More than three years of armed violence in the English-speaking regions of North-West and South-West Cameroon have led to a humanitarian crisis, severely damaging local health systems even as medical needs soar. Access to health care has become a daily challenge. Today, Doctors Without Borders/Médecins Sans Frontières (MSF) is one of the few humanitarian organizations still providing medical care to people in these regions.
In March, the COVID-19 pandemic hit Cameroon, adding another health emergency to the already dire situation. While MSF immediately started supporting the COVID-19 response, other lifesaving activities have not stopped. As calls for a ceasefire remain largely unheeded, violence and displacement continue across the North-West and South-West. The situation is becoming increasingly desperate for people caught in one of the most neglected humanitarian emergencies in the world.
Fear and displacement
According to the latest UN statistics, nearly 680,000 people have been displaced by the violence in North-West and South-West Cameroon and a further 59,000 have fled to neighboring Nigeria. More than two million people need humanitarian assistance as a result of the physical and psychological consequences of the crisis. However, many are struggling to access health care.
"Ongoing violence and movement restrictions mean most health centers have been deserted by their staff or are no longer able to function normally," said Shahbaz Khan, MSF project coordinator for the North-West region. "Humanitarian aid is limited due to insecurity, and people have quickly found themselves unable to find health care. Displaced communities, in particular, now have little or no access to health care and must endure alarming conditions."
Over 2,000 emergency room consultations
In 2018, the worsening situation prompted MSF to launch an emergency medical response in North-West Cameroon. We now support several medical facilities and a network of community health workers who provide primary health care and referral services to displaced and otherwise vulnerable people.
Saint Mary Soledad hospital is one of the facilities supported by MSF in Bamenda, capital of the North-West region. In this 76-bed facility, our teams offer free medical care to pregnant women and young children and medical, surgical, and psychological care to people who have experienced trauma, including victims of car accidents, sexual violence, armed violence, burns, and domestic accidents.
MSF also set up a 24/7 ambulance service to transport patients in need of urgent care. These are most often childbirth and pediatric emergencies, but also include other medical conditions such as patients with perforated ulcers, severe malaria, respiratory infections, or snakebites. Around 5 percent of patients transported by ambulance are victims of intentional violence.
"In 2019, we treated more than 2,000 people in the emergency room and performed 1,500 surgical procedures here," said Dr. Jifon Edwin Fonyuy, an MSF doctor who manages admission and follow-up of emergency room patients at Saint Mary Soledad. "Our ambulance drivers work day and night, and have transported more than 7,300 patients."
Loveline came to the hospital to give birth to her daughter. The two are now recovering.
"I live in one of the most dangerous neighborhoods of Bamenda. Our local clinic is no longer open," she said. "When I felt the contractions start last night, I was really worried. Especially as movements are prohibited on Mondays in Bamenda, so I didn’t know what to do."
It was vital that Loveline reach a health facility, as she has sickle cell disease, a blood disorder that increases the risk of death during childbirth.
"I called the MSF ambulance because I know they are the only ones who can move around during lockdowns. Fortunately, the vehicle arrived quickly. Barely an hour after calling them, my daughter was born. Without the ambulance, we could both have died."
Three days earlier, Paul was also brought to Saint Mary Soledad hospital. The young farmer had been attacked by armed men who tortured and shot him several times after accusing him of being a supporter of their enemies. Having survived his injuries, he managed to get help from a passerby and was taken to a public hospital. But the hospital could not provide him with care he needed, so they referred him to MSF.
"Paul arrived here with five bullets in his body," said Dr. Fonyuy. "One in each hand, two in the arm, and one in the thigh. Since his arrival, our surgeons have operated on him twice. He is now out of danger. His left hand was in a very poor condition, but we managed to save it."
Ornella, a 27-year-old university student, was injured in a motorcycle taxi accident last November. The MSF team tried to save her leg for over three months, but in the end it had to be amputated.
"I never normally use motorcycle taxis, but I needed light bulbs so I could study and I was scared of walking that evening as there had been many attacks in my neighborhood," she recalled. "On the way, a car crashed into my taxi full speed. The car’s driver took me to the nearest clinic, but it was not open. We went to the regional hospital, but they didn't have an orthopedic surgeon. Instead, they called the MSF ambulance to bring me here."
During Ornella’s stay, MSF surgeons carried out several operations to save her leg. "Unfortunately, the damage caused by the accident was too severe and there was no alternative; we had to amputate," said Dr. Fonyuy. "This is always an extremely difficult decision to make given the huge social impact it will have. How to go on with studies? How to find a job? How to build a family?"
"The team here did all they could," said Ornella "Since the amputation, everyone here, not just the psychologists, has been supporting me so much. I will leave the hospital in a few days and I hope I will be able to rebuild my future."
Felix, 23, will also live the rest of his life with the impact of the trauma he recently endured. Three weeks ago, Felix and his family were attacked as they slept, having already been forced from their home by the fighting. His family managed to escape, but he was caught. His attackers held him on the ground and cut off his left hand with a knife before leaving him there unconscious.
"I lay bleeding on the ground for two hours before my sister dared come back for me," he said. "We hid in the forest for two weeks. I was given traditional remedies, but my arm became infected. We eventually decided to leave the bush and go to a health center. There, they could do nothing for me, they just put a bandage on it. The infection worsened. That’s why we came to Bamenda. On the road here, someone told us that the doctors in Saint Mary Soledad could help me."
When he arrived, Felix was very weak and had to be hospitalized for six days so that the doctors could treat the infection and begin providing psychological care. Today is the first time he has come back to the hospital for a follow-up visit since he left last week. Despite the terrible attack he suffered, Felix smiled during the check-up. "Felix is impressive," said Dr. Fonyuy during the follow-up visit. "His wound is healing well and there is no longer any trace of infection."
In each room, every patient’s story highlights the critical context and the urgent need to increase access to health care in the region.
"For many of them, direct or indirect victims of the current crisis, the presence of MSF here is vital," said Khan, the project coordinator. "In this region, as in many others around the world, [MSF is] one of too few humanitarian organizations on the ground providing health care to those living here. In an area marked by regular attacks on humanitarian staff, this support is hard to provide, but people know that we treat our patients impartially. Responding to urgent health needs is our only concern. Viruses, bullets, and infections do not care which side of the crisis you are on. Neither do we."
Some names have been changed to protect the privacy of individuals.
Since 2018, MSF has provided medical and mental health care to people affected by the ongoing violence in the North-West and South-West regions of Cameroon. In a context marked by massive displacement and reduced access to health care, MSF teams help displaced people and host communities by offering primary and pediatric health care, trauma surgery, emergency maternal care, burn treatment, sexual violence care, psychological counseling, and sexual and reproductive health services. We provide an ambulance service and respond to disease outbreaks. Other services include:
- Community-based health care: In both regions, we train and support community health workers to assist displaced people through malnutrition screening and the management of common diseases such as malaria, diarrhea, and acute respiratory infections—particularly among children.
- Referral system: In both regions, we facilitate patient referrals from the community to health centers and hospitals through free 24/7 ambulance services.
- Support of health facilities: We support 30 hospitals and health centers across the two regions. Our support focuses on emergency cases, especially children, pregnant women, and victims of violence. MSF psychological support teams also provide mental health services in some of the health facilities.