FEATURE – Gun battles in Central African Republic cripple access to healthcare


Thomson Reuters 2


Source: Thomson Reuters Foundation

Author: Tom Esslemont


A doctor with the charity Médecins sans Frontières (MSF) examines one of Marceline Wanou’s two sons as they recover from malnutrition in hospital in Bambari, Central African Republic. Picture taken 10th November 2015. THOMSON REUTERS FOUNDATION/Tom EsslemontA doctor with the charity Médecins sans Frontières (MSF) examines one of Marceline Wanou’s two sons as they recover from malnutrition in hospital in Bambari, Central African Republic. Picture taken 10th November 2015. THOMSON REUTERS FOUNDATION/Tom Esslemont


BAMBARI, Central African Republic, Nov 24 (Thomson Reuters Foundation) – After gunmen burned down her village in scrubland of Central African Republic’s Ouaka region, Marceline Wanou fled into the forest with her two young sons, hoping to return in a few days.


Nine months later Wanou has yet to go back, spending six months struggling to survive in the forest until a team of aid workers in July discovered her and 350 other members of her community, badly malnourished with many barely able to walk.


« I was just trying to save my children but after five months of hiding I realised we might all die, » said Wanou, sitting on a hospital bed in Bambari, the main town in the country’s southern municipality that borders Democratic Republic of Congo.


Like millions of others, Wanou’s life has been turned upside down by fighting in the former French colony, where Pope Francis is due to visit later this month despite violence between opposing rebel groups ongoing since 2013.


Clashes between mainly Christian anti-balaka militias and mainly Muslim Seleka factions risk derailing internationally-backed presidential and parliamentary elections now due on Dec. 27 after being postponed in October due to violence.

Wanou is one of nearly 500,000 people from a population of 4.6 million forced to flee their homes by repeated cycles of violence, isolating them from access to the few remaining medical facilities that have not been destroyed.


The battles in Ouaka earlier this year were so intense that Wanou’s mainly Christian community of about 350 people was cut off from humanitarian aid supplies on which they had come to depend and from their home-grown crops.

Wanou said they survived the months in the forest by eating cassava leaves that provide little protein or nutrients. They were unable to seek help with intermittent fighting around them.

When found many of the children in the group displayed signs of severe malnutrition – red hair, swollen feet, bloated stomachs, loss of appetite – said Nicolas Peissel, project coordinator for the charity Médecins sans Frontières (MSF) that found the group.




« We found 24 percent of children under 5 had severe acute malnutrition, which is almost unheard of in the entire country, » Peissel told the Thomson Reuters Foundation.

United Nations agencies define levels of more than 10 percent severe malnutrition as an emergency.


A nationwide survey found one in 50 children aged between 6 months and 5 years old in Central African Republic tested positive for severe malnutrition in 2014, according to the United Nations children’s agency, UNICEF.

Wanou – who looks to be in her late thirties but does not know her age – and her sons were taken to the only functioning hospital in Bambari, where they have spent the last four months.


« It was like a miracle when the (MSF) aid workers came. For the first time I had hope there would be a way out, » said Wanou, barely audible above the sound of a sick child in a nearby bed.


In Ouaka alone, 80,000 people have been forced from their homes by a recent upsurge in fighting, according to United Nations figures, with many civilians too scared to cross front lines to seek help at hospitals and clinics.


Tense front lines have sprung up across Central African Republic where 10,600 U.N. peacekeepers and around 900 French troops have struggled to keep warring factions apart.

Religious tensions have also affected hospital staff, with some doctors and nurses of one faith refusing to work for fear of being mistreated by colleagues of the other.

« With 70 percent of health structures destroyed and with no existing permanent clinics, access is very difficult because of the violence, » Peissel said.


The conflict has impacted MSF’s activity. It was forced to restrict the movements of its medical teams in the capital, Bangui, after one of its teams was attacked by armed men and a vehicle stolen last week by a camp for displaced people.




In Bangui, international forces patrol eerily quiet streets in armoured vehicles past dishevelled groups of armed boys and men, known as self-defence units, outside boarded-up cafes.


The uneasiness is especially palpable in a mainly Islamic area known as PK5, one of Bangui’s most dangerous districts, where renewed violence erupted in September after a Muslim man was killed. Pope Francis is due to visit the main mosque in PK5.

The turbulence lead to an increase in patients seeking treatment in some of the city’s hospitals but many people are still cut off from aid and health services, MSF said.

In Castors, a maternity clinic run by MSF, the number of babies born fell to 334 in October from 884 in July.


« We can only draw the conclusion this is because people are more and more scared to leave their homes and come and seek safe treatment, » said Christine Januel, MSF project coordinator.


The fear is that more babies will suffer health complications, Januel added, in a country where the maternal mortality rate of 880 per 100,000 live births is among the worst in the world, according to the World Health Organisation.


In PK5, Muslims mostly displaced during reprisals by militias in December 2013 camp out near the main mosque in tiny makeshift shelters of rusty iron sheets and plastic sheeting.

« It’s too dangerous to go to hospital because of the armed groups on the streets, » said Muslim woman Fane Oumar, adding her house was looted and torched by Christian gunmen two years ago.


Oumar, who was three months pregnant at the time, said the attackers killed her brother but spared her after she collapsed.

The PK5 community depends on visits, weekly if security allows, from doctors in an MSF mobile clinic.


But the country’s worsening instability and living conditions have not dented local optimism, with Oumar and other Muslims hoping the Pope’s visit on Nov. 29-30 will achieve some good. The last pontiff to visit was Pope John Paul II in 1985.


« I think people no matter what their faith can understand the message of non-violence that the Pope brings, » said one woman sheltering at the mosque.


(Reporting By Tom Esslemont, Editing by Belinda Goldsmith; Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters, that covers humanitarian news, women’s rights, corruption and climate change. Visit www.trust.org)