© Pierre Terdjman/Cosmos

Central African Republic

The political crisis that sparked the violent conflict in 2013 has still not been resolved, leading to a disastrous health emergency

Ongoing political unrest and violence have resulted in a protracted humanitarian crisis in the Central African Republic (CAR). Despite relatively peaceful democratic elections in early 2016, the situation remains extremely concerning.

Despite its considerable mineral deposits and natural resources, it remains one of the top 10 poorest countries in the world.

Map of MSF's activities in Central African Republic, 2015Years 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.

Amid shifting frontlines, thousands of people were killed, wounded or displaced as armed groups fought to take control of territory. Two Médecins Sans Frontières (MSF) workers paid the ultimate price and lost their lives while doing their jobs. Humanitarian needs are immense: in late 2016, 2.3 million people, or around half of the population, were depending on humanitarian aid to survive. According to the United Nations Office for the Coordination of Humanitarian Affairs (UNOCHA), one in five CAR citizens are still displaced inside or outside national borders. Limited access to vaccination and sanitation means that easily preventable diseases continue to take a toll. Malaria is endemic and the leading cause of death among children under five years of age. Mental health needs are also great, with people traumatised by violence and permanent insecurity. The health system is barely functioning, due to a severe shortage of skilled health workers and medical supplies.

This basic lack of access to healthcare has serious repercussions for, among others, people living with HIV (3.7 per cent of the adult population): CAR has one of the lowest antiretroviral coverage rates in the world.

In 2016, humanitarian agencies withdrew from CAR, due to a lack of funding, but MSF is maintaining its presence and teams are running 17 projects across the country.


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MSF’s work in CAR

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.

© Jeroen Oerlemans

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

Sporadic fighting and violence in the city resulted in dozens of casualties. MSF continues to focus on emergency services in the general hospital and carried out 3,700 surgical interventions this year.

The team also conducted 32,300 consultations in the predominantly Muslim PK5 neighbourhood, treating children under the age of 15 at Mamadou Mbaiki health centre. In M’poko camp for internally displaced people near the international airport, more than 106,000 consultations were carried out in the MSF field hospital. 

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MSF scaled up its services for women and babies in Bangui. A team managed the 80-bed Castor maternity hospital, the largest in the country, and assisted around 600 births per month. Other teams supported the Gbaya Dombia maternity in PK5 and rehabilitated a small maternity hospital in the Dameka/Boeing area to cater for the internally displaced people returning to their neighbourhoods.

In 2016, MSF assisted over 8,965 births in Bangui, and offered comprehensive care to 5,239 victims of violence and 1,341 victims of sexual violence. From April to December 2016, MSF provided inpatient care to 941 people with advanced. Many patients at the paediatric hospital in Bria suffer from malaria or malnutrition. © Christophe Da Silva/Hans Lucas AIDS in Bangui’s Hôpital Communautaire.

However, as the level of quality of care in the hospital did not comply with MSF standards, the project was temporarily closed in December. MSF is exploring other options to resume these activities in 2017.

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.

In the provinces

MSF continued to provide comprehensive inpatient and outpatient care to the local community and displaced people in Batangafo and Kabo (Ouham), Boguila, Bossangoa and Paoua (Ouham-Pendé), Carnot (Mambéré-Kadéï) and Ndele (Bamingui-Bangoran). This included basic and specialist healthcare, emergency, maternity and children’s services, community malaria programmes, and diagnosis and treatment for HIV and tuberculosis (TB). Numerous health centres and health posts were also supported through these projects.

In Berbérati (Mambéré-Kadéï), the security situation has stabilised. MSF continued to support the regional hospital as well as four health centres, focusing on care for pregnant women and children under the age of 15. More than 4,200 children were admitted to the hospital in 2016, and over 21,900 paediatric outpatient consultations were carried out in the health centres.

In Bambari, MSF provided primary and secondary healthcare to the host population and around 50,000 displaced people living in the camps. Almost 35,000 consultations were carried out. From October, MSF also supported the paediatric units and operating theatres in the regional university hospital.

In Bria (Haute-Kotto), MSF provided healthcare, including HIV and TB treatment, to children under the age of 15. When intercommunal violence erupted in November, MSF treated around 140 wounded people in the hospital.

In Zémio (Haut-Mbomou), teams offered basic and specialist healthcare in the hospital, with a focus on HIV care. These services were handed over to the Ministry of Health towards the end of the year. Maternity services should also be handed over by mid-2017.

In Bangassou (Mbomou), MSF supports the 118-bed reference hospital, which is currently being expanded, as well as three health centres.

Emergency response team

MSF’s emergency response team Equipe d’Urgence RCA (Eureca) responded to several health and nutrition emergencies across the country, and vaccinated more than 12,800 children against measles. The team also provided assistance to 4,000 South Sudanese refugees in Bambouti.

Vaccinations for children

Almost 95,000 children in Berbérati, Bangassou and Paoua received routine immunisations in 2016 during multi-antigen campaigns. These catch-up campaigns will continue in other areas in 2017.

find out more in our international activity report

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