Why are we there?
- Armed conflict
- Access to health care
- Natural disaster
2014 Operational Highlights
- Nineteen civilians, including three Central African MSF staff members, were killed during an armed robbery on the grounds of MSF’s hospital in the northern town of Boguila, on April 26, 2014. After this tragedy, MSF reduced its activities to essential services only. In October, armed men twice raided Boguila town again. They entered the hospital by force looking for valuables, but hospital staff was able to escape unharmed. The insecurity caused by various armed groups is seriously affecting the population, who hide in the bush. The risks associated with delivering medical and humanitarian aid remain high.
- Since April, Bambari town and prefecture have been affected by fighting, leading to widespread population displacement (over 30,000 people are in camps). Fighting erupts frequently in Bambari town and the surrounding area. Houses and villages have been looted and burned. Sectarian violence has led to many casualties. In a recent wave of violence in December, 60 houses were burned, 14 people were killed, and 14 were wounded by bullets and machetes.
- Zemio had been spared the violence that erupted in the rest of CAR, but a sudden cycle of sectarian fighting started at the end of November. Shooting started in town and barricades were erected. The situation calmed down after a few days. The violence pushed people to temporarily leave their homes because of fear of retaliation.
- Like the rest of the country, Ouham prefecture has witnessed periodic violence outbreaks through the year. MSF projects in Batangafo and Kabo, in northern CAR, have suffered repeated attacks that severely hindered activities, leading to temporary withdrawal of international staff from both places. Clashes between armed forces and militias have repeatedly brought civilians to the hospital in Batangafo, and some violent episodes included attacks against health structures and Muslim patients.
- Since July 2014, MSF has been treating and supporting victims of sexual violence at the General Hospital in Bangui.
- In Bangui, the authorities have announced that they want to close Mpoko camp by February 2015 in order to allow the construction of a fence around the airport and extend its parking area. MSF will continue to provide support to the IDPs while continuing to adapt its services to the needs.
- The insecurity caused by the upsurge of violence that occurred in Bangui in August and October made it extremely challenging for MSF’s teams to reach out to the wounded. Patients, victims of violence, and the sick also had difficulty accessing health facilities and MSF teams.
- The insecurity has also impacted MSF personnel and other aid workers. Over the past few months, they have been subjected to an increase in acts of violence of varying degrees.
- On December 4, 2014, almost one year to the day after anti-Balaka rebels launched an attack on Bangui, the French minister of defense stated that the “job was done” and that the country was returning to “normal.” He then announced the partial withdrawal from CAR of the French peacekeeping force Sangaris. MSF’s view is very different—we believe that the situation remains extremely serious, particularly from a security and humanitarian perspective.
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.
MSF Press Briefing on Crisis in the Central African Republic
MSF Operations as of December, 2014
This is an excerpt from MSF's 2013 International Activity Report:.
Escalating and extreme violence in the Central African Republic (CAR) over the year resulted in a massive, acute humanitarian crisis in addition to an existing chronic medical one.
For over 20 years, the small landlocked country of CAR has witnessed many political and military crises. Continual population displacement caused by pockets of armed conflict, combined with a poorly resourced, dysfunctional healthcare system, prevents people from obtaining the treatment they need. Many die from easily preventable and treatable illnesses such as malaria, respiratory infections, and diarrheal diseases. Prior to the current conflict, mortality rates in some regions were up to five times the emergency threshold.
In response to this chronic medical crisis, MSF was providing basic healthcare through seven comprehensive projects—at Batangafo, Boguila, Carnot, Kabo, Ndélé, Paoua, and Zémio—when the current emergency began to unfold. Despite some interruptions due to insecurity, these projects have adapted and continue to provide medical care to people in the communities, and to respond to localized emergencies caused by population displacement. Teams offer basic and specialist healthcare, mental health consultations, maternity, pediatric and nutritional services, surgery, and HIV and tuberculosis (TB) care.
When 2013 began, the rebel group Séléka had recently seized several strategic towns, and in March they took the capital Bangui, leading to a presidential coup and the gradual destabilization of the country over the course of the year. Increased tensions and violence, including assaults on civilians, spread into previously peaceful areas. In early September, armed self-defense groups, the “anti-balakas,” started to attack Séléka forces and civilian populations in the northwest.
