Since the presidential and legislative elections in December 2020, a wave of violence has swept over Central African Republic (CAR). It comes on top of decades of civil war that have already taken a heavy toll: today, more than half of people living in CAR rely on humanitarian aid.
But as armed clashes between the coalition of non-state armed groups and government forces backed by foreign troops erupted in many parts of the country, the fighting severely disrupted the work of humanitarian organizations and CAR’s already strained health system. Movements of patients and medical staff have been reduced, supplies of essential medicines are limited, and a spike in food prices makes it more difficult for families to afford health care. (Paying for health care is already an enormous obstacle to accessing health care, as 71 percent of the population lives below the poverty line.)
The worsening health crisis disproportionately affects displaced people and refugees. Currently, 1.3 million people—more than one in three—are internally displaced within CAR or have fled to other countries to seek safety. The situation is now comparable to the displacement seen during CAR’s 2013 civil war.
Women’s access to health care is even more precarious. Even outside the periods of acute violence, their socioeconomic status, the risk of exposure to violence at home and elsewhere, and the very limited access to family planning makes women particularly vulnerable. CAR has one of the highest maternal mortality rates in the world.
In Bangassou, in southeastern CAR, and Ndu, in northern Democratic Republic of Congo when many Central African refugees live, MSF provides free health care to local communities and displaced people, including sexual and reproductive health care. Every day, our teams provide pre- and postnatal support for women, ensure sanitary conditions for births, manage obstetric complications, provide access to contraception, and treat victims of sexual violence.
Here, women who fled the violence in CAR share their stories.
Crossing the river: Stories from Ndu, Democratic Republic of Congo
Christelle, a resident of Bangassou, a city in southeastern CAR, was preparing to celebrate the birth of her second child when the coalition of armed groups attacked and took control of the city on January 3, 2021.
“When the shooting started, we immediately fled the city,” she explains. "We jumped in a canoe to reach the Congolese side [of the river].”
Like Christelle and her family, nearly 13,000 people fled Bangassou that day and crossed the Mbomou river to take refuge in the village of Ndu, where many other refugees had already settled in previous years.
MSF supports the local health center in Ndu and has been present in the area since 2017.
Today, Christelle lives in a former school with about one hundred other refugees.
“My pregnancy was very advanced when we fled the city. But I was followed at the health center, and luckily everything went well during the delivery,” she recalls while holding Alvina in her arms.
Christelle and her daughter share a room with about 20 other people. With the recent influx of refugees into the village, living conditions are far from adequate. MSF has increased services at the health center and urgently installed water supply systems. Fortunately, after several days, other humanitarian organizations arrived to provide assistance as well.
Despite the living conditions in Ndu, Christelle does not plan to return to Bangassou. Like many other refugees, she is afraid to return when she thinks about the volatile security situation in her country.
“If I have to go back, I want to be sure that we are safe with Alvina. I don't want us to have to run away again."
Odette is a midwife in Ndu’s small health center.
When more than 13,000 people fled Bangassou and settled in Ndu, the number of consultations at the health center soared and MSF had to quickly increase its support to care for women and children suffering from malaria, respiratory infections, and diarrhea, in addition to the many pregnant women.
Today, Odette is caring for a 25-year-old patient, Amatou. Amatou is about to give birth but is bleeding. “She can’t deliver here, let’s bring her to Bangassou,” says Odette.
Amatou is transported by stretcher to the river, where a pirogue (a long, narrow canoe) is waiting. Odette crosses the river with Amatou and an MSF ambulance meets them on the other side to take them to the University Hospital, where our teams manage the most serious cases.
For Amatou, the presence of MSF on both sides of the river is crucial. The Bangassou hospital is one of the very few able to manage obstetric complications in the area.
"Amatou is in good hands now," says Odette, before heading back to the river to return to the Ndu health center.
Ester was about to give birth to twin girls in Bangassou when the attack took place on January 3. She decided to flee with her eldest daughter, Princia.
"This is the second time that I have taken refuge here. The first time was in 2017,” she explains while waiting for the postnatal consultation for her twins at the Ndu health center.
“I thought I was going to give birth here, but I had complications and the team transported me to Bangassou because I needed a C-section.”
"Fortunately, the delivery went well, and Ester was able to come back here [to] Ndu with her daughters," said Laure, a midwife at the health center.
Today, Ester and her daughter Princia hope that the situation will calm down in Bangassou so that they can return home safely with the twins, Rhode and Laure.
Sheltering in the hospital: Stories from Bangassou, Central African Republic
Like nearly 800 Bangassou residents, Beatrice and her family rushed to the city’s University Hospital when armed groups attacked the town on January 3. “It was total panic. Thousands of people were trying to cross the river in canoes to go to Congo,” she recalls. “Many were in danger of drowning. Instead of crossing, we preferred to come to the MSF hospital here.”
Day after day, the number of people seeking shelter at the hospital—which MSF has supported since 2014—grew. At one point, the hospital compound housed approximately 2,000 people. MSF teams provided all of the people with health care, accommodation, and water.
This is not the first time that Beatrice and her family have taken refuge in the hospital grounds.
“We already came here when violence broke out in 2017. You feel safe in the hospital, and you know you can be treated if something happens. One of my children got sick when we arrived, but he was quickly treated."
The mother of six now lives within the hospital grounds. Her husband left to protect their home, but Beatrice prefers to stay here with her family.
“We heard rumors about a new attack. No one here feels safe enough to leave. I am especially worried about my children. Because of the
insecurity, prices have gone up and finding something to feed them has become a real problem. They don't go to school anymore."
"Politics should not be made with guns in the country," sighs Beatrice. "Because it is always the innocent who suffer."
“When we heard the shots, we were terrified,” said 50-year-old Philomène, who fled to the University Hospital with her family on January 3. “We went straight to the hospital because we knew we would be safe there. "
Philomène has been living here for several weeks with her children and grandchildren. For her, the current crisis comes on top of many other tragedies in her life.
“I am a widow, and I have already lost six of my eight children to disease and violence," she says. “Most of my grandchildren here are orphans. And today we have to live here. "
Despite poor living conditions, Philomène is not yet ready to leave the hospital. “We need security. Only peace will allow us to resume our activities and restart a normal lives. My grandchildren deserve a better life.”
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