Africa

Q & A: Doctors Without Borders on the worsening situation in the Central African Republic

By Khadija Patel 18 September 2013

While the United Nations continues to voice deep concern over the situation in the Central African Republic (CAR), where hundreds of thousands of people continue to be affected by lawlessness and insecurity, the country looks increasingly on the brink of another armed insurgency. KHADIJA PATEL spoke to Ellen van der Velden, Médecins Sans Frontières/Doctors without Borders’ head of mission in CAR about the conditions encountered by her team.

Six months after the coup d’état that forced Francois Bozizé from power, efforts to stabilise the Central African Republic (CAR) appear doomed. The country appears on the verge of another armed insurgency, this time from forces loyal to Bozizé who aim to win the country back from the Seleka rebel coalition. While Seleka was formally disbanded last week, forces fighting under its banner have been doing battle in the north west of the country.

Meanwhile, the country is embroiled in chaos. Even deliveries of humanitarian aid were stalled by truck drivers striking over the parlous security in CAR. While many of CAR’s problems did not begin with the coup this year, the ongoing political instability has merely exacerbated the challenge of bringing vital services to the people of the country.

Médecins Sans Frontières/ Doctors without Borders’ (MSF) has worked in CAR since 1996, providing assistance to thousands of people who are ill, victims of violence and who are deprived of medical care.

Daily Maverick (DM): Can you briefly outline the humanitarian challenges that MSF is dealing with in the Central African Republic?

Ellen van der Velden: We are dealing predominantly with health problems. We have seven long-term and four short-term projects in the country, so a total of 11 projects all over the country For many years the health system in CAR has been extremely weak with very little presence of the central ministry of health in any of the hospitals outside of Bangui.

Supplies to health posts have always been sketchy and reports from these health posts have been very limited. So the health system in itself … has always been quite weak.

Then there was the Seleka uprising, which resulted in the coup d’état on 24 March and because so many people with guns came through the country, most of the health facilities have actually been closed. People fled in fear of the incoming armed forces or they were robbed and looted which has happened quite a lot, not only by the incoming [militants] but also a lot of the health facilities were looted by the local populations on the ground. So, it’s a combination and these activities have not yet restarted. The central resupply of drugs is not happening and most health facilities are de facto closed.

DM: So how is MSF trying to overcome some of these challenges?

Van der Velden: We are trying, in as many health facilities as possible, to supply materials to work with. We bring staff from Bangui as well as outside of CAR and we work with the locally available staff because though these people have fled, very often they are still in the vicinity. So, if an external partner comes up, we supply it and maybe also pay a little … for the salary and that helps to get these people back to work.

DM: You’ve described a lack of security in the country and last week we saw reports of more than 100 people dying in the north west of the country. How does this impact on the kind of work that you do?

Van der Velden: It has come in waves. Throughout the entire crisis so far, MSF has managed to continue its functionality in all of its locations but we recently had to withdraw from one of them because we felt that the security for our staff and our patients was no longer guaranteed. The issue is that there seems to be a religious dimension (added) to the conflict with rhetoric on both sides; Christians against Muslims, Muslims against Christians. We are seeing some violence from both groups.

Our biggest worry right now is how this conflict could potentially escalate and become further generalised. Right now, most of the acute violence seems to be concentrated in the north west. There’s been an attack on Bouca recently. There’s currently an attack happening on Bossangoa. So these towns are fairly deserted. People are of course fleeing this violence. People are also living in the bush, which is a great concern because we are right in the middle of the malaria season and malaria is already the biggest killer [in CAR] … More than half of our consultations at the moment are for malaria.

The violence is having quite impact on us because we have to move very carefully through some areas in the country. We are not saying it’s generalised. It’s particularly in the mid north west, the area of Bouca, Bossangoa, those are currently the most threatened areas.

What we usually do is we have a base location from where we set up the hospitals. And we have a number of posts from where we do supplies and also supervisions. Supervisions in the north west have been limited because it is too insecure. It is unclear what could be happening. So, we’ve had to suspend movement.

DM: Do you have a team in Bossangoa?

Van der Velden: Yes, we currently have a team of five expats there and five people from Bangui … And then we work together with about 30-40 local staff who are nominated by the local committee who manage the hospital … We are working in the hospital. And normally also we do outreach from Bossangoa but because of the establishment of a new rebel group, we have also temporarily suspended this because we were not sure how the security situation in the wider area was going to be impacted.

DM: And what is the MSF team in Bossangoa reporting?

Van der Velden: What is happening right now is that there is quite a bit of violence around. So the Seleka army are involved in keeping these attackers out. And we have received a fair number of people with violence wounds, between 10 and 20 people at the moment. So we are trying to attend to them.

DM: To clarify, you’re saying there are currently clashes underway in Bossangoa?

Van der Velden: Yes, exactly. This is something that started today. And this comes after an attack on Bouka. So, basically the area around Batangafo, which seems to be the stronghold of this new armed group who have from there attacked Bouka last week and then now possibly, I can’t know for sure because I’m not there, but I can only assume that this is the group currently coming towards Bossangoa as well.

DM: From the point of view of MSF in CAR, how best can the international community assist the humanitarian situation in the country?

Van der Velden: It is very important to keep CAR on the political agenda, to keep on talking about it, to also keep government and other parties doing their best to improve the security situation, to stabilise the country and then there’s a fair amount of external help required to get the main sectors back on track like the health sector. DM

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Photo: A soldier from the Seleka rebel alliance stands guard as the Central African Republic’s new President Michel Djotodia (not pictured) attends Friday prayers at the central mosque in Bangui March 29 2013. REUTERS/Alain Amontch

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