"Despite increased international awareness over recent months about the crisis, the extreme living conditions for tens of thousands of displaced around Bossangoa have not led to the deployment of additional experienced aid workers, or to the roll-out of an effective emergency response capacity since early September 2013... Desperate civilians have not been provided with even the minimum standards required in such emergency settings."

Dr. Joanne LiuInternational President, MSF
December 12, 2013

Ms. Valerie Amos
Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator
United Nations

Geneva, December 12, 2013

Dear Ms. Amos,

With this Open Letter, Doctors Without Borders/Médecins Sans Frontières (MSF) wishes to express its deep concern about the unacceptable performance of the United Nations humanitarian system in the Central African Republic over the last year.

In December 2012, when the first rebel offensive in CAR halted a few kilometers from the capital, most UN staff were already evacuated from Bangui and from field locations. Following the coup d’état, the UN finally redeployed beyond the capital six months later, its positioning justified by vague security concerns. Emergency directors did not carry out an assessment until October.

During the growing emergency of the last three months, and most recently in Bangui just a few days ago, there has been no evidence of an adequate humanitarian reaction to the needs generated by repeated outbreaks of violence. The only actions undertaken by UN aid officials have been the collection of data related to the fighting and a few assessments confirming the need for an immediate response. Repeated evaluations in the face of glaring needs, and numerous coordination meetings, have not led to any concrete action around the main hotspots.

Two recent examples best illustrate the situation: MSF has repeatedly asked UN agencies to deliver food, tents and soap to the more than 15,000 people displaced in the vicinity of Bangui’s airport, without any reaction; in Bossangoa, UN aid officials on security lock-down inside the FOMAC compound did not even provide assistance to the displaced sheltering inside the same compound, forcing MSF to intervene once more. Following the fighting in Bossangoa, the UN remained on security lock-down for days, abandoning the more than 30,000 displaced persons in the main Bossangoa camps, while MSF and ACF teams move through the city to provide emergency assistance. 

Despite increased international awareness over recent months about the crisis, the extreme living conditions for tens of thousands of displaced around Bossangoa have not led to the deployment of additional experienced aid workers, or to the roll-out of an effective emergency response capacity since early September 2013. The scant aid scale-up required for months is failing a displaced population in dire need of water and sanitation assistance. Desperate civilians have not been provided with even the minimum standards required in such emergency settings.

Living Conditions in Bossangoa

  Minimum Standard Current Situation
Water 15–20 liters/person/day 7.8 liters/person/day
Latrines 1 latrine/20 users 1 latrine/166 users
Showers 1 shower/40 users None

Even the internal acknowledgement of poor humanitarian leadership, non-existent responsiveness, and the urgent need to vastly improve performance, has not led to visible changes in UN processes and activities. Rather, there have been very time-consuming discussions over the design of a humanitarian emergency programme (100 Day Plan), which would only start on 1 January 2014, leaving the exhausted and traumatized CAR population without assistance for the foreseeable future. Full implementation of the plan would require weeks or even months.

To compound an already dismal situation, there appear to be serious perception gaps over (in)security, both among the various UN agencies and between MSF field workers and UN officials, the latter unwilling to share the rationale behind their extremely risk-averse analyses. The distorted view of the threats faced by aid agencies in the CAR, demonstrated, for example, by UN officials wearing military helmets and flak jackets in an environment that does not require such protective gear, cannot be accepted if it represents a restriction on assisting people in an extreme state of need.

While not playing down residual risks, MSF considers current UN security concerns disproportionate to field realities. Yet those concerns remain the main stumbling block and a constant excuse for UN agencies to postpone required timely scale-up of resources. Overall, such a complete disconnect from their surroundings only serves to discredit and delegitimise UN agencies and their implementing partners, jeopardising future activities and negatively impacting the protection and assistance effort to the CAR as a whole.

Apart from recalling the urgent need to scale up the humanitarian intervention without delay, in order to alleviate the suffering of the local population, and insisting on redeployment beyond Bangui, MSF deplores the appalling performance of UN humanitarian agencies and reminds them of their responsibility to mobilise and coordinate effective and principled humanitarian action, advocate for the rights of people in need, and facilitate sustainable solutions to the current crisis. An internal and independent UN investigation should also be considered by senior UN leadership to better understand such failures and ensure lessons are learned for the future.

Humanitarian emergency responses entail risk, but MSF has shown over the last year that an upgrade in capacity through international staff deployment is feasible. Despite several incidents, not only has MSF never fully evacuated its projects, but it has indeed expanded its presence in six of the most vulnerable areas of the country affected by violence, through new emergency interventions leading to targeted medical aid response activities. However, notwithstanding its own important efforts, MSF and the handful of other competent NGOs in CAR cannot cover all the needs. United Nations agencies need to reinforce their capacity at ground level since many aid agencies rely on them to provide the umbrella under which they can operate.

CC: Anthony Lake, Executive Director UNICEF
Ertharin Cousin, Executive Director WFP
Dr. Margaret Chan, Director-General WHO
Antonio Guterres, High-Commissioner UNHCR
Kevin Kennedy, Under-Secretary-General for Safety and Security UNDSS 

On behalf of MSF,

Dr. Joanne Liu
International President
Doctors Without Borders/Médecins Sans Frontières (MSF)

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