Why are we there?
- Armed conflict
- Natural disaster
In the Central African Republic, mortality rates are consistently above the emergency threshold countrywide, indicating an urgent need for large-scale medical assistance.
Recorded death rates were particularly high in 2011, caused by a high prevalence of preventable, and treatable, diseases, a failed health system and years of conflict.
Despite this, funding for health is declining. In the report State of Silent Crisis, published in 2011, Médecins Sans Frontières/Doctors Without Borders (MSF) called for greater medical assistance in the Central African Republic.
MSF works in five of the country’s 17 prefectures, supporting nine hospitals and 36 health centres, mainly in the more unstable border areas, where it can be very difficult for people to access healthcare.
MSF set up emergency programmes in response to a nutrition crisis in the prefecture of Mambéré-Kadeï, in the west of the country, in 2009. In 2010, the team opened a new programme in the district of Carnot, providing paediatric healthcare and integrated tuberculosis (TB) and HIV treatment in the district hospital and four health posts.
In 2011, MSF registered almost 520 HIV new patients and conducted 5,500 consultations.
Although Carnot is neither affected by conflict nor host to large numbers of displaced people, mortality surveys carried out in 2011 revealed death rates to be at least three times above the emergency threshold. MSF activities will therefore be expanded in 2012.
In contrast, last October, MSF handed over to national and local authorities the emergency assistance programme that it had opened in in the town of Gadzi in 2009.
In Zémio, on the border with the Democratic Republic of the Congo (DRC), MSF continued to assist people fleeing attacks by the Lord’s Resistance Army and fighting in the DRC, carrying out close to 31,000 medical consultations.
Towards the end of the year, MSF started offering antiretroviral (ARV) treatment to people with HIV.
Specialist health services
In the town of Paoua, in Ouham-Pendé, an area recovering from conflict, an MSF team provides paediatric, surgical, maternal, emergency and outpatient services.
As well as conducting 18,900 outpatient consultations and admitting more than 2,700 patients to the hospital, staff carried out consultations at seven health centres in the surrounding area.
Teams provide similar services in places still beset by insecurity and violence. In the neighbouring prefecture of Ouham, at Batangafo, Boguila and Kabo hospitals, staff carried out some 16,700 consultations, admitted 940 inpatients and assisted more than 180 births every month.
At Boguila, MSF regularly organises ‘surgical camps’, in which a team visits for a limited period to perform specialist surgery that would not otherwise be available in the area. Staff also work in 14 health posts around the hospitals.
MSF confirmed that sleeping sickness (human African trypanosomiasis) has been brought under control in the Maitikoulou area. Sleeping sickness is a parasitic infection transmitted by the tsetse fly, and it is usually fatal without treatment.
After screening almost 37,500 people in 2011 and treating just 27 people for the disease, MSF showed that prevalence had fallen to below 0.5 per cent, compared with 5.9 per cent in 2008.
In addition to addressing sleeping sickness, the team carried out more than 56,000 medical consultations and 35,000 antenatal consultations in 2011. The team closed some health posts and handed management of Maitikoulou hospital over to the Ministry of Health.
In Ndele, the capital of Bamingui-Bangoran prefecture, an MSF team is providing medical assistance to both displaced people and local residents.
Staff held more than 5,100 consultations and admitted 90 patients to the hospital every month. Surgeons performed an average of 14 operations per month. Teams also ran mobile clinics and worked in five health centres.
Malaria, HIV and TB
Every one of the estimated five million people living in the Central African Republic is likely to be infected with malaria at least once per year.
The disease remains a major threat to public health and the principal cause of death and illness among children. In total, MSF treated more than 212,000 patients for the disease in 2011.
By July 2011, 998 HIV patients were receiving ARV treatment at MSF clinics, a large increase over the previous year. However, the Central African Republic has the highest prevalence of HIV in central Africa, with the greatest incidence in the capital Bangui and in areas affected by conflict.
The National Centre for the Struggle against AIDS has estimated that 45,000 people, including 14,000 children, currently need ARV treatment. At present, only one-third, or some 15,000 people, have started treatment.
The prevalence of TB has increased significantly among both HIV-positive and HIV-negative people, and is estimated to have at least doubled between 1990 and 2009.
MSF provides TB diagnosis and care at its hospitals in Batangafo, Kabo and Ndele.
At the end of 2011, MSF had 1,341 staff in Central African Republic. MSF has worked in the country since 1996.
Melissa is the mother of a seven-month-old girl who arrived at Batangafo hospital with malaria and anaemia, requiring a blood transfusion.
“I had to leave my other children with my family to come to the hospital. My baby had a fever for three days. When she started having convulsions I decided to search for help.
"After two days walking to the health centre in Boulam, they referred us to the hospital by motorbike taxi.”
After two days at the hospital, Melissa’s daughter’s condition had improved.