CAR: "The Suffering of the People is Fueling the Armed Conflict"

Andre Quillien/MSF

Jean Philippe Garcia de la Rosa recently returned from a mission as logistics coordinator for Doctors Without Borders/Médecins Sans Frontières (MSF) in Central African Republic (CAR). In 2014, he witnessed the evolution of a conflict that first hit the headlines in late 2013, as renewed fighting between opposing militias launched a new chapter in a war that has left most of the country’s population in poverty and displaced thousands from their homes. Here, he describes his experience.

After the hard clashes in early 2014, has the situation in the country improved?

CAR has the same problems it had a year ago and prospects have not improved at all. No solutions have been found to the underlying problems, such as the ancestral confrontation between shepherds and farmers, and now more and more people resort to violence to solve them.

People’s daily life is still fraught with difficulty. You just have to look at the rise in the price of basic commodities. Civilians continue to suffer and that is fueling the armed conflict. The anguish and despair felt by many young people lead them to join armed groups. Many young Muslims who fled Bangui after the persecution unleashed a year ago will end up holding a weapon.

The large international presence and United Nations (UN) decision to hold crisis level three (the highest possible) in CAR are clear signs that the situation has not significantly improved.

What are the main challenges from a logistics point of view in such a difficult context?

Many problems in CAR are somehow the same as in other MSF missions, only to a higher degree. And many of these challenges are interconnected. In the last year, supply problems have grown because of the closure of some borders and the difficulty of finding local suppliers.

One factor that has complicated things even more is the fuel shortage, which has gotten worse following the deployment of the new UN contingent (started in September). This has led to an increase in fuel demand while supply has remained the same because of the limited capacity of the local provider.

Despite all the hurdles, our mission managed to improve the supply system through a joint effort of all our teams. In particular, we have responded to our priority of strengthening our performance in hygiene and sanitation in the health structures where we work. Training of our staff was key to meeting the challenges in this regard.

READ: "There's Not One Single Muslim Left in Bocaranga"

How has the ongoing insecurity affected the transportation of MSF supplies and teams?

The ongoing armed conflict greatly affects movements all over the Central African territory. We have to negotiate continuously with the various armed groups to facilitate access through the checkpoints, which became more and more difficult to cross by the end of last year.

The instability has even forced us to stop some airlifts of supplies and teams because of the lack of security, and that obviously affects our activities. In addition, this year there are expected to be even more fuel shortages due to the security situation in the country.

Has there been progress in rebuilding the country?

The country is small but it poses many difficulties for reconstruction. The Seleka and anti-Balaka militias have tried unsuccessfully to become political groups, in part because they are very heterogeneous, with different factions right from the origin. In addition, each region and each city have their own problems and their own leaders, making it very difficult for political groups to grow at a national level.

Moreover, the international community is too concentrated in Bangui [CAR’s capital] and cannot see well what happens in the rest of the country. The intervention could have been more determined from the start, a year ago, but maybe that would have triggered a conflict more difficult to control. Now local people are asking who is responsible for the lack of solutions and the continued insecurity. And, last but not least, if you act against one of the warring parties then you have to do it against the other, and the international community has not known how to manage this need for balance.

How far has the "religious war" discourse spread in CAR?

What we see in CAR is also found in other countries in conflict. The population is the main victim of the conflict. They have to survive with almost nothing and people end up looking for someone to blame. The easiest scapegoat is simply “the others,” whether he is a foreigner or someone with a different religion. Two years ago, after the coup by the Seleka (militia made up mostly of Muslims that forced a coup in March 2013), the idea that the villains were the Muslims grew very fast among Christian communities. Then the government fell and many Muslims had to flee Bangui, but the problems for the rest did not disappear. People saw it was not a matter of Seleka or anti-Balaka (the opposing militia), or Christian or Muslim. Many realized that the conflict had nothing to do with religious issues.

What should the focus of the humanitarian community be in this scenario?

We must focus on getting aid to people in the best possible way. In this country, if you lift a stone you immediately see lots of unaddressed needs. The problems go beyond the conflict, but we must not lose focus of what our priority is.

From MSF’s point of view, I think our work is well-recognized by all the stakeholders. One of our greatest assets is our local colleagues, who are also part of the local community and allow us a better understanding of the reality. We have to remain focused on reaching people wherever they need us, beyond the cities, anywhere.

MSF has been working in CAR since 1997. Since December 2013, in response to the crisis, MSF has doubled its medical assistance in CAR and is running additional projects for Central African refugees in neighboring countries.

"We must focus on getting aid to people in the best possible way. In this country, if you lift a stone you immediately see lots of unaddressed needs. The problems go beyond the conflict, but we must not lose focus of what our priority is."

Jean Philippe Garcia de la Rosa
Depuis janvier 2014, MSF travaille dans le centre de santé de Mamadou M’Baiki - situé dans le quartier de PK5, à Bangui - où nous offrons des soins de santé primaire aux enfants âgés de moins de 15 ans. Pendant le pic annuel de paludisme, le centre de santé de Mamadou M’Baiki peut recevoir jusqu'à 800 enfants par semaine. En 2014, sur nos différents projets menés dans le quartier de PK5 (centre de santé + dispensaires mobiles à la grande mosquée et à Kpéténé), nous avons dispensé près de 40 000 consultations (29% de cas de paludisme). <br/> Since January 2014, MSF has been working in Mamadou M'Baiki health center - located in the PK5 district in Bangui - where we offer primary health care to children under 15. During the annual malaria peak, Mamadou M'Baiki health center can receive up to 800 children a week. In 2014, on our various projects in the PK5 area (health center + mobile clinics at the Grand Mosque and Kpéténé area) we have provided almost 40,000 consultations (29% for malaria cases). *** Local Caption *** En RCA, le contexte sanitaire est catastrophique, les indicateurs particulièrement dégradés : le paludisme (1ère cause de morbidité et mortalité) est endémique, chaque enfant âgé de moins de 5 ans fait en moyenne deux crises par an. La couverture vaccinale est très basse. Le pays possède la plus haute prévalence de VIH-Sida des pays d’Afrique Centrale (entre 5 et 10% suivant les zones). Le système de santé offre un accès aux soins limité et coûteux, les ressources humaines qualifiées manquent, les problèmes d’approvisionnement en médicaments sont récurrents. Dans ce pays à l’Etat fantôme, les opérations menées par MSF se substituent à celles du ministère de la Santé.<br/> In CAR, health situation is catastrophic, indicators particularly degraded: malaria (first cause of morbidity and mortality) is endemic, every child under 5 years has an average of two attacks per year. Vaccination coverage is very low. The country has the highest prevalence of HIV-AIDS among the countries of Central Africa (between 5 and 10% depending on the area). The health system offers limited and expensive access to care, skilled medical human resources are lacking, drug supply problems are recurrent. In this country without State, MSF operations substitute those of the MOH.
Andre Quillien/MSF