CAR: High Humanitarian Needs, Low International Attention

Diminishing budgets and reduced international non-governmental organization (NGO) activity in the Central African Republic (CAR) have had adverse effects on the population’s high humanitarian needs at a time of ongoing political instability. As of now, only 28 percent of the necessary humanitarian aid budget for 2017 has been pledged. “The most acute phase of the crisis may be over, but the problems are far from solved,” says Emmanuel Lampaert, Doctors Without Borders/Médecins Sans Frontières (MSF) country representative in CAR.

Currently, more than 850,000 people are either internally displaced or have fled to nearby countries, and 2.3 million—or half the country’s population—rely on humanitarian assistance for survival. While general elections early this year were a sign of progress for CAR, violence continues to trouble the country’s population. Last June, the head of a clearly identified MSF convoy bringing in supply from Bangui was killed in an ambush on the road by armed men. East of Bangassou, armed groups terrorize villages, stealing crops, and abducting people; because of the insecurity, MSF was forced to cancel a planned vaccination campaign.

Accessing to health care remains an issue; those that are able to reach health care often cannot afford it. For example, consultations at a health post close to the MSF-supported health center in Mbalazime, a village about seven miles from Bangassou, usually cost between four to six dollars—far above the means of many of the local population. For the same price, a person can buy enough rice to sustain a family for a month.

Local health centers and health posts are understocked, understaffed, and struggle to offer adequate services to the population. At the MSF-supported regional hospital in Bangassou, Dr Osmar Sosa Del Toro performed twelve urgent surgeries in just one day; one woman’s intestines had been perforated during a cesarean section a month earlier, and another brought in her six-month-old baby with a severely infected abscess on his left leg. “[The baby] received an injection in a health center one week ago. It was badly done and was badly infected, which can lead to septic shock in such a young child,” says Del Toro.

Malnutrition, often a result of repeated illness in children, is a chronic issue. CAR is among the top three countries most affected by malnutrition; but in the first half of 2016, less than 25 percent of children suffering with malnutrition received proper care. “It’s strange, because for the most part there is food in the homes of our patients,” says Dr Ilaria Moneta, an MSF pediatrician. “But it’s very difficult for parents to motivate a sick child to eat and to know how to properly feed a child. It’s a slippery slope: they’re sick, so they don’t eat, so they get weaker and fall ill again.”

Next month, donors will gather in Brussels to assess and plan the next steps in supporting CAR. So far, the signs are not encouraging. Humanitarian and health needs in CAR remain critical, and will only worsen if funding continues to decreased and NGOs continue to reduce activates. “If CAR was one of our patients, we could say that it’s out of the emergency room indeed, but still in need of intensive care. Discharging it now would have tragic consequences,” says Lampaert.

MSF began activities in early 2014 in Bangassou, supporting the regional university hospital. It is progressively increasing its reach through work with the community and in prevention activities.

MSF also supports a 118-bed reference hospital in Mbomou district that has a population of 206,000. The hospital includes pediatric, maternity, and neonatal care, internal medicine, and surgery, as well as a transport system to bring the most serious cases from six health centers in the district.

In addition, MSF supports the health centers of Yongofongo, Mbalazine and Niakari districts, offering free primary health care for everyone, and training for staff.