CAR Crisis

Background

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 Central African Republic (CAR) of Sangaris, the French peacekeeping force.

Despite official discourse, MSF’s view is very different. From a security and humanitarian perspective we consider the situation extremely serious.

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, in response to the crisis, we have doubled our medical assistance in CAR and are running additional projects for Central African refugees in neighbouring countries.

Between January and October 2014, our teams have:

  • Performed 13,286 surgical procedures
  • Assisted 15,131 deliveries
  • Provided 618,188 consultations for malaria
  • Treated and supported 485 victims of sexual violence

Read the full MSF CAR crisis update, December 2014

CAR Crisis: Latest news from MSF

 

A map of MSF projects in Central African Republic, as of December 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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