Humanitarian Emergency in Central African Republic

Many of the people living in the Central African Republic (CAR) are struggling due to multiple ongoing crises that are occuring in the region including political instability, armed conflict, poverty and climate crisis. The culmination of these issues have made it difficult for CAR to stabilize and begin to rebuild, leaving nearly half of the population (3.4 million) in need of humanitarian assistance.  

The cost of conflict on the civilian population

Numerous armed conflicts have generated a serious humanitarian crisis as well as a constant increase in violations of human rights and international humanitarian law. The conflict has forced thousands to migrate, fleeing to refugee camps in the region or neighboring countries. 1 in 4 Central Africans is displaced either within the country or to a neighboring country, and the waves of return of displaced and repatriated people have slowed considerably. CAR has never had so many people in humanitarian distress.

The conflict has also impacted the country’s healthcare system. Health infrastructures are the targets of attacks by armed groups when they are not abandoned because of the flight of populations and medical personnel. With less health centers and professionals to run them, there is a rapidly growing number of people in dire need of healthcare. Victims of Gender-Based Violence (GBV), people suffering from mental disorders, or cases of communicable diseases are left without the crucial care they need. The lack of a healthcare system further puts the country at risk of epidemics. 

As is the case in most conflict situations, women and children suffer the most from violence. More than 1.4 million people need gender-based violence intervention, including prevention, risk reduction, and other support. Women and girls are extremely affected (they represent 95% of GBV survivors in CAR), and minors represent 21% of GBV cases.

The growing risk of the climate crisis

Due to a combination of political, geographic, and social factors, the Central African Republic is recognized as highly vulnerable to climate crisis impacts, ranked 180 out of 181 countries in the 2020 ND-GAIN Index. The most significant environmental problems in the Central African Republic are desertification, water pollution, as well as increasingly frequent climatic hazards such as fires, floods, or low levels of rain, which can seriously hamper their health, food and economic security. 

The country’s nutritional situation is becoming alarming. Food Security Phase Classification of October 2021 reports that 2.05 million people, or 42% of the population analyzed, face high acute food insecurity, including 619,565 people in emergency. According to these estimates, more than 60,000 children under the age of 5 require urgent care. The climate disaster along with the volatility of the security context causes the closure of markets and has a strong impact on the resources and livelihoods of the populations, in particular rural ones and those located on the most affected axes. 

People affected by natural disasters are also vulnerable to disease and epidemics caused by ingestion or contact with unsafe water. More generally, epidemics rage regularly in the Central African territory and the weakness of basic services makes it impossible to respond to them quickly.

Doctors of the World intervention in Central African Republic 
 

Since 2013, Doctors of the World has supported the country’s health system to provide a response to the health emergency. This support involves relaunching care activities that encompass a wide range of health topics that are the most pressing to the population in CAR. 

Prioritizing Sexual and Reproductive Health 

Women and children struggle the most to access care, especially in situations of crisis and conflict. At DotW we paid particular attention to sexual and reproductive health (SRH) needs, by providing pre and postnatal consultations, family planning, gynecological consultations and referral of obstetrical emergencies. In 2021, our program was able to provide 54,082 SRH consultations and assist in 3,429 deliveries. 

The teams also set up multi-sector care services (medical and psychosocial) for survivors of gender-based violence and community mobilization around SRH and mental health issues. Through this program we were able to support 96 survivors of GBV. 

Thanks to its presence for several years, Doctors of the World has acquired extensive experience and has succeeded in establishing good cooperation with the Central African authorities as well as with civil society.

Strengthening Healthcare System and Providing Rapid Response with our Mobile Clinic

Our association also wanted to help CAR to prepare for any health emergencies. To accomplish this task, DotW implemented two projects: one focused on expanding support and training for CAR health facilities and the other was implemented through mobile clinics. 

In our first project, Doctors of the World is currently expanding its support to the health district of Bouca by targeting a new axis (Bouca/Marali) to provide support to four additional health facilities in order to reach 62% of the total population of this district. The project also provides for enhanced support to the health district in terms of monitoring, evaluation, mobilization and coordination of actors around the District’s operational action plan, and strengthening of IPC (infection prevention and control) measures in the supported health facilities. 

Our second project began in 2019 as a new rapid response medical team which operates in a mobile clinic in conjunction with the Rapid Response Mechanism (RRM) and in coordination with the Cluster Health and the Central African Ministry of Health. Its focus is to provide emergency relief to a wide array of problems that require rapid response. 

Since the program began, the team has already intervened with people displaced in Bangui following heavy flooding, in Abba in the north-west of the country following population displacements, then in Damara to respond to an epidemic of measles. It also intervened in 2021 in Dekoa, Kouango and Bossembélé  following violence and the displacement of populations linked to the electoral and post-electoral crisis. In addition, the mobile clinic team was trained by WHO on SARS COVID-19 response activities, which enabled them to set up prevention activities during their deployments. 

This mobile clinic intervenes following a shock (displacement of populations, epidemics) to relaunch access to care for populations affected by the crisis. The overarching goal of the mobile clinics program is to combine an immediate emergency response with a relaunch of the local health system affected by the shock. Deployments include a full package of services: primary health care, sexual and reproductive health care, including cases of GBV (medical care and psycho-social support), nutrition (MAS), psycho- social and community mental health awareness. Since 2021, the mobile clinic has strengthened its ties to the communities it works with and, in return, they spread key messages for us, whether it’s to prevent infection, share information about our services, or encourage pregnant women to book a prenatal session with us. For each of its interventions, the mobile clinic coordinates with the health authorities of the area and the partners present on site for the multisectoral response.

Photographs

© Sebastien-Duijndam