Central African Republic: Violence and displacement- women's stories

05 Mar 21

Since the presidential and legislative elections of December 2020, a new wave of violence has swept over the Central African Republic (CAR). Over the weeks, armed clashes between the coalition of non-state armed groups and government forces backed by foreign troops erupted in many parts of the country, often taking a heavy toll on the civilian population and regularly affecting the security and work of humanitarian organizations and health facilities.

The crisis worsens the health situation

In a country already plagued by decades of civil war, this new outbreak of violence exacerbates an already alarming situation: today, more than half of the population needs humanitarian aid.

The MSF team from Bangassou is supplying the hospital in Rafai, on the Eastern axis of Bangassou,  with medications and mosquito nets.

The impact of the current crisis is particularly visible on the health front. Before the new crisis broke out, the sanitary system was already very weak, with a limited access to many services and facilities.

Access to health was already a daily challenge. Obviously, the latest cycle of violence made things even worse.

Movements of patients and medical staff are reduced, the supply of essential medicines is limited, and the spike in food prices reduces the ability of families to access healthcare as paid healthcare is the norm –including for pregnant women and children under five who, on paper, should officially benefit from free care. A key issue in a country where 71% of the population lives below the extreme poverty line.

The MSF outreach team from Bangassou on mission to Rafai, on January 25, 2021.

This worsening health crisis disproportionately affects displaced people and refugees, whose numbers have skyrocketed since December.

Currently, 1.3 million Central Africans - more than one in three people - are internally displaced or refugees abroad, often in very precarious living conditions. A displacement situation comparable to that experienced by the country during the 2013 civil war.

On January 3, 2021, about 13,000 people fled Bangassou, in the south-east of the country, and crossed the Mbomou river to find shelter in the small village of Ndu, in the Democratic Republic of the Congo, where MSF is supporting the local health centre.

A displaced family who fled violence and live in the grounds of the MSF-supported Bangassou university hospital, January 28, 2021.

On the same day, on the Central African side, nearly 800 people - most of them women and children - took refuge in the compound of Bangassou University Hospital, also supported by MSF.

Day after day, the number of people seeking shelter at the hospital kept on growing. At one point, the hospital compound housed up to 2,000 displaced people, to whom our teams have ensured access to care and water.

Female refugees at risk

In the context of CAR, women’s health status is particularly at risk. Even outside of periods of acute violence, their socio-economic status, their exposure to violence and the very limited access to family planning - a source of close pregnancies, high risk delivery and major health issues - make them particularly vulnerable.

Hundreds of Bangassou residents rushed to the city’s University Hospital when armed groups attacked the town on January 3.

Unsurprisingly, the country has one of the highest maternal mortality rates in the world, and times of crisis and displacement only exacerbates this reality.

In Bangassou and Ndu, access to free maternal care is one of MSF's priorities. Every day, our teams provide pre and post-natal support for women, supervise childbirth in good sanitary conditions, manage obstetric complications, provide access to family planning and provide care to victims of sexual violence.

The outreach team crossing villages on its way to Rafai, eastern axis from Bangassou, on January 25, 2021.

Just weeks after the January 3 offensive on Bangassou, photo-journalist Alexis Huguet went there and met women who had fled violence. For many, the January flee from Bangassou was not the first one. Many had already fled, alone or with their children.

The presence of MSF on either side of the Mbomou River has proven to be crucial, if not vital.

Christelle, refugee in Ndu: “I don’t want to run away again” 

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Christelle, a resident of Bangassou, was preparing to celebrate the birth of her second child when the coalition of armed groups attacked and took control of the city.

“When the shooting started, we immediately fled the city,” she explains. "We jumped in a canoe to reach the Congolese side.”

Like Christelle and her family, nearly 13,000 people crossed the Mbomou river to take refuge in Ndu, where many other refugees had already settled in previous years.

Christelle is holding her baby girl Alvina in Ndu, in the school where she lives since the January 3rd attack on Bangassou.

Today, Christelle lives in a former school with a hundred other refugees. “My pregnancy was very advanced when we fled the city. But I was followed at the health center, and luckily everything went well during the delivery”, she recalls, while holding her daughter Alvina in her arms.

Christelle was a resident of Bangassou. She was preparing to celebrate the birth of her second child when the coalition of armed groups attacked and took control of the city.

Christelle and her daughter share a room with about 20 other people. With the recent influx of refugees into the village, living conditions are far from ideal. MSF, present in Ndu since 2017, has stepped up care services at the health center and urgently installed water supply systems.

Fortunately, after several days, other humanitarian organizations arrived to help the refugees as well. Despite the living conditions in Ndu, Christelle does not plan to cross the river again and return to Bangassou.

If I have to go back, I want to be sure that we are safe with Alvina. I don't want us to have to run away again.

Christelle, refugee in ndu

Like many other refugees, she is too scared when she thinks about the volatile security environment in her country. 

Beatrice, sheltered at the Bangassou hospital: “This is the second time that I take refuge here”

Like hundreds of Bangassou residents, Beatrice and her family rushed to the city’s University Hospital when armed groups attacked the town on January 3.

Beatrice and her family rushed to the city’s University Hospital when armed groups attacked the town on January 3.

“It was total panic. Thousands of people were trying to cross the river in canoes to go to Congo. Many were in danger of drowning. Instead of crossing, we preferred to come to the MSF hospital here” she recalls.

This is not the first time that Beatrice and her family have taken refuge in the hospital grounds.

Béatrice, 43 years old, is sitting in an empty building of the Bangassou hospital with one of her grandchildren.

