February 25, 2014

As intense violence continues to spread throughout the northwest of Central African Republic (CAR), Doctors Without Borders/Médecins Sans Frontières (MSF) teams have opened a new project in Bouar, a town that has been severely impacted by the conflict and its consequences. Today, around 6,000 people remain trapped and unable to flee.

For the last month, MSF has been supporting the hospital in Bouar. Florent Uzzeni, deputy emergency program manager, is currently in CAR and describes what he is seeing unfold on the ground.

What is the current situation in Bouar and why did MSF decide to work here?

Insecurity in the country, which started in March 2013, has led to waves of population movements. The most recent occurred in January. Several armed militias have also passed through Bouar, leading to fighting and violence against civilians. Since January, the presence of several thousand armed men throughout this small town has created an unpredictable situation and left the communities in a state of stress and anxiety. However, as of a few days ago, the situation in Bouar has changed dramatically with the arrival of the French troops [taking part in Operation Sangaris] and there are no more armed men to be seen.

MSF has been supporting the Bouar hospital for a month, helping the staff to treat the wounded and manage other medical emergencies.

We are hearing about the increasing vulnerability of the minority communities. What is their situation in Bouar?

Since January 21, thousands of Bouar’s minority Muslim population have gathered around the mosque. The Hausa district has become an enclave and people are afraid to leave because they are victims of abuse and intimidation. Several days ago, we heard more than a dozen gunshots over a 20-minute period near the displaced persons’ site. Armed men threatened residents and extorted money in exchange for security. This community is becoming increasingly fearful. People fear for their lives. Several have lost family members, killed during the recent weeks’ violence. Most have lost their belongings and can no longer operate their businesses. Many see fleeing as their only option.

Have there been displacements to neighboring countries?

We have seen people heading to Cameroon in recent weeks. In early February, there were 8,500 displaced people at the site but in the last few days, around 2,000 have fled to the border town of Garoua-Boulaï in Cameroon. More people are arriving every day so it is difficult to get a reliable figure. At this point, we are seeing women and children in trucks heading towards Cameroon. Safety on the road between Bouar and Garoua-Boulaï has improved slightly with the recent arrival of the Sangaris troops. On the other hand, the men are staying because they are afraid of being killed on the road. Most of the displaced people are afraid to leave and those who do take enormous risks.

What is the humanitarian situation facing the displaced people?

People have not received food assistance since January. We conducted a nutrition screening and will begin an outpatient program to treat malnourished children at the Hausa site. The nutritional situation is not catastrophic yet, but we identified around 20 malnourished children last week. If nothing is done, the situation could worsen quickly. The region typically experiences a spike in malnutrition during the dry season, as well as many cases of respiratory infection.

Which activities has MSF focused on since January?

Since our arrival, we have treated 72 patients in the hospital emergency room. Approximately 40 of them were victims of a truck accident, which occurred as they were fleeing to Cameroon. They were treated in Bouar before being escorted to Garoua-Boulaï a few days ago, where the MSF teams picked them up to continue providing treatment on the other side of the border.

The wounded patients we are treating now at the Bouar hospital were injured several months ago. For example, we recently saw patients with femoral fractures that occurred several months ago. They had hidden in the bush because of the insecurity. Some have begun to come out because the situation is a bit calmer now than in prior months.

What is the situation with regard to access to medical care?

It’s difficult. People—mostly the Muslim minority—are afraid to leave their neighborhood[s] to go to the hospital because of insecurity in the town and the presence of armed men on the roads. A health center was set up at the site to provide primary health care. However, people with gunshot and knife wounds have no choice but to go to the hospital, which is a kilometer from the site. They take considerable risks on the road when they travel to seek treatment.

Outside the town, several health center directors have reported that their facilities were looted. Some were threatened several times since March by armed groups. The Bouar hospital even experienced an incursion by armed men on January 31, interrupting its activities for two days. In Bohong, 70 kilometers [about 43 miles] from Bouar, the health center was attacked several times, most recently in December, and was forced to close its doors despite the community’s need for care. As soon as the security situation allows, we will organize mobile clinics on the outskirts of Bouar.

MSF has been working in CAR since 1997, and now runs eight regular projects in Batangafo, Boguila, Carnot, Kabo, Ndéle, Paoua, Bria, and Zémio; and seven  emergency projects in Bangui, Bouar, Bangassou,  Bozoum, Bossangoa, Yaloke, and Berberati. MSF has more than 240 international staff and 2,000 Central African staff working in the country. Additional MSF teams are assisting refugees from CAR in Cameroon, Chad, Democratic Republic of Congo, and Republic of Congo.

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