Johan Berg works as a doctor for MSF in Bangassou, in the southeastern area of Central African Republic, on the border with Democratic Republic of Congo. Among other projects elsewhere in the country, MSF runs a hospital and three health centres here in collaboration with the Central African Ministry of Health.
I was woken by our logistics responsible at 06am Saturday morning. He informed me that there was open fighting in the town. I did not expect it would happen so suddenly, even if I knew there was a high risk.
No sounds were heard except for the shots being fired. Nobody dared to leave their house. As we got the information that all the bridges leading to the hospital had been destroyed, it was impossible for us to reach the hospital by car. After assessing the security situation, we decided to send a team to the hospital to have an idea of the situation there. Our ambulance, parked at the hospital, met us at the river and the team crossed on foot. The security situation did not allow me to go to the hospital that first day. It was hard to stay put without being able to do anything to help.
I was able to go to the hospital on Sunday. Le quartier Tokoyo, a part of town next to the hospital, was set alight. We still heard bullets flying. The only people that dared to come to the hospital were those with no other choice: the wounded, many of whom had gunshot wounds. Normally, around 100 patients per day come to our emergency room, most of them children. But on that day none came and to my knowledge, most, if any, of the health centres were not operating.
But on that day none came and to my knowledge, most, if any, of the health centres were not operating.
The patients that come to our hospital are usually very ill, especially at the moment since we are in the middle of the malaria season. It was hard to know that all these patients who would normally come to our hospital, were out in the villages and in the woods hiding without any treatment. We know that this means that many of them will die and that those who survive will be very ill when they finally dare to come.
On Monday, the wounded kept coming. Many were severely hurt. A few people very sick with other illnesses also came. We saw children convulsing from severe malaria, unconscious because of low blood sugar and/or anemia. We also saw people in severe emotional shock.
Several times we had to throw ourselves to the ground for shelter while trying to provide healthcare to our patients.
One woman, who was five weeks pregnant, had seen her husband killed in front of her eyes. After that she was tied down and beaten with rifle butts. She, like hundreds of others had fled to the hospital to seek protection. She was 20 years old and was there with her four children. The stress was too much for her. She could barely stand up, let alone walk. Both Sunday and Monday there was fighting going on just outside the gates of our hospital. Several times we had to throw ourselves to the ground for shelter while trying to provide healthcare to our patients.
Many of our national colleagues were missing. Progressively we received news of their wellbeing and now have news from almost everyone. Some staff are staying at the hospital; many of them arrived with their children and do not dare to leave. Many have also fled the violence and are hiding.
We lack many of the people who are crucial in ensuring that the hospital services continue running in a moment of such high need: nurses, but also support personnel such as cleaning staff. Some people work for 24 hours straight. After that, they sleep a few hours and start work again. Since all the markets are closed and the security situation makes it impossible for airplanes to land, it is difficult for us to find enough food for both patients and staff.
We have only one surgeon who is working as fast as he can but the high number of patients means that many have to wait for surgery. One example is a 15-year-old child who had a penetrating gunshot wound through the chest. We support our patients as well as we can with antibiotics, liquids and blood transfusions until they can have surgery. As soon as a plane can land we hope to have some reinforcements.
The Red Cross had to borrow body bags from us to be able to bury some of the dead.
We have received reports of several deaths from the fighting. It is unclear exactly how many. The Red Cross had to borrow body bags from us to be able to bury some of the dead.
A large part of the population is displaced. Some are hiding in the forest, others in town. We have sent a team to a site where more than 1,000 people are hiding. Many are dehydrated because of the heat. They lack food and clean water and are living in conditions that could lead to spread of disease. We have been able to give them some rehydration salts, emergency nutrition and healthcare and we are helping set up sanitation facilities.
The town is a bit calmer, however still not safe. While more patients have come to the hospital, we are still mostly seeing those who are the severely ill, the majority of them children. The wards are filling up with sick people and we lack staff.
There is not enough room on the wards. Some of the wounded are staying in tents on hospital grounds where the temperature reaches 40 degrees Celsius during the day. They are also lying tightly squeezed together on mattresses in our offices. It is likely that the sick will continue to arrive and that the hospital will continue to fill. Staff are exhausted. New outbursts of violence can start at any minute.
The population is in need of safety, medical care, clean water, malaria treatment and psychological support. We will continue to do our work.
* Main picture : among the people who sought refuge in the mosque, there were several wounded and the corpses of several dead.© MSF