Nearly every province in the Central African Republic (CAR) is under the control of one or more of the armed factions that have proliferated in this small central African nation. According to a report published in 2017 (Splintered Warfare), the number of armed factions has ballooned from four or five in 2013 to over 14 known armed factions today, in addition to a host of newly created militia groups. Over the past year, civilians in CAR have endured violence comparable to the bloodiest months of the third Central African civil war in 2013-2014, which precipitated the deployment of Blue Helmets to the country in an effort to put a stop to the massacres committed by the warring factions. Some areas are now off-limits to humanitarian workers due to the extreme safety risks that they would encounter if they tried to enter.
Click on the link to see an interactive map and timeline of the main incidents in the Central African Republic in 2017.
Civilians are paying the heaviest price in this conflict. In this country of 4.5 million, one person in five has been forced to flee their home due to violence since the crisis began in 2013; 688,000 people have been displaced and 540,000 are now refugees in neighbouring countries. That is 1.2 million men, women and children unable to return to their homes.
There is an ever-growing need for humanitarian relief, including access to food, water, shelter and education. Thousands are without access to medical care, many of them at risk of dying from preventable diseases like malaria, diarrhoea and respiratory infections, the three main causes of death for children under five in the country. Vaccine coverage in children has fallen from 66% to 55% in the space of just two years; distribution of antiretroviral medicine has plummeted from 74% to 20% for HIV-positive individuals; and tuberculosis diagnoses are down from 60% to 26%. These conditions have put the population in an extremely vulnerable situation.
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The main entrance to the MSF base in Zemio. The base was completely destroyed and looted during the attacks in the summer of 2017. © Mia Hejdenberg/MSF
With fifteen projects located across all the conflict zones, MSF is a direct witness to the disturbing developments in CAR. It has become one of the most dangerous countries for humanitarian workers, with 15 killed there in 2017. The growing number of attacks on medical facilities, ambulances, medical staff and patients are particularly worrying.
In 2017, MSF recorded around forty security incidents, such as physical attacks on healthcare personnel and patients, armed robberies, and murders inside healthcare facilities. MSF was subject to an average of three attacks per month perpetrated against medical facilities, vehicles and personnel. This is extreme, even for a conflict zone. In some places, teams have been forced to stop their work, leaving the population without medical care.
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Leonard Gangbe, 33, farmer, is treated at the Paoua hospital in northwestern Central African Republic. © Alexis Huguet
"Over the past year we have cared for patients who were shot, stabbed, beaten, burned alive in their homes or raped’" explains Frédéric Lai Manantsoa, MSF Head of Mission in CAR.
The healthcare system has almost entirely broken down and ongoing attacks on healthcare facilities, patients and ambulances are making the situation even worse.
The attacks perpetrated in 2017 show a total disregard for humanitarian values and prevent MSF from being able to properly protect patients and staff. The new year has not brought with it any cause for hope. If nothing is done to calm the violence, 2018 will offer no relief to a population that has nowhere to go for refuge. "The healthcare system has almost entirely broken down and ongoing attacks on healthcare facilities, patients and ambulances are making the situation even worse’" Frédéric Lai Manantsoa states.
