In the past week week, renewed clashes between Christian youths and young Muslims have been producing more victims in Bangui, capital of Central African Republic (CAR). Some of them have been treated at the city's General Hospital, where Doctors Without Borders/Médecins Sans Frontières (MSF) supports the emergency surgery service.
4:00PM, Wednesday, May 28, General Hospital of Bangui
"There is fighting in PK5."
The news spread almost immediately in the emergency department. A few minutes later, a wounded patient transported on a motorcycle arrives, flanked by two of his friends. He was wounded in the cheek. Then a second person reaches the entrance with a gunshot wound. He is immediately attended to by the emergency physician. Thirty minutes later, there is a third man, thrown by the blast of a grenade. The excitement is building, the room block is prepared, surgeons and anesthesiologists spread the word.
MSF has been working in this hospital since the end of February 2014 to support the wounded. It is actually a three-story building, where hospital rooms are always filling up. At the moment, the occupancy rate is almost 90 percent—empty beds are rare. "It's been over twenty years since the hospital did not function, explains Pascal Muhitira, the MSF project coordinator in the hospital. "MSF took over every aspect of this wing of the hospital. We now have 104 inpatient beds and four intensive care beds. But sometimes it overflows, and we are required to add beds. "
In some areas, the level of violence is still extreme. "In February, gunshot wounds accounted for 80 percent of injuries we received," Muhitira says. "Since then this percentage has declined and evened out. We had more road accidents, a sign that life returned in some neighborhoods of Bangui. But here over the last few days, new clashes erupted between young Muslims and Christian youth in neighborhoods PK5 and Boeing. In one day, Sunday, we received 16 wounded, and the next day another four."
On the first floor, a surgeon, an anesthesiologist, and a nurse are busy in the in the operating theater. A young man of 30 years is on the operating table, a leg amputated. "This is a patient who had a gunshot wound, bleeding in the thigh," says MSF surgeon Joel Bost. "As he lived outside Bangui, the people made him a tourniquet. It was seven hours before he arrived. During this time, circulation was cut off to part of the leg. We opened his thigh to address the wound and stop the bleeding. During post-operative care his leg developed gangrene because of the tourniquet. It was necessary to amputate the leg."
The next patient is called Casimir. He is 68 years old and has severe burns to his torso and face. "It was the evening of Sunday, Mother's Day, May 25, at 11:30PM," his son, Jules-Stéphane, he recalls. "I was woken by a big bang . . . A grenade! I searched my father’s house, which was already on fire. I broke down the door. When it opened, my father was there. He was burned. He just had time to say 'Get your mom!' and he collapsed." Casimir and Jules-Stéphane's mother were both hospitalized for severe burns. There is nothing left of their home. On his mother's mobile phone, Jules-Stéphane scrolls through photos showing a pile of charred black stones.
In the block, MSF physiotherapist Julie Van Hulse carefully observes the burned patients. "For burn care, physiotherapy is very specific," she says. "In the case of Casimir, for example, the severe burns are in the inside of the arm. So we have to be careful not to let his arm flex, otherwise the skin will scar in that position, and he will no longer be able to use his arm."
5:00PM: Back in the Emergency Department
MSF logisticians put mattresses in the lobby of the hospital, and prepare for a new influx of wounded. The news was confirmed: an attack has just taken place in the Church of Fatima neighborhood. Nobody knows how many deaths and injuries will happen. A few hours later, the evidence arrives. MSF teams have treated nine new wounded victims of clashes between Christian youths and young Muslims in Bangui.
Since the end of February 2014, MSF has worked at the General Hospital in the department of emergency surgery with a team of 20 international and 250 Central African staff. In April, nearly 421 surgical procedures were performed, and 150 patients were supported for injuries related to violence.
In the rest of the country, more than 300 international staff and 2,000 local staff are working with MSF. MSF has developed projects in nearly 15 cities in CAR, and provides assistance to Central African refugees who have fled to Chad, Cameroon, and the Democratic Republic of Congo.