled; in late July, there were 16,000 refugees in Ndu, a small village on the DRC side of the border, and 2,000 Muslim IDPs on the site of the Catholic mission, protected by MINUSCA troops.

MSF provided more than 5,500 consultations through mobile clinics to displaced people in Bangassou and Ndu. In early August, fighting also broke out in Gambo, a town 75 kilometers [about 47 miles] northeast of Bangassou. In the following days, MSF treated 15 wounded people from Gambo at Bangassou hospital.

Zemio

On June 28, fighting broke out in Zemio between local anti-Balaka militia members and armed Fulani people. The violence displaced about 20,000 people, with more than 7,000 seeking refuge at the health center, 5,000 at the Catholic mission, and others fleeing to different sites around the town. MSF provided medical and logistical support to the IDPs, but on July 11, armed men entered Zemio health center and shot at a family. A baby was killed in the attack. This shocking murder, witnessed by MSF staff, along with the lack of respect for medical care by armed groups in the area, forced MSF staff to withdraw from Zemio, leaving behind thousands of patients with no access to medical care.

Batangafo

Heavy fighting erupted on July 29 in the town of Batangafo, with tents in the IDP camp burned down and several nongovernmental organizations' buildings looted—including MSF's. At least 10,000 people sought refuge on the hospital grounds, a further 5,000 at the church, and 1,000 more in other places in town. MSF treated wounded people before fighting broke out again on August 1.

The team started water and sanitation activities to support IDPs at the hospital. However, due to the presence of armed men on and around the hospital grounds, gunshots fired, and tensions escalating again in late August, MSF later made the difficult decision to reduce activities to lifesaving surgery, an inpatient department, and maternity services.

Other Locations

In January, MSF deployed its emergency team to assess the situation of IDPs fleeing fighting around Bambari. Four wounded patients were referred to Kaga Bandoro, and the team reinforced Mbres hospital and conducted an emergency multi-antigen vaccination campaign for 1,200 children.

In Maloum, in February and March, MSF launched a response for the people who had fled there from Bria and Bambari, distributing over 15,000 essential relief items to displaced people. The team also organized a multi-antigen vaccination campaign for over 5,000 children and pregnant women.

MSF also assessed the situation around Nzako and Bakouma (Mbomou province) and provided medical care to people affected by violence, providing more than 400 consultations between March 23 and mid-April. The conflict continues around Nzako and Bakouma, with regular upsurges of violence. While the MSF team has started to establish links with Bakouma, teams have not yet succeeded in reaching Nzako.

On May 8, clashes between anti-Balaka fighters and Union for Peace in the Central African Republic (UPC) combatants in Alindao caused the displacement of 16,000 people, both within the town and towards Bambari. An MSF team started supporting Alindao hospital and health center on May 24, admitting 117 patients to the hospital, including 53 who had gunshot or knife wounds and 17 who needed to be transferred to Bambari for more extensive treatment.

MSF also vaccinated 5,675 children against measles and 2,555 with a multi-antigen vaccine in Alindao. The situation remains volatile, with frequent clashes leading to displacement. MSF’s emergency team handed over the support of Alindao health structures to other humanitarian actors at the end of June.

Currently, 60 percent of Bambari’s population are IDPs, totaling 57,000 people, 10,300 of whom have arrived since mid-March 2017. In May, MSF’s team in Bambari treated 22 people with war wounds, including four children. In all, 162 war-wounded patients received treatment from November 2016 to May 2017.

This information is excerpted from MSF’s 2016 International Activity Report.

Years of political unrest and violence have resulted in a protracted humanitarian crisis in CAR. In 2016, thousands of people were killed, wounded, or displaced as armed groups fought for territory. Two MSF workers were killed while doing their jobs. Many humanitarian agencies withdrew from CAR in 2016 due to lack of funding, but MSF maintained its presence, with 17 projects across the country.

Violence in the capital, Bangui, resulted in dozens of casualties. MSF provided emergency services in the city’s General Hospital, carrying out 3,700 surgical interventions in 2016. The team also conducted 32,300 consultations in the PK5 neighborhood, treating children under the age of 15 at Mamadou Mbaiki health center. More than 106,000 consultations were carried out at the MSF field hospital in M’poko camp for internally displaced people at Bangui’s airport. MSF scaled up services for women and babies in the city, managing the 80-bed Castor maternity hospital and assisting around 600 births per month; supported the Gbaya Dombia maternity facility in PK5; and rehabilitated a small maternity hospital in the Dameka/Boeing area.

MSF provided comprehensive inpatient and outpatient care to local communities and displaced people in Batangafo, Kabo, Boguila, Bossangoa, Paoua, Carnot, and Ndele. In Berbérati, MSF supported the regional hospital and four health centers. More than 4,200 children were admitted to the hospital in 2016, and over 21,900 pediatric outpatient consultations were carried out in the health centers.

In Bambari, MSF provided primary and secondary health care to the host population and around 50,000 displaced people living in camps, carrying out nearly 35,000 consultations. In Bria, MSF provided health care to children, and in Zémio teams offered basic and specialist health care in the hospital. In Bangassou, MSF supported the 118-bed reference hospital, which was being expanded, as well as three health centers.

MSF’s emergency response team Equipe d’Urgence RCA (Eureca) responded to several health and nutrition emergencies across the country and vaccinated more than 12,800 children against measles. The team also aided 4,000 South Sudanese refugees in Bambouti. Nearly 95,000 children in Berbérati, Bangassou, and Paoua received routine immunizations in 2016 during multi-antigen vaccination campaigns.

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