War and conflict

Waiting for the violence to end in the Central Africa Republic

Dr Genevieve Cote: "It is a really strange atmosphere. It is completely empty. You drive through those villages and there is no one there. You don't see anyone apart from sometimes you see someone running and really running for their lives. Not just walking around. They are like really, really afraid. Even when we are doing a mobile clinic they are not coming out of the bush until they are sure that they see the MSF flag and that they recognise us.

"In the first five minutes when you get to the location with the mobile clinic, there is no one around and after five or ten minutes, people start coming out and they come to the clinic."

Selena Brewer: "Some men fled directly when armed men came to the village and started shooting. They heard cars arriving, they saw people shot and they saw men firing at random, so they fled and they fled with whatever they could take with them. Other people were affected when roves of villages were burned so those people particularly are not going to be able to go back to their villages anytime soon. Other people have been attacked by bandits, which is continuing. Some have been attacked on the road. Sometimes bandits attack the villages. Sometimes bandits have attacked groups of people who have been sheltering in the bush. So these people ave arrow wounds and wounds from hunting rifles."

Dr Genevieve Cote: "They are always ready to go. They are always packed. They always have everything with them. In the long run, if we stay here and we ask more questions, we are going to find lots of mental illnesses related to all this violence and displacement."

Selena Brewer: "No one who we have spoken to feels it is safe to come back to their village. People don't believe that it isa safe to come back and there is no reason for them to believe that anything has changed from three months ago or six months ago."

Prospere and his family have been living in the bush for six months. They fled from their village when the military arrived four days after Christmas, burning all the houses and killing a man. Now Prospere and his relatives - 13 in all - live in two small shleters they built themselves, five kilometres into the bush.

Prosper is "lucky" since others from his village are hiding much farther in the bush, up to 15 kilometres from their village. Everyone must walk back to the village pump every time they want water.

The bush shelters are basic, a round wall of loosely woven straw with bundled straw for the roof. These shelters do not keep out rain, heat or mosquitoes - and as each one is only a couple of meters in diameter they are incredibly crowded. While the villagers want to return to their homes they cannot, they are still too afraid.

Prospere is not alone. In the last six months, an estimated 50,000 people have been forced to flee their homes in fear. Approximately 20,000 have fled over the border to Chad - the rest are hiding in the bush. When traveling through northern parts of the Central African Republic (CAR), there are long stretches of empty roads where every single village has been deserted, leaving ghost villages. Occassionally, one will see a bag left on the road, dropped suddenly when someone fled into the forest at the sound of a coming vehicle - or one sees someone running away in the distance.

"I was in my house in the village when they came - the whole village was scared there would be attacks, because we knew there had been a rebel attack a few days before. So when I heard the vehicle I fled with my three children with what they were wearing. Everything else we had was burned." - Woman, now living in the bush in CAR

Many are too afraid to stay in the area, or hope that life in a refugee camp will be slightly easier than life in the bush, and have gone to Chad.

"They came to my village - they shot at us - at everyone. There were many injured. I ran - with my wife. It whas while I was fleeing that I was shot three times - in the thigh, the arm and in my face. I was lucky, my wife brought my to the border on a push-push (wheeled cart), but others died. And everyone from the village fled, there is nothing there now. Many are here in the camp. I will not go back - I cannot run, so if they came again I would be killed." - Man, now living in Goré, Chad

The violence and fear in the region is shocking, and the conditions for those living in the forest are incredibly hard. Yet the violence comes on top of other difficulties civilians face in this country. Currently 67 per cent of the population (and almost all of the population in rural areas) lives in total poverty, on less than US$1 per day. Most people do not survive past the age of 42. One out of five children do not live to see their fifth birthday. Violent banditry has long been rife.

The area's recent violence has only made matters worse - people living in the bush are much more vulnerable to disease, and yet they now have less access to health care than they did in their small villages.

Even before the violence started, there was only one doctor per 90,000 people in this region. While there used to be a few local health posts with perhaps a nurse or pharmacist - many have closed because of this recent violence or earlier rounds of fighting in 2003 and 2001.

In the area where MSF is working, all but two of the health posts are now closed. Where health care is available, it is not free. Care must be paid for - and very few can afford it.

Now that MSF is providing medical assistance, patients travel incredible distances, some travelling on foot as far as 70 kilometres away to visit the MSF clinics. They have no other choice.

"People lost everything when they ran - their homes, their few possessions, their seeds. Village scholls are closed, health posts are closed, whole villages are empty. Where they are living, hiding in the bush, they are indrecibly vulnerable to disease, but also to more attacks. The worst thing is seeing people so afraid, so frightened that they still flee at the sound of a vehicle. We treat as many people as we can - hundreds of people come out of the bush to our mobile clinics - but what they really need is to be able to go home." - Janet Raymond, nurse/midwife, Goré, Chad

But for now they are too afraid. So they stay in the refugee camps in southern Chad or they put up with terrible living conditions in the bush of northern CAR waiting for the violence to end.

Why would I go back? I want to come home but it is not worth dying for Refugee, living in Goré, Chad

MSF activities in CAR

  • MSF runs multiple mobile clinics in the surrounding areas of Markounda, Paoua and Batagafo/Kabo. These clinics are responsible for hundreds of consultations on a weekly basis.
  • MSF provides inpatient care in the hospitals of Paoua and Boguila and in the Markounda clinic treating tens of patients on a weekly basis

-Out of Goré, in Southern Chad, MSF offers assistance to the 15,000 refugees from northern CAR through two medical clinics and provides the water supply and the sanitation system.

MSF has been working in the Central African Republic since 1997