CENTRAL AFRICAN REPUBLIC: DESCENT INTO CHAOS

Central African Republic (CAR) has known decades of violence, displacement and lack of medical access, and Médecins Sans Frontières (MSF) has been working there since 1996. This year, however, the country was confronted with a massive humanitarian crisis to which many in the international community, and the world in general, remained largely indifferent.

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Thousands of people fled to M’poko airport in Bangui to escape Séléka gunmen in August, blocking the runway and preventing flights from landing. By December MSF’s airport clinic was addressing the medical needs of more than 100,000 displaced people who had taken refuge in the makeshift camp.
PHOTO: © Camille Lepage / Polaris

On 9 September, the anti-balaka targeted the town of Bouca and buildings were burned to the ground. Séléka fighters were executed, and civilians fled into the bush or sought shelter in the Catholic mission compound. Once the violence had subsided, MSF helped 400 families who had lost their homes.
PHOTO: © Juan Carlos Tomasi / MSF

Since the start of the conflict, tens of thousands of people have fled their homes to escape vigilantes armed with machetes and guns. In September in Bossangoa, 30,000 people sought refuge in the grounds of the Catholic mission, and 8,000 people from the Muslim community sheltered in a mosque.
PHOTO: © Camille Lepage / Polaris

The woman pictured above is being rushed from a camp at the church in Bossangoa to the MSF-supported hospital for treatment. People are sheltering in large groups for safety, in the Catholic mission compound, in the hospital, in a school and next to the airstrip. Those in the bush are particularly at risk of contracting malaria – CAR’s number one killer – but all are living in precarious conditions with little access to sanitation facilities. In a country of over 4.5 million people, which already has some of the worst health indicators in the world, the crisis has heavily impacted the healthcare of civilians, as routine vaccinations have not taken place, HIV treatment regimens have been interrupted and levels of malnutrition and malaria have increased.
PHOTO: © Marcus Bleasdale / VII

PHOTO: © Camille Lepage / Polaris

This patient in the Community Hospital in Bangui has received a gunshot wound to the leg. Despite repeated calls for those engaged in the fighting to respect medical structures, ambulances, medical personnel and the ill and wounded, attacks on healthcare facilities and workers continued and on more than one occasion, armed men entered the hospital. On 29 December they threatened to lynch some of the patients. All humanitarian organisations working in CAR have been victims of looting and robberies, and staff have been threatened.
PHOTO: © Juan Carlos Tomasi / MSF

PHOTO: © Marcus Bleasdale

Towards the end of 2012, the Séléka – a coalition of rebel groups mainly from the north and east of the country – made their way towards the capital, Bangui. En route they took control of numerous towns and villages, forcing residents to flee into the bush to escape the violence. The presence of the Séléka exacerbated the ongoing conflict between farmers and pastoralists, and CAR’s armed forces, FACA, withdrew from areas where they had been integral to keeping the situation under control. The anti-balaka (anti-machete) traditional self-defence groups started fighting the Séléka whom they perceived as pro-Muslim for favouring the pastoralists from the north.

Despite signing a peace deal with the government in January, the Séléka marched on Bangui in March and seized power claiming unfulfilled promises. President Bozizé left for Cameroon (he himself had taken power by force in 2003), state security forces were disbanded, and rebel Michel Djotodia proclaimed himself president, suspended the constitution and dissolved parliament.
In August he was officially sworn in. The coup left the country in chaos, and widespread violence and looting ensued as CAR remained at the mercy of armed groups.

Djotodia announced in September that he had officially disbanded the Séléka coalition, but many fighters refused to put down their weapons. They committed atrocities against civilians, and the anti-balaka – its ranks swelled with former soldiers, gangs and other self-defence groups – reciprocated with attacks on members of the Muslim community.

Displaced people found themselves living without access to safe water, facing food shortages and malnutrition, and with an increased threat of malaria. Despite the huge rise in people’s needs, however, the humanitarian presence in the country reached an almost record low. Many UN agencies and NGOs withdrew to the capital due to the lack of security, leaving much of the country without aid. In light of the situation on the ground MSF felt compelled to publish an open letter to Valerie Amos, UN Under-Secretary-General, on 12 December, citing the ‘unacceptable performance of the United Nations humanitarian system in the Central African Republic over the last year’ and Arjan Hehenkamp, General Director of MSF in the Netherlands, wrote a piece for The Guardian newspaper stating that ‘The aid world has failed the people of the Central African Republic’.

On 5 December, a wave of violence swept through Bangui as armed groups launched an offensive after the arrival of French troops to disarm the ex-Séléka. Attacks on Christians followed by revenge killings against Muslims took place around the country as the ex-Séléka withdrew. The anti-balaka increased the number of attacks against Muslim communities in the north and west of the country, as they saw these areas as potential political bases for the ex-Séléka. MSF treated hundreds of wounded people.

At the Community Hospital, MSF teams were treating 15 to 20 wounded a day during early December, predominantly for gunshot and machete wounds. Patients who had been tortured and beaten were seen at the hospital, and many people presented with defensive injuries to their heads, hands and arms. Amitié Hospital, Bangui’s main hospital, was attacked and looted, and health staff fled amid threats. Ten days after the unrest began, the UN Office for the Coordination of Humanitarian Affairs estimated that one in four residents of Bangui had been displaced.

The beginning of 2014 brought no respite for CAR. When Djotodia left power in January, Christian militias began attacking Muslim civilians and many were forced to flee to neighbouring countries such as Chad or Cameroon. MSF continues to treat the wounded and respond to the massive displacement of people; at the time of writing MSF has more than 300 international staff and 2,500 Central African staff working in the country. MSF and a handful of other organisations have shown that it is possible to keep working in CAR throughout the crisis, and even to expand operations. However, more international intervention is needed. The violence continues and the population of CAR live in fear.

For more details on MSF’s response in CAR, see the country report, pp. 36–37.

Josianne Displaced person who took refuge in the bush, Bria “ Since this all started, we flee, we sleep in the bush, we don’t eat well, we are bitten by mosquitoes. There are too many illnesses. We are always running. You can see for yourself what state we are in. We want peace.”

Dr Sabine Roquefort MSF doctor at the Community Hospital, Bangui “ We are accustomed to working in very violent environments, but this organised, wilful intent to mutilate, wound and kill shocked me. The level of violence and suffering has struck me more powerfully than in any other conflict setting where I have worked.”