The health situation in Central African Republic (CAR) is catastrophic, and conflict and displacement prevent people from obtaining the medical services they desperately need.
At the beginning of 2014, most of the Muslim population in the western half of CAR left the country in the space of a few months to escape attacks. Several thousand people remained living in enclaves, fearful for their lives. Intercommunal violence and attacks by armed groups were not limited to the Muslim population though, and all communities in CAR were affected.
By December 2014, some 430,000 people were internally displaced in the country and hundreds of thousands of others had crossed the border into Chad and Cameroon. Although a transitional government was formed in January (elections are anticipated in 2015), many areas remain unsafe and people do not want to return home. Banditry and security incidents are common, and Médecins Sans Frontières (MSF) has been directly affected by armed attacks, harassment and robberies. On 26 April, 19 unarmed civilians, including three MSF national staff members, were killed by armed men at the MSF hospital in Boguila.
There is a severe shortage of skilled staff, and of vaccines in the country. Access to care is limited and expensive, and drug supplies are frequently interrupted. MSF remains the main healthcare provider in CAR, with many long standing programmes offering comprehensive services, as well as emergency projects that are set up as needed. Malaria is rampant, and appalling living conditions are causing health issues such as intestinal infections and diarrhoeal or skin diseases.
Providing healthcare in Bangui
In Bangui, the capital city, MSF provides emergency surgery at the general hospital for victims of violence and trauma such as road accidents. From December 2013 to March 2014, MSF supported maternal health activities and surgery in the Castor health centre until the situation improved and people could access other health centres in the city. In June, some activities resumed and MSF started to carry out obstetric and other emergency surgery. A programme offering medical and psychological care for victims of sexual violence was opened in July.
Basic healthcare for children under 15 is available at Mamadou M’Baiki health centre in the city’s PK5 district, and MSF ambulances transport emergency patients of all ages to hospital. Mobile clinics also began visiting displaced people several times a week at the Grand Mosque, Fatima’s Church and St Joseph’s Parish Centre this year. More than 39,900 consultations were carried out in PK5, nearly a third of them malaria-related.
There were approximately 100,000 displaced people living in and around M’poko airport in makeshift camps at the peak of the violence in 2014, but by the end of the year this number had dropped to 20,000. Two-thirds of patients travelled from Bangui to access the healthcare offered by MSF at the camps, as services were lacking in the city. People were treated for malaria, births were assisted and over 80 victims of sexual violence were helped.
When MSF started working in the general hospital in February, the emergency surgery activities at community hospital in the capital were handed over to the International Committee of the Red Cross. The project assisting displaced people at the Don Bosco centre closed in March once their number had significantly decreased.
Caring for the displaced
In January, MSF began activities at Berbérati regional university hospital, responding to the needs of displaced people, victims of violence, pregnant women and children. Weekly mobile clinics visited some 350 people living in the Berbérati area. In July, teams started outreach activities to support seven health centres providing healthcare in surrounding villages. Malnutrition, malaria, diarrhoea, respiratory tract infections and measles were the main health concerns. More than 41,900 outpatient consultations and 3,000 surgical interventions were performed. MSF also launched an intervention from Berbérati to Nola, Sangha-Mbaéré prefecture, and 23,000 children were vaccinated there against measles.
From January to April, MSF responded to the health consequences of a spike in violence against enclaves of displaced people and the local population in Bouar, Nana-Mambéré, with mobile clinics and by supporting the emergency room and surgical activities at Bouar hospital.
Following the attack in Boguila, Ouham prefecture, in April, MSF’s comprehensive healthcare services were reduced to a health centre with an outpatient unit, four health posts, maintenance of malaria testing and treatment sites (‘palu points’) and HIV treatment. The palu points were handed over to the NGO MENTOR Initiative in November. Another long-running project provided basic and specialist healthcare in Kabo. A series of security incidents resulted in a partial evacuation of the MSF team in February but the situation stabilised in the second half of the year. Staff treated more than 46,000 patients, most of whom had malaria.
MSF also supported the 165-bed Batangafo hospital and five local health centres. The village became part of the frontline in 2014 and there were security incidents during the year. More than 96,000 outpatient consultations were carried out and almost 5,000 patients were admitted. The emergency programme that had started in Bossangoa in 2013 for displaced people continued, although activities in the camps ceased in April when people were able to return home.
Following outbreaks of violence and population displacement in Ouaka prefecture, MSF opened projects in Bambari and Grimari in April. Mobile clinics travelled to villages and found many people still living in fear in the bush. MSF supported palu points and health centres and vaccinated 4,000 children in the prefecture against polio and measles in August. The Grimari project closed in October, and the focus was concentrated on Bambari.
In Kémo, MSF started supporting Dekoua parish clinic in May, following clashes that displaced civilians. Activities focused on outpatient consultations, assisting births and treating malnutrition. MSF also conducted mobile clinics. More than 5,500 consultations were undertaken, mostly for young children. The project closed in August when people left the area.
Teams offered a comprehensive package of healthcare in Carnot, Mambéré-Kadéï, in a longstanding project, carrying out over 49,000 consultations during the year. Approximately 500 Muslims from Carnot have taken refuge in a church in the city; more than 4,470 consultations were provided to them through a regular mobile clinic.
Access to general healthcare
MSF opened a hospital-based project in Bozoum, Ouham-Pendé, in January but closed it in March, as people felt safer visiting the nearer health centres. In Bocaranga, MSF ran a project between May and September to treat children under five during the annual malaria peak, and mobile clinics visited the northwest of the country. The comprehensive healthcare project in Paoua has been operating for many years and the team carried out some 71,400 consultations there in 2014.
In late February, MSF started working at the 80-bed referral hospital in Bangassou, the capital of Mbomou prefecture, where services had been severely disrupted. Basic and specialist healthcare, including internal medicine, maternity, paediatric and surgical services, were available. From May, MSF supported the 30-bed hospital in Ouango and rehabilitated its maternity, paediatric, internal medicine and surgery wards, as well as the operating theatre and the laboratory. The Ouango hospital was supported by MSF temporarily between May and October.
MSF also provided comprehensive healthcare to children under 15 in the refurbished hospital in Bria, Haute-Kotto, where there are high rates of malaria and malnutrition. More than 48,000 consultations were undertaken, and an average of 80 children were admitted to hospital each week.
A programme of basic and specialist healthcare at Ndele hospital, Bamingui-Bangoran, and four nearby health centres continued. Staff saw a significant increase in patients with violence-related injuries.
MSF remained the main healthcare provider for those living in the east of the country in Haut Mbomou. Health facilities are scarce in this prefecture and people travel up to 200 kilometres to reach the main health centre in Zémio and four outlying health posts.