Since December 2014, an estimated 20,000 refugees from Central African Republic (CAR) have fled over the Ubangi river into the Bili and Bosobolo health zones of Equateur Province in northern Democratic Republic of Congo (DRC). These new arrivals join some 10,000 refugees already present in the area. In response, Doctors Without Borders/Médecins Sans Frontières (MSF) is providing emergency medical aid to both refugees and host communities in three health centers and the area’s general reference hospital.
Most refugees arrived with few, if any, possessions and are heavily dependent on the local community’s already-strained resources. Available supplies of food and drinking water must be divided among the rapidly increasing population and the threat of malnutrition and water-borne illness looms.
"Food is scarce and the markets are empty," says Nathalie Gielen, MSF Emergency Pool field coordinator. "We’re seeing rates of severe malnutrition above the emergency threshold, which is of serious concern. In the first week of MSF activities in this area, we have already hospitalized 10 children for severe malnutrition."
Refugees report suffering violent attacks, kidnappings, rape, robbery, and threats from armed groups on the Central African side of the border. Yet some have become so desperate that they are choosing to return to CAR in search of food.
"Life is hard here," says Anne Kabo, a 73-year-old Central African refugee who has been living in DRC with her family since May 2014. "We don’t have our fields or any money to buy things. Back home in CAR I had what I needed to work in the fields. But here, I have nothing. Sometimes I work for the locals in exchange for sorghum leaves to feed the family. We eat whatever we can every day or two. It’s mostly sorghum leaves, with no oil."
Lack of sanitation and potable water are also major problems in the area. There is no source of safe water, and sanitation—especially in the makeshift sites where refugees live—is very poor. Many people take their drinking water directly from the nearby river, which could lead to the spread of water-borne diseases.
"In such conditions, the spread of disease is more or less inevitable," says Gielen. “Last week there was a suspected case of typhoid fever in one of the makeshift sites where the refugees live—a 12-year-old boy. The family buried the body right next to their hut."
Plans currently exist to relocate the refugees to a camp near Bili, 60 kilometers (about 37 miles) south of the river, starting in late February. But moving thousands of refugees could take weeks. Meanwhile, both refugees and the host population are in dire need of humanitarian assistance.
"Though many people have just arrived in this area, there are others who have been living in these conditions for months," says Gielen. "Refugees and the host community are struggling to find adequate food and water, supplies of which were scarce to begin with." More humanitarian assistance—especially in terms of food and water and sanitation—is needed until a more durable solution is in place.”
MSF is providing emergency medical aid in Sidi, Gbangi, and Dula health centers. MSF teams are also supporting the district hospital in Bili, providing hospitalization, mental health services, and maternity services. Since commencing activities on February 6, the team has carried out 754 consultations and hospitalized 72 patients.