Since its independence from France in 1960, Central African Republic (CAR) has been subjected to numerous coups and a lack of stability. Despite its considerable mineral deposits and natural resources, it remains one of the top 10 poorest countries in the world.

MSF in CAR 2015

1,016,100 outpatient consultations
585,100 patients treated for malaria
9,500 surgical interventions
2,629 MSF staff
£45m expenditure

Years of unrest have displaced tens of thousands of Central Africans, with many crossing the border into Chad and is often effected by violence wrought in neighbouring countries like South Sudan.

On 4th December 2014, almost one year to the day after anti-Balaka rebels launched an attack on Bangui, the French Minister of Defence stated that the “job was done” and that the country was returning to “normal.” He then announced the partial withdrawal from CAR of Sangaris, the French peacekeeping force.

Daily terror and fear remain a reality for people in CAR. Insecurity has also impacted MSF personnel and other aid workers. Over the past few months, they have been subjected to an increase in acts of violence of varying degrees.

MSF has been working in CAR since 1997. Since December 2013, we have doubled our medical assistance in CAR and are running additional projects for Central African refugees in neighbouring countries.

Patient story

Corine, from Bangui

“Even when the children sleep under a mosquito net it is not possible to avoid malaria.

"During these months, I almost always have at least one child who has malaria, and it is painful to see my children suffer like this.” Read the full story

Staff story

Benjamin Black, MSF UK obstetrician
Benjamin Black, obstetrician/gynaecologist

"The patient had been sent to us from a health centre across the border (a river) in Congo. I started trying to piece the story together.

"This was her first pregnancy and she had apparently been in labour for four days already; the membranes had also ruptured four days earlier and now all that was draining was thick green meconium-stained fluid (where the baby has passed a motion in the womb).

"She had come to us by boat, car and foot at full term and in a ridiculously prolonged labour. No wonder she looked terrible.

"I went on to auto-pilot, and as I continued gathering information I started placing an intravenous cannula. I was already planning our trip to the operating theatre. I started a fast-running drip and asked the midwife to get some intravenous antibiotics started.

"I methodically started feeling her abdomen, the baby was head down but still quite high ...

"During my time in CAR over 17 percent of women needing surgery during labour were for ruptured uterus – one of the most serious and life-threatening obstetric complications – all had had a previous caesarean section. Whilst we are fortunate enough to be set up to perform emergency caesarean sections, I cannot guarantee that the same would be true for this women in her future pregnancies, particularly given the wider social, economic and political context."

Read more from Benjamin on his blog

 

MSF’s work in CAR: 2015

There were hopes for peace in CAR following reconciliation talks in May, but sporadic violence persisted throughout the country and escalated in September in Bangui. This increased the need for urgent humanitarian assistance.

The political crisis that sparked the violent conflict in 2013 has still not been resolved and has exacerbated a pre-existing humanitarian and health emergency. An estimated 447,000 people are internally displaced, with tens of thousands living in overcrowded, improvised shelters such as schools and churches without adequate food, water, sanitation or healthcare.

Over 70 percent of health facilities have been damaged or destroyed and there is a shortage of trained healthcare workers.

MSF and other NGOs provide the majority of the health services, but their work is repeatedly obstructed by armed groups and organised crime. In 2015, mobile clinics, support activities and vaccination campaigns had to cease operating several times in the areas of Kabo, Bambari and Boguila, and MSF and other NGO facilities were robbed, attacked and looted.

Responding to children’s needs

Malaria remains the biggest killer in the country and the leading cause of death in children under five. Three rounds of preventive malaria treatment were administered in Ndele, Kabo and Batangafo between July and November, reaching around 14,000 children.

Only 13 percent of infants under one are receiving a full immunisation package. In July, MSF launched a year-long campaign across 13 prefectures, targeting 220,000 children under five for comprehensive vaccination against diphtheria, tetanus, whooping cough, polio, Haemophilus influenzae type B, hepatitis B, pneumococcus, yellow fever and measles.

Healthcare in Bangui

In the capital Bangui, violence is rife, and MSF focuses on emergency services in the city’s general hospital. In 2015, the team carried out 4,100 surgical interventions and provided medical and psychological care to 675 victims of sexual violence.

During the year, MSF carried out up to 400 consultations a day at M’poko hospital in the airport displacement camp, and 15,400 emergency cases were treated and/or referred to facilities in Bangui.

At Castor health centre, MSF continued to treat victims of violence and provide free maternal and emergency healthcare around the clock. The team assisted over 7,400 births, admitted 10,500 people to hospital and offered comprehensive care to 275 victims of sexual violence.

Aisha and her husband Abakar walked for 42 kilometres to reach the hospital in Batangafo, north of CAR. The journey took them 12 days.

Comprehensive care projects

MSF continued to provide comprehensive inpatient and outpatient care to residents and displaced people at its longstanding projects in Kabo (Ouham), Boguila (Ouham-Pendé) Paoua (Ouham-Pendé), Carnot (Mambéré-Kadéȉ) and Ndélé (Bamingui-Bangoran).

This included basic health consultations, emergency, maternity and children’s services, and diagnosis and treatment for HIV and TB. Numerous health centres and/or satellite health posts were also supported through these projects. The maternity and surgery departments of Paoua hospital were handed over to the Ministry of Health in April.

Emergency response team

MSF’s Equipe d’Urgence RCA (Eureca) responds to acute localised emergencies in the country. Between April and September, Eureca completed emergency health and nutrition interventions in Kouango and Vakaga, where they trained 80 Ministry of Health staff and donated drugs to five health posts.

The Eureca team also vaccinated 9,700 children against measles and pneumococcus in Gadzi in December and provided healthcare to people displaced in the immediate aftermath of the violence in Bangui in September.

Find out more in our 2015 International Activity Report.

At the end of 2015, MSF had 2,593 staff in the Central African Republic. MSF first began working in the country in 1997.

 

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