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Central African Republic

Renewed violence and its impact on access to healthcare in Bria

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The cycle of attacks and violence in 2017 has left Bria’s neighborhoods entrenched or emptied by their inhabitants.

    Attacks of an extreme brutality have this year been directed against the Fulani community, for the most part Muslims, by various groups­—some of them factions made up of Muslim fighters. In May, Christian neighbourhoods were particularly targeted, resulting in over 40,000 people leaving the area in a town populated by about 47,000 inhabitants.

    The newly displaced went to the precarious PK3 sites, in the outskirts of the town. That is also where most anti Balaka and so-called self-defence militias are based. They attack any fighters and civilians who they consider to be “foreigners”, Muslims, Arabs or Fulani, but some have also forged alliances of convenience with ex-Seleka factions, their former enemy. Clashes are frequent between these factions.

    The dividing lines, now deeply marking the geography of the town, deal with identity and various other issues, which cannot be reduced to a conflict opposing Christians and Muslims.

    The town is divided into zones held by rival armed groups, forging volatile alliances. Reprisals and exactions are everyday reality for the population. In this context, any attempt for a family and a sick child or a wounded to leave their neighborhood and reach the hospital puts their lives in immediate danger. Despite the short distance to seek medical care, moving around the city amounts to crossing frontlines and being exposed to attack, robbery, being beaten up or killed based on perceived complicity with one or other side.

    MSF set up mobile clinics in various strategic locations, such as the Fulani enclave in Gobolo, Borno neighborhood and PK3, the camp where live mostly Christian displaced people, in order to facilitate access to healthcare for children under 15 years old injured persons and manage referrals to the hospital when needed.

    Once admitted at the hospital, the medical journey is not over for the most severe cases, which have to be referred to the MSF surgical program in Bangui. Many hurdles may again come in the way to urgent medical care, including threats against MSF personnel who manage the referral.

    Our work consists in providing free medical care to those who need it.

    "Our work consists in providing free medical care to those who need it, regardless of their origins, beliefs, political affiliations and the reason they are sick or injured. It is a medical duty enshrined in in the international humanitarian law. We cannot fulfill it if our team is under threat," said Anne-Marie Boyeldieu, MSF Head of mission in December 2017. Few days before her statement, armed men in Bria stopped an MSF ambulance, pointing guns at the vehicle to oppose the referral of an injured patient to the hospital. The incident was eventually resolved without further violence but the patient could not reach the hospital.  

    In September 2017, more than 30 MSF staff members where forced to flee their neighborhood and found shelter for weeks inside the hospital. “We’re stuck in the hospital, like prisoners. We have to sleep in our office,” said Armel Zengbe, MSF’s nursing supervisor at the hospital. Every morning, an MSF vehicle used to go to pick up other staff members who have sought refuge in PK3 camp and were unable to reach by themselves the nearby hospital to work without risking their lives.