MSF support to the populations of Bangassou and Ndu

Central African Republic: Repeated attacks on medical facilities leave thousands without care

People must be allowed to access vital health services

An MSF staff member tends to a patient in need of surgery, January 2021.
© Alexis Huguet
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BANGUI/NEW YORK, JULY 19, 2021—A surge in violence across the Central African Republic (CAR), including repeated attacks on patients, health staff, and medical facilities, has forced Doctors Without Borders/Médecins Sans Frontières (MSF) to suspend several medical activities, further reducing access to medical care for thousands of vulnerable people, the international medical humanitarian organization said today. MSF calls on the government of CAR and all parties to the conflict to respect the neutrality of health facilities and to allow people unhindered access to medical care and humanitarian assistance.

“The resurgence of conflict in CAR since December has taken a heavy toll on the civilian population and on medical care,” said Rhian Gastineau, MSF head of mission in CAR. “We are very alarmed by the repeated attacks on patients, health workers, and medical facilities.”

Over the past six months, MSF teams have witnessed dozens of health facilities ransacked, damaged, and occupied by armed men. Patients have also been attacked, abused, interrogated, and arrested during armed incursions of hospitals. Community health workers in rural areas have been threatened and assaulted, and motorbike drivers delivering lifesaving drugs and transporting sick and wounded patients to the hospital have been attacked, injured, and robbed at gunpoint.

Health facilities ransacked

In February of this year, an MSF-supported health center in Elevage camp for displaced people near Bambari was hit by a rocket amidst fighting between government forces and non-state armed groups. In June, the camp was set on fire and destroyed. The 8,500 people living there were forced to flee again—many sought shelter in the compound of a mosque in Bambari town. An MSF health post was also destroyed in the fire. 

This year, MSF mobile teams in the prefectures of Ouaka, Ouham-Pendé, and Ombella-Mpoko have witnessed multiple health facilities ransacked and partially destroyed—solar panels, medical supplies, and mattresses were stolen, and doors and windows were smashed.

In Bangui and elsewhere, armed men have entered health facilities managed or supported by MSF to interrogate or arrest patients. In February, armed men attempted to kill a patient in the MSF-supported hospital in Bouar.

Health care workers attacked

In May, near the town of Kabo, two community health workers—trained by MSF to treat people in remote areas for common diseases such as diarrhea, malaria, and malnutrition—were shot in the legs and head during armed robberies, while two others were too fearful to continue working after receiving death threats.

In June, a convoy transporting patients to MSF’s hospital in Batangafo was caught in an ambush by armed men—a patient’s caretaker was killed, and the motorbike driver and two patients were injured. Two other attacks occurred in the area later that month, while similar attacks occurred near Bossangoa and Bria.

“Since December, moving around on the outskirts of major towns has been extremely difficult and dangerous due to checkpoints, robberies, and attacks,” said Gisa Kohler, MSF deputy program manager.  

Forced to suspend activities

As a result of these incidents, on several occasions MSF has been forced to temporarily suspend its medical activities, including providing lifesaving care, supervising health center staff, supplying drugs, and transporting patients. “Being forced to suspend our activities only exacerbates people’s vulnerability and results in avoidable deaths, [including] young children and women with complications in pregnancy and childbirth,” says Kohler.

In Paoua, Bria, and elsewhere, the growing insecurity has prevented MSF teams from making regular visits to the outlying health centers they support. This has a profound impact on the quality of care provided and disrupts the supply of essential medicines.

Since April, MSF has had to reduce referrals of patients by motorbike from rural areas to Kabo due to the risks involved—halving the number of referrals each month. In June, MSF community health workers in some areas around Kabo were only able to carry out a quarter of their usual number of weekly consultations due to the insecurity.

“The suspension and reduction of medical outreach activities across numerous areas where we work is very concerning, particularly with the ongoing rainy season, when cases of malaria and other life-threatening diseases peak,” said Kohler.  

Fear and panic disrupt health care

Many people are too scared to leave their homes to visit a doctor, and many health staff have fled to seek safety.

With nowhere else to go, thousands of people arrive at hospital compounds in search of safety, disrupting health services. Sometimes—as witnessed in Kabo in July—the rumor of an attack is enough to cause people to flee.

“Unfortunately, it is not new for violence to impact medical care in CAR,” said Gastineau. “The [number] of armed groups and the active fighting have caused a very volatile situation, which also affects areas that were previously considered relatively stable. [This] further [restricts] access to health care for a population already struggling to [access] the basics. Now, more than ever, all parties to the conflict should reinforce respect for international humanitarian law, including the protection of civilians and medical facilities, transport, and staff.”

MSF has worked in Central African Republic since 1997 and currently runs 13 projects in Bangui, Bria, Bangassou, Bambari, Kabo, Batangafo, Paoua, Bossangoa, and Carnot, and one mobile emergency team. Since the conflict intensified in late-2020, MSF has worked to ensure continuity of care in all its projects and has launched emergency projects in the conflict-affected areas of Boguila, Bossembélé, Bouar, Grimari, Mbaiki, Damara, Boali, Dékoa, Liton, Kouango, and Ippy.