Thousands of people fleeing violence have taken refuge in the bush, living without proper shelter or safe drinking water, in parts of the Central African Republic (CAR). Médecins Sans Frontières/Doctors Without Borders (MSF) is providing emergency care and negotiating for access to areas where medical staff have fled and healthcare is no longer available.
As the government and rebels negotiate a peace deal, people are still afraid of violence and continue to seek safety.
“Death in the bush”
“There are sick people in the bush but they do not seek treatment for fear of the military,” says Nicolas, a 46-year-old community nurse. “It is sure that there will be death in the bush. We returned to the health centre because of MSF. MSF’s neutrality protects us.”
On January 10th, MSF opened an emergency project in the government held town of Damara, on the front line.
MSF is providing basic healthcare to the population affected by the conflict, by conducting mobile clinics and providing support to internally displaced people in order to prevent deaths due to common illnesses such as diarrhoea, respiratory infections and malaria, which is a chronic health care threat. Medical staff are treating up to one hundred patients per day, mainly for malaria and malnutrition.
Alarming mortality rates
“The Central African population already suffers from some of the worst health indicators in the world with alarming mortality rates, even in peaceful times. Because of the recent instability, many people have been forced to displace themselves,” says Sylvain Groulx, an MSF coordinator in CAR.
At an MSF project in Batangafo, in the north west of the country, consultations at the hospital have dropped from an average 128 a day, in the 10 days before the town was taken by rebel forces, to an average of 66 a day. Many families have fled into the bush spending nights in the cold, without mosquito nets, and lacking food and safe drinking water.
In December, MSF sent an emergency surgical team to Kaga Bandoro, where six people were treated for bullet wounds. Twenty-seven civilians, including women and children, received treatment for burns after an explosion at a petrol station.
MSF has carried out an evaluation of seven health centers in the capital of Bangui, and mobile teams are now visiting those health centres on a regular basis, providing training for the rapid diagnostic malaria test and providing malaria drugs to treat approximately 840 malaria cases.
MSF is also prepared to offer emergency surgical response in Bangui, with one team pre-positioned in Maternité Castor, ready to respond.
MSF has also sent teams to evaluate the situation from Grimari to Bria, and Sibut. The organisation is transporting several tons of medicine to distribute immediately to health facilities that are open.
Violence, displacement and insecurity
Before this conflict, CAR was already in a chronic medical emergency. The population has suffered from decades of violence, displacement and insecurity caused by clashes between rebel groups and government forces, as well as armed bandits.
Access to health care is limited due to a lack of qualified human resources, a weak presence of the Ministry of Health outside the capital city and frequent ruptures of essential medicines. Investment from international donors and aid agencies will likely shrink if there is no guarantee of a stable government and no guarantee of security for aid personnel.
MSF has 75 international staff working in five of the 17 prefectures in the country. All of its seven projects have remained operational with expatriate and national staff throughout the crisis. The number will continue to grow to support new emergency projects.
