There were hopes for peace in Central African Republic (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. Armed groups have remained active and 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 per cent of health facilities have been damaged or destroyed and there is a shortage of trained healthcare workers. Many people are afraid to travel to the few health centres that remain, or cannot afford to pay for treatment.
MSF and other NGOs provide the majority of the health services, but their work is repeatedly obstructed by armed groups and organised crime. This year, 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. In this atmosphere of insecurity, it was difficult to maintain the supply of medical materials. In Batangafo – located on the frontline between areas controlled by different militias and one of the most insecure areas in CAR – MSF continued to provide basic and specialist healthcare at the referral facility and five health posts, and this included outpatient consultations, surgical interventions and maternal and child health. Batangafo is also the location of one of the country’s largest camps for internally displaced people, with a population of over 30,000. More than 10,000 people sought protection in the hospital compound after violent clashes erupted in the town in October.
Despite such incidents, MSF continued to run a substantial programme of basic and emergency healthcare for communities with urgent needs across 13 prefectures and 15 localities, in both MSF hospitals and public health facilities. Teams carried out vaccination campaigns, operated mobile clinics and provided emergency surgery, maternity services, specialised care for victims of sexual violence and treatment for malnutrition, HIV and tuberculosis (TB).
Responding to children’s needs
Malaria remains the biggest killer in the country and the leading cause of death in children under the age of five. Three rounds of preventive malaria treatment were administered in Ndele, Kabo and Batangafo between July and November, reaching around 14,000 children. High malnutrition rates and low vaccination coverage are also compromising children’s health and shortening their lives. Only 13 per cent of infants under the age of one are receiving a full immunisation package. In July, MSF launched a year-long campaign across 13 prefectures, targeting 220,000 children under the age of five for comprehensive vaccination against diphtheria, tetanus, whooping cough, polio, Haemophilus influenzae type B, hepatitis B, pneumococcus, yellow fever and measles.
Healthcare in Bangui
In the capital Bangui, violence is rife, and MSF focuses on emergency services in the city’s general hospital. In 2015, the team carried out 4,100 surgical interventions and provided medical and psychological care to 675 victims of sexual violence. A new surgical hospital for emergencies is under construction and should open in 2016. MSF also conducted 37,000 consultations in the predominantly Muslim PK5 enclave, treating children under the age of 15 at Mamadou Mbaïki health centre and people of all ages at the Grand Mosque.
During the year, MSF carried out up to 400 consultations a day at M’poko hospital in the airport displacement camp, and 15,400 emergency cases were treated and/or referred to facilities in Bangui. At Castor health centre, MSF continued to treat victims of violence and provide free maternal and emergency healthcare around the clock. The team assisted over 7,400 births, admitted 10,500 people to hospital and offered comprehensive care to 275 victims of sexual violence.
On 26 September, the death of a motorbike taxi driver sparked retaliatory violence, violent protests against the interim government and clashes with international peacekeepers. Buildings were looted and destroyed and over 44,000 people were displaced. MSF treated almost 200 casualties in two days, many with gunshot wounds. Mobile clinics were also launched after the consequent displacement, and 9,800 consultations undertaken between October and December.
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.
The large emergency project that began in Bossangoa (Ouham) in 2013 continued to offer basic and specialist care through the hospital and a health centre in Nana-Bakassa, and also supported three health posts (Bowara, Benzambé and Kouki). An intensive care unit and a TB building were built this year. In May, the nutrition programme and outpatient department were handed over to the Ministry of Health.
In Berbérati (Mambéré-Kadéȉ), MSF supported the regional hospital as well as four health centres focusing on care for pregnant women and children under the age of five. Around 6,000 children were admitted to the hospital in 2015, and over 20,000 outpatient consultations were carried out in the four health centres. A total of 1,800 children were treated for severe acute malnutrition. In May, 28,000 children aged between six months and 10 years received measles vaccinations in Berbérati and Mbako. In Bambari (Ouaka), MSF provided basic medical care to the host population and around 80,000 people living in camps through the health centre, mobile clinics and nine malaria treatment points. Nutritional rehabilitation is a key part of the programme and 1,380 children were treated for severe malnutrition.
In Bria (Haute-Kotto), MSF provided healthcare to children under the age of 15, including HIV treatment, and vaccinated 16,600 children against measles in March. In Zémio (Haut-Mbomou), teams offered basic and specialist care in the hospital, with a focus on HIV care, and supported four peripheral health posts and eight malaria treatment points.
In Bangassou, the capital of Mbomou prefecture, MSF continued to work in the referral hospital offering basic and specialist healthcare, including maternity, paediatric and surgical services. Over 120,000 people in the region depend on Bangassou hospital, and there were over 48,000 outpatient consultations in 2015. Teams also began supporting health centres in Niakari and Yongofongo. In February, MSF launched a measles vaccination campaign in Rafaï that reached almost 4,900 children, and another in August in Bangassou that reached 37,000 children.
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.
Against the odds
Benjamin Black – Obstetrician / Gynaecologist
"The patient had been sent to us from a health centre across the border (a river) in Congo. I started trying to piece the story together. This was her first pregnancy and she had apparently been in labour for four days already; the membranes had also ruptured four days earlier and now all that was draining was thick green meconium-stained fluid (where the baby has passed a motion in the womb). She had come to us by boat, car and foot at full term and in a ridiculously prolonged labour. No wonder she looked terrible.
I went on to auto-pilot, and as I continued gathering information I started placing an intravenous cannula. I was already planning our trip to the operating theatre. I started a fast-running drip and asked the midwife to get some intravenous antibiotics started.
I methodically started feeling her abdomen, the baby was head down but still quite high ...
During my time in CAR over 17 per cent of women needing surgery during labour were for ruptured uterus – one of the most serious and life-threatening obstetric complications – all had had a previous caesarean section. Whilst we are fortunate enough to be set up to perform emergency caesarean sections, I cannot guarantee that the same would be true for this women in her future pregnancies, particularly given the wider social, economic and political context.
The birthrate is very high, there is poor access to family planning and poor infrastructure. If she has a caesarean what would be her risk of complication or death in her next six to 10 pregnancies, assuming the time for transfer remained the same?"
To learn more about Benjamin’s decision and how the mother returned home with a healthy baby, visit the MSF blog.