“We already came here when violence broke out in 2017. You feel safe in the hospital, and you know you can be treated if something happens. One of my children got sick when we arrived, but he was quickly treated."

Like nearly a thousand other people, mostly women and children, the mother of six now lives within the hospital grounds. Her husband left to protect their home, but Beatrice prefers to stay here with her family.

Politics should not be made with guns in the country. Because it is always the innocent who suffer.

beatrice, refugee in bangassou

“We heard rumors about a new attack. No one here feels safe enough to leave. I am especially worried about my children. Because of the insecurity, prices have gone up and finding something to feed them has become a real problem. They don't go to school anymore ... "

Since the offensive on Bangassou, MSF teams are providing care, access to water and accommodation for these displaced people, while maintaining regular medical activities in the hospital.

"Politics should not be made with guns in the country," sighs Beatrice. "Because it is always the innocent who suffer."

Odette, midwife in Ndu: “Amatou is in good hands now”

Odette works as a midwife in the small health center in Ndu, DRC. Facing the town of Bangassou, on the other side of the Mbomou river, the village has been hosting CAR refugees for years following spikes of violence.

Odette, a midwife working in the small health center in Ndu, DRC.

When the armed offensive started on Bangassou on January 3, more than 13,000 people fled the city and crossed the river to seek refuge in this village.

The number of consultations at the health center exploded and MSF had to quickly increase its support to take care of women and children suffering from malaria, respiratory infections and diarrhea, not to mention the many pregnant women.

Amatou (lying down in the pirogue), 25,  is a refugee and is about to give birth but the midwives in the MSF-supported Ndu health centre identified some complications that cannot be managed from the health centre.

Today, Odette is alongside Amatou, 25. The young woman is about to give birth but is bleeding. “She can’t deliver here, let’s bring her to Bangassou,” she says.

Amatou is therefore referenced to the MSF-supported hospital in Bangassou, on the other side of the river, where she can be operated, if needed. Amatou is brought here by Odette, a midwife working in the small health center in Ndu, DRC.

Amatou is then transported by stretcher to the river where a pirogue awaits her. She will make the crossing with Odette before being taken by the MSF ambulance to the university hospital, where our teams manage most serious cases.

Amatou, 25, has been referenced from Ndu to the MSF-supported Bangassou university hospital because of some complications linked to her pregnancy. She is now being examined by the nurses of the maternity ward, on January 27, 2021.

For Amatou, the presence of MSF on either side of the river has made the difference today. The Bangassou hospital is the one of the very few able to deal with obstetric complications in the district.

"Amatou is in good hands now", rejoices Odette after accompanying the mother-to-be to the delivery room, and heading back to the river to go back to the Ndu health center.

Odette feels relieved as she managed to accompany Amatou and her family to the Bangassou hospital safely for the delivery.

Philomène, sheltered at the Bangassou hospital: “My grandchildren deserve a better life” 

When the coalition of armed groups attacked and took control of Bangassou on January 3, more than 800 people - mostly women and children - took refuge in the grounds of the university hospital that MSF supports since 2014. Philomène, 50, was among them.]

“When we heard the shots, we were terrified. With the family, we went straight to the hospital because we knew we would be safe there."

View of Philomène’s temporary housing located in the Bangassou hospital compound. She shares this empty building with her relatives and other families who fled violence.

Philomène has been living here for several weeks with her children and grandchildren. For her, the current crisis comes on top of many other tragedies in her life.

“I am a widow, and I have already lost six of my eight children to disease and violence, "she explains. “Most of my grandchildren here are orphans. And today we have to live here ... "

Philomène’s daughters and grandchild.

Since the arrival of hundreds of displaced people at the hospital - their number will even rise to 2,000 - MSF teams have redoubled their efforts to ensure access to water and healthcare.

Living conditions remain precarious. But Philomène is not yet ready to leave the hospital.

“We need security. Only peace will allow us to resume our activities and restart a normal life. My grandchildren deserve a better life.”

Philomène and her grandchildren.

Ester, refugee in Ndu: “It’s the second time I flee in Ndu”

Ester was about to give birth to her twin girls in Bangassou when the January 3 attack took place.

Like nearly 13,000 other residents of the city, she decided to flee by crossing the river with her eldest daughter Princia to settle in Ndu, in the Democratic Republic of the Congo.

Ester (in pink) and her older daughter Princia (in yellow) are holding the twins Laure and Rhode, before their consultations, on January 27, 2021. The twins were born a few days after the clashes of January 3, 2021 in Bangassou.

"This is the second time that I have taken refuge here. The first time was in 2017,” she explains while waiting for the post-natal consultation for her twins at the Ndu health center.

“I thought I was going to give birth here, but I had complications and the team transported me to Bangassou because I needed a c-section.”

Ester's older daughter Princia is holding one of the newborn twins before the post-natal consultation, on January 27, 2021.

Since 2017, MSF has been supporting maternal and child health care at the Ndu health center. Patients suffering from complications or in need of more advanced care are transported and cared for by MSF at Bangassou University Hospital.

"Fortunately, the delivery went well and Ester was able to come back here in Ndu with her daughters," said Laure, a midwife at the local health center.

Laure, midwife at the health centre in Ndu, Democratic Republic of the Congo, is examining one of Ester’s newly born twins, on January 27, 2021.

Today, Ester and her daughter Princia hope that the situation will calm down in Bangassou, in order to return home safely with the twins Rhode and Laure, named after the midwife who accompanied Ester during her pregnancy.

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