Central African Republic: crisis update - September 2017

Renewed violence in Central African Republic (CAR) has forced hundreds of thousands of people to flee their homes, either to be displaced elsewhere within CAR, or to seek refuge in Democratic Republic of Congo. MSF is responding to the crisis and is providing medical assistance in several areas throughout CAR.

Context

 

Consequences of the violence on humanitarian needs
The violence has led to over 600,000 people being internally displaced nationwide, the highest number since April 2014. The renewed fighting has also forced 60,000 people to cross into Democratic Republic of Congo since the end of April 2017. Alindao, Bria and Bangassou (among others) have seen the overwhelming majority of their populations displaced (16,000 displaced people in Alindao out of a population of 18,000, and 41,000 displaced in Bria out of a population of 47,000). In Bangassou, 2,000 displaced people still live on the site of the Catholic church and 7,000 people sought refuge on the site of Zemio health centre when fighting started in June. Those sites are not adapted to their needs and lack basic services such as water, latrines and shelters, increasing the risk of epidemics.

People are seeking refuge in hospitals, churches and mosques, but are also hiding in the bush for long periods of time. In addition to war wounded people, MSF sees the direct consequences of violence on the health of civilian populations: children not able to reach medical facilities during malaria season; regular vaccination campaigns, HIV and tuberculosis (TB) treatment interrupted; pregnant women left without assistance when they deliver.

MSF’s response to the recent violence

Bria
In November 2016, heavy fighting in Bria – where MSF usually runs a paediatric project – forced thousands of people from their homes. The fighting spread to nearby villages, and civilians were targeted. MSF teams responded to the situation by supporting surgical trauma care and setting up mobile clinics. In March, MSF’s paediatric project again shifted to emergency mode to respond to an influx of wounded following renewed fighting. The team treated 24 wounded at Bria hospital reinforced mobile clinics to better reach populations affected by the violence.

Fighting erupted in Bria on 15 May between members of the FPRC-led coalition and local 'auto-defense'. The conflict displaced the vast majority of the town’s population, now gathered in camps. In the second half of May, MSF teams saw 1,100 people in outpatient consultations, and also launched mobile clinics in Bria and the surrounding villages, providing 860 consultations to internally displaced people (IDPs). MSF also supplied water to the camp and helped build latrines.

Heavy fighting flared up again in Bria town on 20 June, the day following a peace agrrement signed by different parties in Rome, Italy, causing reportedly about 100 casualties. MSF ambulances were able to access the conflict-affected neighbourhoods on the same day to take the wounded back to the hospital, where 43 wounded patients were taken care of. In July, about 20,000 IDPs remained in the camp and 3,000 were still in the hospital compound, while MSF continued running mobile clinics and water and sanitation activities.

Bangassou
In mid-May, Bangassou was attacked by an armed group supported by local militias who attacked the MINUSCA base and the predominantly Muslim neighbourhood of Tokoyo. MSF’s team provided care to 133 wounded people and consultations to 1,100 patients during mobile clinics in places where displaced people have gathered. After the events of mid-May, up to two thirds of the city had fled, and in late July, there were 16,000 refugees in Ndu, a small village on the DRC side of the border, and 2,000 Muslim IDPs on the site of the Catholic mission, protected by MINUSCA troops. MSF provided more than 5,500 consultations through mobile clinics to displaced people in Bangassou and Ndu. In early August, fighting also broke out in Gambo, a town 75 km northeast from Bangassou. In the following days, MSF treated 15 wounded from Gambo at Bangassou hospital.

Zemio
On 28 June, fighting started in Zemio between local anti-Balaka and armed Fulani people. The fighting displaced about 20,000 people, with more than 7,000 sought refuge at the health centre, 5,000 at the Catholic mission and others fled to different sites around the town. MSF provided medical and logistical support to the IDPs, but on 11 July, armed men entered Zemio health centre and shot at a family. A baby was shot in the head and died. This shocking killing, witnessed by MSF, and a lack of respect by armed groups in the area for medical care forced MSF staff to withdraw from Zemio, leaving behind thousands of patients with no access to medical care.

Batangafo
Heavy fighting erupted on 29 July in the town of Batangafo, with tents in the IDP camp burned down and several NGO houses – including the one from MSF – were looted. At least 10,000 people sought refuge on the hospital grounds, a further 5,000 at the church, and 1,000 more in different places in town. MSF treated wounded before fighting broke out again on 1 August. The team started water and sanitation activities in order to support the IDPs on hospital grounds, but due to armed men on and around the hospital grounds, with gunshots fired and tensions escalating again in late August, MSF took the difficult decision to reduce activities to life-saving surgery, and in-patient department and maternity services.

Other locations
In January, MSF deployed its emergency team to assess the situation of IDPs fleeing fighting around Bambari. Four wounded patients were referred to Kaga Bandoro and the team reinforced Mbres hospital and conducted an emergency multi-antigen vaccination campaign for 1,200 children.

In Maloum in February and March, MSF launched a response for the people who had fled there from Bria and Bambari, distributing over 15,000 essential relief items to displaced people. The team also organised a multi-antigen vaccination campaign for over 5,000 children and pregnant women.

MSF assessed the situation around Nzako and Bakouma (Mbomou province) and provided medical care to the people affected by violence, providing more than 400 consultations between 23 March and mid-April.The conflict continues around Nzako and Bakouma with regular upsurges of violenc, and while the MSF team has started to establish links with Bakouma, teams have not yet succeeded in reaching Nzako.

On 8 May, anti-Balaka clashes with UPC combattants in Alindao caused the displacement of 16,000 people both within the town and towards Bambari. An MSF team started supporting Alindao hospital and health centre on 24 May, admitting 117 patients to the hospital, including 53 who had gunshot or knife wounds and 17 who needed to be transferred to Bambari for more extensive treatment. MSF also vaccinated 5,675 children against measles and 2,555 with a multi-antigen vaccine in Alindao. The situation remains volatile with frequent clashes, leading to displacement. The Emergency team handed over the support of Alindao health structures to other humanitarian actors end of June 2017.

Currently, 60% of the population of Bambari are IDPs, totalling 57,000 people, 10,300 of whom have arrived since mid-March this year. In May, MSF’s team in Bambari treated 22 people with war-wounds, including four children, most with gunshot wounds with open fractures. In total, the team treated 162 war-wounded from November 2016 to May 2017.