November 30, 2023
Dr Paul Mushombe Nibhumba: Testimonial from Doctors of the World Medical Coordinator in Mali
Since 2012, the population of CAR has been severely affected by ongoing political instability. On average, 32,000 people are forced to leave home each month and seek safety elsewhere in the country. Hundreds of thousands of people have been forced to flee their homes to escape the fighting and the levels of poverty have worsened in both towns and rural areas.
Doctors of the World began an emergency response in CAR in 2013. We continued our work by operating mobile clinics to provide access to healthcare for those displaced by the fighting. Our teams now provide support to existing health facilities in Malimaka, Gobongo, Bégoua, Lithonia, Gbango and Bouboui.
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.
Since 2012, the population of CAR has been severely affected by ongoing political instability. Thousands of people have been forced to flee their homes to escape fighting and the levels of poverty have worsened in both towns and rural areas.
Access to healthcare has been severely disrupted by the instability, and the crisis has been compounded by CAR’s lack of infrastructure. CAR has also become a host for thousands of refugees from neighboring areas of conflict such as South Sudan which increase the burden on the country’s already overwhelmed health providers.
“Four Selekas saw us, my 13 year-old daughter and me. They raped us in front of my 0ther children.” – Judith, Survivor of GBV
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.
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. 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.
As the climate disaster continues to escalate, Doctors of the World is working on addressing two of its dangerous implications: malnutrition and infectious disease. With malnutrition, our program focuses on screening children that pass through our clinics and provide assistance if needed. In 2021, DotW screened 34,793 children for malnutrition and provided treatment for 385 children suffering from severe acute malnutrition.
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.
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 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.