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23 Dec 13 23 Dec 13

Central African Republic: “What is happening today is serious and tragic”

On the morning of 5th December 2013, violent fighting broke out in Bangui, the capital of Central African Republic (CAR). In the hours that followed, teams from Médecins Sans Frontières/Doctors Without Borders (MSF) went to the city’s Hôpital Communautaire to provide emergency assistance and treat hundreds of wounded patients. Sixteen MSF medical staff divided themselves between the emergency, surgery and inpatient departments, including Dr Sabine Roquefort. Now back in Paris, she describes what happened.   

“I arrived in Bangui on 15th November. Things were already very tense and there was a lot of shooting in the city. 

I was coordinating MSF’s emergency medical response for the whole of CAR. We had already decided that it would be a good idea to position a surgical team in one of the city’s hospitals. In a week, we had set up at the Hôpital Communautaire, which is centrally-located and close to our living quarters – which is important in the event of security problems. 

Setting up at Hôpital Communautaire

We had already worked in the hospital in April and May, after the capital was taken by Seleka forces. So the hospital staff knew us, which made it easier to organise things. 

We had to start with logistics. Rain was getting into the operating theatres, the paint was flaking off and there were mushrooms growing from ceiling. We started by restoring one of the operating theatres. 

The deliveries of medicine and medical supplies from abroad arrived in a week. A surgical team – surgeon, nurse-anesthetist and surgical nurse – also arrived very quickly. By 30th November, we were ready for the wounded. 

On 2nd December, Bouali – a camp of Fulani nomads, located three hours from Bangui – was attacked. People said that an armed group known as the anti-Balakas [literally ‘anti-machetes’] had attacked them. 

The wounded made their way through the bush and stopped a car along the main road to get to the hospital. 

A woman told us that her six-month-old baby had been killed with a machete. She had lacerations to her scalp.  One of her other children was wounded. We operated on him and on several others. 

Patients spill out into the corridors of the Community Hospital in Bangui © Samuel Hanryon

Dead on arrival

Three days later, on 5th December, the fighting started at around 5 am in Bangui and intensified throughout the day. That day, we registered 120 people at the Hôpital Communautaire. Eight were dead on arrival. 

The wounded were treated primarily by our international staff, because security conditions prevented the Central African staff from getting to the hospital. Only the director managed to get there. He carried out surgery at the same time as we did, with support from one of our nurse-anaesthetists and using our supplies. 

Some of the wounded required immediate treatment. These included patients with thoracic and abdominal wounds, which take a lot of time because you have to do an exploratory laparotomy – you have to open the belly and check to see if there is a bullet inside, which can take three or four hours. 

Most of the cases were open fractures, with bullets lodged in joints or in bones. I treated an elderly woman who had been shot in each knee – that’s going to affect her for the rest of her life. 

That day, and over the following days, armed men were coming and going in the hospital. Things were very tense. There were threats and pressure.  

We couldn’t stay there after the 6 pm curfew because it was too dangerous. We were afraid that the patients would be killed at night. Fortunately, that didn’t happen and we managed to avoid the worst. 

Outside, we could hear shooting. The situation felt chaotic, which it was. You had to be very careful travelling through the city. It was dangerous. There were corpses in the streets. 

It felt as though the city had been emptied out – there was no one on the streets. People had fled or were hiding at home. 

Flood of wounded

On 8th December, we received a new flood of wounded patients after fighting near the airport, which is further from the hospital. Small groups were brought by ambulance, which meant we could manage the arrivals more easily. 

Many people only had light wounds, but there were large numbers of wounded. It was total confusion and required a major triage effort. We had to ask each patient to bring only one family member so that we could organise treatment as efficiently as possible and so that the doctors could work in relative calm. 

The constant influx and mix of people – the wounded, armed men, family and staff – was quite stressful

The Central African staff were able to return to work  gradually, over several days. However, it’s extremely dangerous for them. They received direct threats. 

We can’t ask them to take unnecessary risks. They had to be surrounded by international staff because our presence protects them, at least for now. 

The Hôpital Communautaire is the only health facility for adults that is currently open in Bangui. On 5th December, the main Bangui hospital, Hôpital de l’Amitié, was attacked. 

We went there a few days later and it had been completely ransacked. There were no staff and no supplies. It hasn’t operated since. 

Tessy Fauscht, medical coordinator, at Bangui airport where tens of thousands have sought refuge © Samuel Hanryon

Extreme vulnerability

We have started a project at the Castor maternity centre to provide minor surgery, obstetrical care and caesareans, and we have launched mobile clinics. But that’s not enough. The health system was already in trouble before the latest crisis, and the needs are so much greater given what’s going on now. 

People are extremely vulnerable. They need basic healthcare, and hospital-level care as well. Where is a seriously ill person supposed to go in Bangui today?  

With MSF, we are used to working in very violent environments, but this organised, wilful intent to mutilate, wound and kill shocked me. Let me tell you about one family I met. Twenty armed men stormed their house and looted everything. 

The son, aged around 30, sustained machete wounds to both arms. They fled toward the airport, a few kilometres from their home. They had to cross a river with water chest-high, and the son – with a double open fracture – had to keep his arms raised above his head. 

The level of violence and suffering is what struck me the most, compared to the other conflict settings where I have worked. 

Bangui is not the only city affected by extreme violence. We met journalists who had been in Bossangoa and they were very frightened. These were seasoned reporters, but they were distraught as they told us what they’d seen – men taken by force out into the bush. 

The entire country is involved and it’s been going on for months. There will be a lot of work to do gathering statements from witnesses. Without catastrophising the situation, and without resorting to shorthand like “genocide” or “Christians versus Muslims,” we have to be able to describe what is happening in CAR today. What is happening there is serious and tragic.”  

Find out more about MSF's work in the Central African Republic