The civilian population in the north of the Central African Republic is bearing the brunt of an ongoing conflict between rebel and government forces. Doctors Without Borders/Médecins Sans Frontières (MSF) is running a hospital and operating mobile clinics in and around 10 locations in Markounda, northeastern Central African Republic. In addition, thousands of people have fled from the north of the Central African Republic into southern Chad around the town of Goré. An MSF team of 6 international and more than 20 national staff focus on basic health care doing on average 800 consultations a week as well as nutritional and water-and-sanitation activities.

Dr. Simon Collins has been working for MSF out of the village of Markounda, Central African Republic. 2006 Photo © Ton Koene

"Even the sound of a car made people run into the bush; this pervasive fear among the population is what struck me the most," says Simon Collins, MD, working for MSF in the Central African Republic. Since November 2005 he has been working in the north of the country, out of the village of Markounda, close to the border of neighboring Chad.

"Violence has become part of their lives," says Dr. Collins, "When we are on the road with our mobile clinics we regularly passed burned houses; one village after the other completely destroyed and abandoned. It gave us an eerie feeling when we stopped to see what had happened–this total silence around you. Only after a half hour or so did people slowly emerge out of the bush. From talking to local people, it be came clear that they now associated the arrival of motor vehicles with men coming to burn and kill–hence their ongoing fear, even when we arrive for a clinic."

MSF mobile clinics are used because either fear or distance prevents the population from coming to Markounda. 2006 Photo © Ton Koene

The civilian population in the north of the Central African Republic is bearing the brunt of an ongoing conflict between rebel and government forces. As a result of the emerging violence, the collapsed health care, and the displacement of the local population, MSF started operations in November 2005 with two mobile clinics operating out of Markounda. Mobile clinics are used because either fear or distance prevents the population from coming to Markounda.

"I have never seen such an intense fear among the people we were trying to help," says Dr. Collins. "For example, at a clinic in one village, 400 people attended. Suddenly a villager thought they heard a vehicle approaching from the distance. All 400 rose and fled into the bush within seconds, leaving the MSF workers standing alone and stunned."

Around the town of Markounda, almost all the houses have been burned down. Whole areas have been abandoned. In this region alone, thousands of villagers have fled into the bush or over the border to neighboring Chad. 2006 Photo © Ton Koene

The intensity of attacks on the population has been significant and repeated. In one particular village, the attackers burned 494 houses out of the 498. "The attacks were so intense. I recall one particularly in December last year when 930 houses were burned within a day. Clearly civilians were being targeted," says Dr. Collins. "The following week, we managed to not only provide medical care when needed but also distribute plastic sheeting, blankets, and soap."

Within a few months time the MSF team expanded to 5 international and 30 national staff. Ten mobile clinics were set up along the border area with Chad, most of them visited every other week. More than 4,000 consultations are being conducted on a monthly basis. Many of the patients required more intensive treatment than could be provided through mobile clinics. As a result, MSF set up a 16-bed, 24-hour-care hospital in Markounda. Each week, MSF admits 10 to 15 people to the hospital and treats several hundreds of patients at the hospital's outpatient section.

"The numbers are maybe not as massive as in other conflict areas in Africa," says Dr. Collins. "Overall we working to assist some 10,000 people. This will increase within the coming weeks to 30,000, as we will also being working in the regional referral hospital. Many of these people are hiding in fear in the bush. These people desperately need care, not only medical care but, as important, also the notion that they are not forgotten."