Central African Republic - No place like home?

CAR Crisis

Background

The Central African Republic (CAR) is slipping deeper into crisis. With almost half the population of 4.6 million people in need of emergency aid, and with no functioning government in CAR, people are living in fear in the bush without food, hygiene, shelter or healthcare.

Violence in the capital, Bangui, has been raging since the 5th of December 2013 and security is proving to be a challenge for our teams.

Between January and June 2014, we have:

  • Provided 435,507 outpatient consultations
  • Admitted 13,678 patients to hospital
  • Provided 171,990 consultations for malaria 
  • Treated more than 3,908 patients for violence-related wounds
  • Delivered 4,182 children

We currently have 20 projects running in CAR, half of which opened this year. We have 300 international staff working alongside 2,000 Central African colleagues.

Despite the security situation, the United Nations and other NGOs should not use the ongoing violence as an excuse not to act and help the millions of people in need of assistance. MSF is calling on all other groups to scale up their response.

Latest UN figures for CAR, as of 30th June 2014

  • 535,000 internally displaced people
  • 110,000 internally displaced people in Bangui
  • To date, almost 140,000 people from Central African Republic have sought refuge in Cameroon, the Democratic Republic of the Congo, Chad and the Republic of Congo since December 2013.

CAR Crisis: Latest news from MSF

Central African Republic crisis map June 2014

Our work

Background 2013

MSF had been working in CAR before the crisis broke in December, carrying out thousands of consultations and surgeries. Below are our statistics for the whole of 2013:

 

This is an extract from our latest Activity Report, looking back on our work in the previous year.

Escalating and extreme violence in the Central African Republic (CAR) over the year resulted in a massive, acute humanitarian crisis in addition to an existing chronic medical one.

For over 20 years, the small landlocked country of CAR has witnessed many political and military crises. Continual population displacement caused by pockets of armed conflict, combined with a poorly resourced, dysfunctional healthcare system, prevents people from obtaining the treatment they need.

Many die from easily preventable and treatable illnesses such as malaria, respiratory infections and diarrhoeal diseases. Prior to the current conflict, mortality rates in some regions were up to five times the emergency threshold.

In response to this chronic medical crisis, Médecins Sans Frontière/Doctors Without Borders (MSF) was providing basic healthcare through seven comprehensive projects – at Batangafo, Boguila, Carnot, Kabo, Ndélé, Paoua and Zémio – when the current emergency began to unfold.

Despite some interruptions due to insecurity, these projects have adapted and continue to provide medical care to people in the communities, and to respond to localised emergencies caused by population displacement. Teams offer basic and specialist healthcare, mental health consultations, maternity, paediatric and nutritional services, surgery and HIV and tuberculosis (TB) care.

 

Beginning in December, violence and chaos took hold in Bangui.

 

When 2013 began, the rebel group Séléka had recently seized several strategic towns, and in March they took the capital Bangui, leading to a presidential coup and the gradual destabilisation of the country over the course of the year. Increased tensions and violence, including assaults on civilians, spread into previously peaceful areas. In early September, armed self-defence groups, the ‘anti-balakas’, started to attack Séléka forces and civilian populations in the northwest.

Throughout this period, MSF provided free medical care to people wounded in attacks or displaced by violence. Mobile clinics were launched and teams supported government healthcare facilities, providing emergency aid to people wounded in attacks or in need of medical attention. Additional activities were started to ensure access to clean drinking water and improve hygiene for the displaced population.

Short-term emergency projects opened and closed in the first half of the year in Damara and Sibut, supporting outpatient services at local hospitals. The Damara team also offered treatment to people who had temporarily fled into the bush.

More than 12,800 consultations were carried out through these projects. Emergency projects also opened in 2013 in Bangui, Bouca, Bossangoa, Bria, Sibut, Damara and Gadzi, and emergency medical teams visited Yaloke and Bouar. Emergency surgery and basic healthcare were available for the wounded, and teams regularly treated patients for malaria, respiratory and skin infections, diarrhoeal diseases and malnutrition.

Beginning in December, violence and chaos took hold in Bangui. Despite the arrival of international forces in the capital, there were daily clashes, attacks, lynchings and reprisals. In the first two weeks of that month alone, the UN estimated that some 214,000 people were displaced by the conflict. Hundreds of thousands of people fled their homes and gathered in camps including M’Poko at Bangui airport (100,000 people), the monastery of Boy-Rabé (15,000) and the Don Bosco Centre (15,000).

Living conditions were, and still are, deplorable.

Water distribution point at M’Poko airport camp.

 

With hardly any other organisations providing emergency assistance, MSF undertook extensive work to ensure a clean water supply, basic standards of hygiene and human waste disposal: at the Don Bosco site, a team dug 20 emergency trench latrines and provided 30 cubic metres of water a day. They later built 150 latrines there, and a further 350 latrines in M’Poko airport camp.

In addition, MSF ran a water treatment plant that produced 600,000 litres of clean drinking water per day and also distributed relief supplies to the displaced population of Bangui. MSF medical staff provided trauma surgery and basic health consultations.

However, the basic needs of the displaced people in CAR remained unmet as there was insufficient mobilisation by other humanitarian organisations. At Castor health centre in Bangui, surgeons responded to 465 trauma cases in just three weeks. MSF also supported a Ministry of Health measles vaccination programme.

MSF repeatedly spoke out, asking that all parties involved in the conflict allow access to medical care for the sick and wounded and calling for an end to the violence against civilians, and patients and staff in healthcare facilities. MSF also denounced the lack of mobilisation of UN humanitarian agencies and called for the deployment of more means and resources – from the UN and other aid organisations – to provide an appropriate response to the extensive human needs.

Towards the end of the year, MSF had more than 250 international and 2,500 Central African staff providing free medical care to approximately 600,000 people in seven hospitals, two health centres and 40 health posts.

At the time of writing, MSF is the largest employer in CAR.

By year’s end it was estimated that over 700,000 Central Africans were displaced inside CAR and that a further 75,000 had crossed into neighbouring countries.

At the end of 2013, MSF had 1,631 staff in the Central African Republic. MSF first started working in the country in 1996.

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