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.
Amid shifting frontlines, thousands of people were killed, wounded or displaced as armed groups fought to take control of territory. Two 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 about 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.
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.
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, 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 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.
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-Kadéȉ) 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-Kadéȉ), 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 reponse 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 During the year, almost 95,000 children were vaccinated against up to nine diseases in Berbérati, Bangassou and Paoua during multi-antigen vaccination campaigns. These catch-up campaigns will continue in other areas in 2017.
Farah* – 26, mother and shopkeeper
I gave birth at the Gbaya Dombia maternity hospital on the afternoon of 30 October 2016.
The birth went very well, and afterwards I was transferred to a recovery room. I was there with my friends and family when I heard gunfire, and then I heard banging at the gate of the hospital. It was then that the wounded started to arrive. There were a lot of people and they were everywhere. There were wounded in all the beds except mine.
In this neighbourhood [PK5] insecurity is constant. We regularly hear gunshots and every two or three days there’s a fight. People argue and then pull out a weapon. Weapons are everywhere. Even honest, hardworking people carry weapons to protect themselves.
* Name has been changed