Throughout this period, MSF provided free medical care to people wounded in attacks or displaced by violence. Mobile clinics were launched and teams supported government healthcare facilities, providing emergency aid to people wounded in attacks or in need of medical attention. Additional activities were started to ensure access to clean drinking water and improve hygiene for the displaced population.
Short-term emergency projects opened and closed in the first half of the year in Damara and Sibut, supporting outpatient services at local hospitals. The Damara team also offered treatment to people who had temporarily fled into the bush. More than 12,800 consultations were carried out through these projects. Emergency projects also opened in 2013 in Bangui, Bouca, Bossangoa, Bria, Sibut, Damara, and Gadzi, and emergency medical teams visited Yaloke and Bouar. Emergency surgery and basic healthcare were available for the wounded, and teams regularly treated patients for malaria, respiratory and skin infections, diarrheal diseases, and malnutrition.
Beginning in December, violence and chaos took hold in Bangui. Despite the arrival of international forces in the capital, there were daily clashes, attacks, lynchings, and reprisals. In the first two weeks of that month alone, the UN estimated that some 214,000 people were displaced by the conflict. Hundreds of thousands of people fled their homes and gathered in camps including M’Poko at Bangui airport (100,000 people), the monastery of Boy-Rabé (15,000) and the Don Bosco Centre (15,000). Living conditions were, and still are, deplorable. With hardly any other organizations providing emergency assistance, MSF undertook extensive work to ensure a clean water supply, basic standards of hygiene and human waste disposal: at the Don Bosco site, a team dug 20 emergency trench latrines and provided 30 cubic meters of water a day. They later built 150 latrines there, and a further 350 latrines in M’Poko airport camp. In addition, MSF ran a water treatment plant that produced 600,000 liters of clean drinking water per day and also distributed relief supplies to the displaced population of Bangui. MSF medical staff provided trauma surgery and basic health consultations. However, the basic needs of the displaced people in CAR remained unmet as there was insufficient mobilization by other humanitarian organizations. At Castor health centre in Bangui, surgeons responded to 465 trauma cases in just three weeks. MSF also supported a Ministry of Health measles vaccination program.
MSF repeatedly spoke out, asking that all parties involved in the conflict allow access to medical care for the sick and wounded and calling for an end to the violence against civilians, patients, and staff in healthcare facilities. MSF also denounced the lack of mobilization of UN humanitarian agencies and called for the deployment of more means and resources—from the UN and other aid organizations—to provide an appropriate response to the extensive human needs. Towards the end of the year, MSF had more than 250 international and 2,500 Central African staff providing free medical care to approximately 600,000 people in seven hospitals, two health centers and 40 health posts. At the time of writing, MSF is the largest employer in CAR.
By year’s end it was estimated that over 700,000 Central Africans were displaced inside CAR and that a further 75,000 had crossed into neighboring countries.
Urgent health crisis
The conflict only exacerbated medical needs, which were already huge, even in stable areas of the country. The health system suffers from a lack of qualified staff and there are few public facilities outside the capital.
Shortages of essential medicines are frequent and many people cannot afford to pay the fees required for treatment. In short, a large proportion of the population does not have access even to the most basic health care, and mortality rates are above emergency levels.
In 2012, MSF teams worked with the Ministry of Health in seven hospitals and more than 30 health posts, providing a wide range of services: basic and specialist health care, maternity and paediatric services, surgery, HIV and TB care, and treatment for neglected diseases, including sleeping sickness (human African trypanosomiasis).
In 2013 and 2014, MSF opened several new emergency programs designed to treat people directly or indirectly injured due to the violence and people whose treatment was interrupted because they fled their homes to escape imminent attacks.
In any and all years, though, malaria is one of the main causes of death in the country and a major priority for MSF programs. The goal is to boost prevention and offer communities diagnosis and treatment in more locations.
- In the report State of Silent Crisis, published in 2011, Médecins Sans Frontières/Doctors Without Borders (MSF) called for greater medical assistance in the Central African Republic.
At the end of 2013, MSF had 1,631 staff in Central African Republic. MSF has worked in the country since 1996.
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 centre in Boulam, they referred us to the hospital by motorbike taxi.”
After two days at the hospital, Melissa’s daughter’s condition had improved.