After the deadly civil war that took place in 2013-2014, CAR enjoyed a period of relative calm. However, tensions between numerous armed groups exploded again at the end of 2016, throwing the country into a renewed spiral of violence. The conflict raged on throughout 2017 and into 2018. Violent attacks in several locations aggravated the already dire health needs of the population, 15 per cent of whom - or close to 700,000 people - are displaced.

The health system is barely functioning, due to a severe shortage of skilled health workers and medical supplies. Limited access to vaccination means that easily preventable diseases continue to take a toll. Malaria is the leading cause of death among children under five years of age. This basic lack of access to healthcare has serious repercussions, for example for people living with HIV; CAR has one of the lowest antiretroviral coverage rates in the world.

In many regions, MSF health structures are the only place for people to seek treatment free of charge. Our teams provide consultations and hospital care in 10 provinces, including maternity care, paediatric services and medical assistance for victims of sexual violence, basic emergency care, vaccinations and malaria treatment. Special emphasis has been put on ensuring continuity of care for HIV/AIDS patients in Carnot and Paoua.

Armed groups control 70 per cent of the country, and large numbers of wounded have few options for treatment. Some are referred to the capital, Bangui, for want of specialist facilities elsewhere in the country. Many cannot access the care they need. Even those not injured in the conflict are restricted in their access to medical care, food, water, shelter and education. It is not possible to reach many areas caught in the conflict, leaving people cut off from even basic services.