In late 2014, thousands of people from the Kouango area of southern Central African Republic (CAR) began to cross the Ubangi River seeking safety in neighboring Democratic Republic of Congo (DRC) from armed clashes between rival militias. More than 20,000 fled to DRC, and thousands more went to the nearby towns of Bambari and Grimari, north of Kouango. They were looking for protection after months of incessant robberies, killings, and burnt houses.
While Doctors Without Borders/Médecins Sans Frontières (MSF) teams in DRC provided aid to the incoming refugees, an emergency team in CAR started an intervention focused on children, women, and victims of violence who remained in Kouango town and its surroundings. The local population’s access to health care was very limited or non-existent, and there were also huge food, housing, and sanitation needs. Many who stayed in the area left their homes and sought refuge in the bush out of fear of the militias.
"There are still some armed clashes, but simple rumors are enough to keep people afraid and away from home," said Jana Brandt, coordinator of MSF’s emergency team.
"We have seen some areas where all there is are burnt houses," said Brandt. "People are hiding in the forest afraid of the presence of armed groups. There are no security forces or actors providing health care. People are living in very dire conditions that could get worse at any moment if the insecurity persists. On top of that, the rainy season is about to start and people living in forests are completely exposed to harsh weather. Villagers even risk their houses being destroyed if they cannot come home soon to prepare them for the heavy rains to come."
"What we are seeing here is an example of the situation that hundreds of thousands of people suffer in CAR every day: a terrible mix of violence, displacement, and a lack of access to even basic health care," she stated.
Poor road conditions make movements in the area extremely difficult, and add a hurdle for trade and supply, as do checkpoints set up by armed militias. What’s more, the presence of militias have forced nomadic pastoralist populations that traditionally come to the area to feed their herds to move nearer to villages where their cattle feed on farming lands, further exacerbating food scarcity.
“It’s very difficult for farmers to work in their lands, and pastoralists have all kinds of hurdles themselves. With this scenario, a situation of food insecurity in the mid-term is foreseeable,” said Brandt.
MSF’s mobile clinics are providing primary health care with outpatient consultations in different parts of the area, giving special attention to cases of malaria, diarrhea, and respiratory infections. In the first week of activity, MSF’s mobile clinics performed more than 400 consultations, the majority of which were malaria-related. A 24/7 emergency room will also be set up in Kouango, and surgery will be available for those urgent cases in which time or security constraints make evacuation unfeasible.
MSF has been working in CAR since 1997 and currently has more than 300 international staff and more than 2,000 Central African staff working in the country. In response to the current crisis, MSF has doubled its medical projects since December 2013 and currently runs around 20 projects, including several for Central African refugees in neighboring countries such as Chad, Cameroon, and DRC.
In DRC’s Equateur province, MSF focuses on nutrition and primary and secondary health care for Central African refugees. In Bili hospital, MSF supports the pediatric and maternity wards and performs emergency surgery. Almost 7,500 consultations were performed in March, half of them for CAR refugees. A recent MSF campaign also vaccinated 43,000 children against measles and around 20,000 against polio.
