Bangassou - General context 2016
Central African Republic

Great humanitarian need, little international attention

Bangassou could be a poster child for the mistakenly optimistic discourse around “stabilization” and “normalization” of the Central African Republic (CAR) that followed the latest elections in the country. The few colonial buildings in the town are still pockmarked by bullet holes, a remnant from the 2013 takeover by the Séléka rebellion that drove people to flee.

But after close to two years of near total absence, state authorities have come back. A prosecutor was reinstated last December, then a judge, 30 constables, social services and a labour inspector. But this return does not mean that everything is back on track, and Bangassou town is just a pocket of relative peace in a highly unstable region.

Last June, the head of a clearly identified MSF convoy carrying supplies from Bangui was killed in an ambush on the road by armed men. East of Bangassou, roaming bands mimicking the modus operandi of the Lord resistance Army (LRA) terrorize villages, pillaging crops and abducting people. Because of the insecurity, MSF had to cancel a planned vaccination for children in this area despite the high needs.

Since the general election early this year, CAR has been touted as being on the road to recovery despite this insecurity. Over the past few weeks, spikes in violence across the country have dampened that enthusiasm; but still, the so-called “normalization” has led to a steady decrease in humanitarian budgets for the country.

As of today, only 28 per cent of the necessary humanitarian aid budget for next year has been pledged, even though the needs remain huge 850,000 people are internally displaced or have found refuge in a nearby country 2.3 million, or half the country’s population, rely on humanitarian assistance for survival.

Things are not back to normal in CAR. “What does ‘normal’ mean for a country that has been in a protracted crisis for decades? The most acute phase of the crisis may be over, but the problems are far from solved,” says Emmanuel Lampaert, MSF’s country representative in CAR.

The Monday morning market in Mbalazime, a village 12 kilometers from Bangassou, draws crowds into MSF-supported health centre located just next door. At the entrance, a sign reads “CARE IS FREE” – and that makes a huge difference. A consultation in a nearby health post usually costs 2,500 to 3,000 CFA (3.7 to 6 euros). For the same price, you can buy a full plastic basin of rice, enough staple food to sustain a family for a month.

Bangassou - General context 2016
A midwife in Mbalazime health centre weighs a newborn baby during a post-natal checkup. Mbalazime is one of three health centres supported by the MSF team in Bangassou, Mbomou prefecture, CAR. Between January and June 2016, 296 women gave birth safely in these three structures.
Sandra Smiley/MSF

The local health centres and health posts, understocked and understaffed, struggle to offer proper services to the population, and the consequences of the lack of healthcare can be seen in the 118-bed MSF-supported regional hospital in Bangassou.

On his third day on the job in the hospital, Dr Osmar Sosa Del Toro performed 12 surgeries. All were urgent. For example, one woman had a perforated intestine from a botched caesarean section a month earlier. A six-month-old baby had a severely infected abscess on his left leg. “He received an injection in a health centre one week ago. It was badly done and his leg was badly infected, which can lead to septic shock in such a young child,” says the surgeon. Leafing through the admission log in the paediatric ward, we can see that such infections are common.

Across the yard, in the malnutrition room of the pediatric ward, Dr Ilaria Moneta does her rounds. Malnutrition, often the result of repeated illnesses, is a chronic issue. “It’s strange, because for the most part there is food in the homes of our patients. But it’s very difficult for parents to motivate a sick child to eat and to know how to properly feed a child. It’s a slippery slope: they’re sick, so they don’t eat, so they get weaker and fall ill again”, says the paediatrician.

A recent reporthttp://www.ifpri.org/topic/global-hunger-index puts CAR – followed by Chad and Zambia – as the country most affected by malnutrition, but over the first half of 2016 barely 25 per cent of children suffering from malnutrition received proper care, according to OCHA.

Next month, donors will gather in Brussels to plan the next steps to support CAR. So far the signs are not encouraging for the people of the country. Due to diminishing budgets, some international NGOs have started reducing their activities, even though in Bangassou, like everywhere else in the country, the needs remain enormous.

If CAR was one of our patients, we could say that it’s out of the emergency room, but still in need of intensive care. Discharging it now would have tragic consequences Emmanuel Lampaert, MSF’s country representative in CAR
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Central African Republic
Voices from the Field 13 September 2016