"The population is in need of safety, medical care, clean water, malaria treatment, and psychological support. We will continue to do our work."
Doctors Without Borders/Médecins Sans Frontières (MSF) doctor Johan Berg works at the hospital in Bangassou, a small town in southeastern Central African Republic (CAR), where recent fighting resulted in widespread casualties and displacement. Here he describes his experience.
I was awoken by a team member at 6:00 a.m. Saturday morning [May 13, 2017]. He informed me that there was open fighting in the town. I did not expect it would happen so suddenly, even though I knew there was a high risk.
No sounds could be heard except for the shots being fired. Nobody dared to leave their house. We learned that all the bridges leading to the hospital had been destroyed, so it was impossible for us to reach the hospital by car. After assessing the security situation, we decided to send a team to the hospital to get an idea of the situation there. Our ambulance, parked at the hospital, met us at the river and the team crossed on foot. The security situation did not allow me to go to the hospital that first day. It was hard to stay put without being able to do anything to help.
"The Wounded Kept Coming"
I was able to go to the hospital on Sunday. Tokoyo, a part of town next to the hospital, was set alight. We still heard bullets flying. The only people that dared to come to the hospital were those with no other choice: the wounded, many of whom had gunshot wounds. Normally, around 100 patients per day come to our emergency room, most of them children. But on that day none came and to my knowledge, most, if any, of the health centers were not operating.
The patients that come to our hospital are usually very ill, especially at the moment since we are in the middle of the malaria season. It was hard to know that all these patients who would normally come to our hospital were out in the villages and in the woods hiding without any treatment. We know that this means that many of them will die and that those who survive will be very ill when they finally dare to come.
On Monday, the wounded kept coming. Many were severely hurt. A few people very sick with other illnesses also came. We saw children convulsing from severe malaria, unconscious because of low blood sugar and/or anemia. We also saw people in severe emotional shock.
One woman, who was five weeks pregnant, had seen her husband killed in front of her eyes. After that she was tied down and beaten with rifle butts. She, like hundreds of others, had fled to the hospital to seek protection. She was 20 years old and was there with her four children. The stress was too much for her. She could barely stand up, let alone walk.
Both Sunday and Monday there was fighting just outside the gates of our hospital. Several times we had to throw ourselves to the ground for shelter while trying to provide health care to our patients. Many of our Central African colleagues were missing. Progressively we received news of their well-being, and now have news from almost everyone. Some staff are staying at the hospital; many of them arrived with their children and do not dare to leave. Many have also fled the violence and are in hiding.
We lack many of the people who are crucial to ensuring that hospital services continue running in a moment of such high need: nurses, but also support personnel such as cleaning staff. Some people work for 24 hours straight. After that, they sleep a few hours and start work again. Since all the markets are closed and the security situation makes it impossible for airplanes to land, it is difficult for us to find enough food for both patients and staff.
We have only one surgeon who is working as fast as he can, but the high number of patients means that many have to wait for surgery. One example is a 15-year-old child who had a penetrating gunshot wound through the chest. We support our patients as well as we can with antibiotics, liquids, and blood transfusions until they can have surgery. As soon as a plane can land we hope to have some reinforcements.
We have received reports of several deaths from the fighting. It is unclear exactly how many. The Red Cross had to borrow body bags from us in order to bury some of the dead.
A large part of the population is displaced. Some are hiding in the forest, others in town. We have sent a team to a site where more than 1,000 people are hiding. Many are dehydrated because of the heat. They lack food and clean water and are living in conditions that could lead to the spread of disease. We have been able to give them some rehydration salts, emergency nutrition services, and health care, and we are helping set up sanitation facilities.
The town is a bit calmer, but it is still not safe. While more patients have come to the hospital, we are still mostly seeing those who are severely ill, the majority of them children. The wards are filling up with sick people and we lack staff.
There is not enough room in the wards. Some of the wounded are staying in tents on hospital grounds where the temperature reaches 40 degrees Celsius [over 100 degrees Fahrenheit] during the day. They are also lying tightly squeezed together on mattresses in our offices. It is likely that the sick will continue to arrive and that the hospital will continue to fill. Staff are exhausted. New outbursts of violence could start any minute.
The population is in need of safety, medical care, clean water, malaria treatment, and psychological support. We will continue to do our work.