Six months after the capital of Bangui was seized by Seleka rebels, the situation in CAR remains unstable.
Six months after the coup d’état and the seizure of capital city Bangui by Seleka rebels, the situation in Central African Republic (CAR) remains unstable. France has called on African countries and institutions and the UN Security Council to take up the crisis and has finally included CAR among its foreign policy priorities. Meanwhile, the country remains in chaos, facing uncertainty and renewed tension and violence, including in areas that have been spared until now. Doctors Without Borders/Médecins Sans Frontières (MSF) has worked continuously in CAR since 1996 and continues to provide assistance, addressing the needs of thousands of people who are ill, victims of violence, and deprived of medical care.
“We are very worried about the current situation in the CAR and what might happen in the future,” stated three MSF heads of mission. “Our teams in the field are seeing increasing violence and security incidents. The populations—our patients—are suffering the most. MSF faces a serious humanitarian and health crisis in CAR today and we don’t know how it will evolve.”
CAR has experienced decades of political-military conflict that has reached a state of chronic humanitarian and health emergency today. With the coup d’état last March, the situation deteriorated further and has not returned to normal since then. Years of crisis have weakened the health system and today, as malaria cases reach their annual peak and medical supplies and workers are in short supply, it cannot meet the population’s growing and pressing medical needs.
Additionally, routine vaccinations and drug supplies have been interrupted, particularly for patients with tuberculosis or living with HIV/AIDS. “We treat many sick patients in the health facilities where we work, but we are also seeing a sharp increase in the number of people who have been injured due to violence,” says Ellen van der Velden, MSF head of mission.
In many areas of the country, MSF has adapted its existing activities or launched new projects to meet the needs. In the region of Paoua, a town in northwestern CAR that has largely avoided clashes and violence, the security situation has worsened markedly. In recent weeks, teams have registered and operated on many patients with bullet wounds—up to six people per day—at the town’s reference hospital.
Hundreds of villagers have surged into Paoua, fleeing threats of attack by armed men and fearing abuses. This influx of displaced persons is likely to affect the volume of activity in the hospital’s pediatric, surgery, obstetric, hospitalization, and TB treatment an vaccination departments where MSF works.
On August 5, MSF opened a pediatric program for children 15 years of age and under in Bria, in the eastern part of the country. “This isolated area has been completely abandoned,” says Jordan Wiley, MSF head of mission. “MSF evaluated the health situation there in May and we saw 788 patients in one week. This number has grown steadily since that time.” More than three-quarters of these patients have malaria. Thirty-six children were hospitalized, primarily for the severe form of the illness, but also for respiratory infections and diarrhea. More than 500 children were screened for malnutrition and those requiring hospitalization were admitted to an MSF nutritional center. MSF will support a new round of routine vaccinations in the area.
The Boguila projects and the Bossangoa project that opened on an emergency basis (both north of Bangui) face an influx of malnutrition and malaria cases. Clashes between armed groups in Bossangoa region, whose victims are both combatants and civilians, are reported regularly. MSF teams are focusing their efforts on malaria, diarrheal illnesses, malnutrition, and victims of violence (specifically sexual violence and bullet wounds).
Nearly 200 children under the age of 5 are seen daily at Bossangoa. MSF has also resupplied antiretroviral drugs and anti-TB treatments for 350 patients treated at the Bossangoa hospital who have not had access to medication since the coup d’état last March, and launched an emergency obstetrics program.
Many families in Boguila fleeing violence and abuse are still living in the bush, exposed to the elements and without means of subsistence. MSF mobile teams return every day with ill and/or malnourished children who require hospitalization. In July MSF held 8,556 consultations, compared to 5,673 in July 2012.
At Batangafo hospital, in the center-west of the country, the number of victims of violence has also increased suddenly. Over the last few weeks, 18 victims of bullet wounds (combatants and civilians) were admitted there. MSF continues its activities at the hospital and in several health centers on the outskirts of the city. MSF’s mobile teams crisscross the region three times a week to provide assistance to displaced people who cannot yet return home.
Malaria is the most commonly seen illness, with 31,556 cases between January and July. Eighty-three percent of the 1,818 patients hospitalized over the same period in Batangafo were children under 5, suffering from malaria complicated by anemia and/or severe malnutrition. Between January and July 2013, the hospital admitted more patients (38,000) than during the same period last year (33,000).
In early August, MSF expanded its activities in the region and is now working in Bouca, approximately 100 kilometers [about 62 miles] from Batangafo, where MSF now provides care specifically for mothers and children. More than half (700) of the 1,200 patients seen since the project began had malaria.
Similarly, in the Kabo and Ndélé hospitals in northern CAR, most of the patients treated by MSF teams between January and July had malaria (14,268 out of 35,424 visits in Kabo and 4,916 out of 15,774 in Ndélé). During the same period, MSF held 52,169 consultations in the 11 health centers it supports in the region.
To combat a measles epidemic (69 cases recorded since early August), MSF has just opened a new emergency pediatric program in Gadzi, western CAR. “We launched a vaccination program targeting 12,000 children under five,” says Sylvain Groulx, MSF head of mission. “Newborns will be immunized against polio at the same time and will receive a deworming treatment because intestinal parasites are common in this region.”
This new project is also intended to monitor and follow children’s nutritional status. Seven nutritional centers have thus been set up in the area and a stabilization center for the most serious cases was established in Gadzi. Over a period of a few weeks, 51 children entered the nutritional program and 1,175 visits were held in the health centers that MSF supports (60 percent due to malaria). Dermatological and respiratory illnesses are also frequent and were treated.
Insecurity in Bangui Also Affects MSF
On the night of August 27, four to five thousand people fleeing new incursions into their neighborhoods by Seleka rebel forces north of Bangui took refuge on the tarmac of the city’s airport, blocking flights.
One week ago, an MSF expatriate team and driver were traveling through Bangui when uniformed men attacked their car. The vehicle was stolen and subsequently recovered. MSF condemns this recent attack as well as other security incidents it has experienced, including the incident in March, when MSF offices in Bangui were ransacked and looted and vehicles were stolen. MSF again calls on the Central African government to ensure the protection of its population, both in the capital and the provinces.
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