Cen­tral African Repub­lic: A Failed State Im­plodes

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The teem­ing hos­pi­tal grounds in Bos­san­goa, a north­west­ern town in the Cen­tral African Repub­lic (CAR), of­fers a glimpse into the wors­en­ing cri­sis the coun­try has faced since a rebel al­liance known as Seleka took power by force in March 2013.

Over a thou­sand peo­ple are seek­ing shel­ter in the fa­cil­ity. Amid clouds of smoke from cooking fires, chil­dren sit list­less, women pound maize and groups of men stare off into space.

“We’re here be­cause of the Seleka, who came to our vil­lage, looted, ran­sacked and killed,” said Prophete Ngay-bola, a father of eight with an­other on the way.

“We’ve lost our houses, our fields, our goods. Houses were razed with all our things in. We are... I don’t even know what to call us. We have noth­ing now. I can’t even go to my house or fields. If they see me there, they’ll kill me.”

Hu­man­i­tar­ian and devel­op­ment in­di­ca­tors were dire be­fore the coup, but now, amid in­creas­ing vi­o­lence by armed groups and be­tween com­mu­ni­ties and re­li­gious faiths, they are even worse: al­most the en­tire pop­u­la­tion of 4.5 mil­lion has been af­fected; 1.1 mil­lion peo­ple out­side the cap­i­tal, Ban­gui, are es­ti­mated to be se­verely or mod­er­ately food-in­se­cure; and there are al­most 400,000 in­ter­nally dis­placed peo­ple (IDPs), dou­ble the fig­ure of just a few months ago.

Around 65,000 peo­ple have fled the coun­try, most to neigh­bour­ing Cameroon.

“CAR was a failed state be­fore. Now, it’s just worse,” said Amy Martin, coun­try head of the UN Of­fice of Co­or­di­na­tion for Hu­man­i­tar­ian Af­fairs (OCHA).

“We’re es­ti­mat­ing over 1.5 mil­lion peo­ple who need as­sis­tance of var­i­ous kinds, whether it’s health, nu­tri­tion, shel­ter, pro­tec­tion,” she said.

But se­cu­rity con­cerns mean that aid agen­cies, whose ve­hi­cles have come un­der at­tack, can only guess at what’s hap­pen­ing in some ar­eas, and Martin said the ac­tual num­ber of peo­ple af­fected by the cri­sis could be much higher.

Ad­e­quate re­sponse is fur­ther ham­pered by a lack of funds: just 44% of the $195 mil­lion dol­lars sought to tackle the cri­sis has been forth­com­ing.

Sit­u­a­tion dire

“In most of the coun­try, we’re very wor­ried about the level of vi­o­lence we’re see­ing and that we’re hear­ing about and [that we] get pa­tients from in our hos­pi­tal,” says Ellen Van der Velden, head of MSF Hol­land, which is op­er­at­ing in Bos­san­goa. The team has chil­dren un­der five re­cov­er­ing from bul­let wounds.

Over 36,000 peo­ple are seek­ing refuge at Bos­san­goa’s Catholic Mis­sion, af­ter flee­ing a coali­tion of rebels-turned-“govern­ment” forces that Michel Djo­to­dia, a north­ern Mus­lim, en­listed to bring him to power in the March coup.

Made up of large num­bers of mer­ce­nar­ies from neigh­bour­ing Chad and Su­dan as well as most of the coun­try’s for­mer prison pop­u­la­tion, these forces are mainly Mus­lim, and have ex­acted a deadly

re­venge on mainly Chris­tians in for­mer Pres­i­dent Fran­cois Boz­ize’s home­land. France has warned that CAR is “on the verge of geno­cide” be­cause of the spi­ralling sec­tar­ian vi­o­lence.

Self-de­fence groups call­ing them­selves “anti-bal­aka” – armed with ma­chetes, bows and ar­rows and spears – have sprung up and com­mit­ted atroc­i­ties not only on Seleka but also on the wider Mus­lim com­mu­nity. Such in­ter-faith con­flict is a new phe­nom­e­non in CAR.

As armed groups trawl the area, loot­ing, killing and raz­ing crops and homes, vil­lages on the 100 km stretch of road be­tween Bos­san­goa and the cap­i­tal Ban­gui lie empty. The only signs of life

IRIN found were goats wait­ing pa­tiently for their own­ers.

Sick and in­jured

Aside from the ter­ror, peo­ple are suf­fer­ing from ill­nesses as they hide in their fields with no shel­ter, medicine and food. Only the bravest or sick­est take the high­way to seek med­i­cal help at Bos­san­goa Hos­pi­tal.

“I’m ab­so­lutely wor­ried that there are many cases out there that we can’t reach. Not only vi­o­lence, but the malaria,” said MSF doc­tor Florin Ou­de­naar­den. In the 10 days she has worked at the hos­pi­tal, the MSF team there has seen four chil­dren die, as many come in so weak­ened by anaemia, malaria and mal­nu­tri­tion that it is im­pos­si­ble to re­vive them.

A four-year-old boy screams be­tween doses of painkiller­s, his legs sus­pended from the ceil­ing; he was shot through the hips dur­ing a re­cent at­tack on a gold mine 25 km from Bos­san­goa.”

Van der Velden says that aside from the vi­o­lence, malaria is the big­gest killer, es­pe­cially among chil­dren. At a re­cent out­reach clinic, 120 out of 200 chil­dren tested pos­i­tive for it.

A two-year-old boy with se­vere malaria was re­cently rushed to the clinic by the out­reach team, only to die on ar­rival.

“If we had got there a day ear­lier, we could have saved him,” she says.

Among the lat­est child vic­tims at the hos­pi­tal are a skele­tal boy hooked up to a drip and cov­ered in foil paper, who can barely blink for lack of strength.

An­other is a four-year-old boy who screams be­tween doses of painkiller­s, his legs sus­pended from the ceil­ing; he was shot through the hips dur­ing a re­cent at­tack on a gold mine 25 km from Bos­san­goa. MSF’s sur­geon doubts he will ever walk again; the bul­let shat­tered his joint, re­quir­ing what would be a com­pli­cated and ex­pen­sive pro­ce­dure in the best of places.

Aid lim­ited

Due to in­se­cu­rity and a lack of fund­ing, UN agen­cies are only work­ing in the towns, and the time and man­power of the In­ter­na­tional Com­mit­tee of the Red Cross (ICRC) and MSF are lim­ited com­pared to the scale of the cri­sis.

“Peo­ple are dy­ing out there that can’t ac­cess health care, and that’s def­i­nitely a big con­cern,” says Van der Velden.

“Our prob­lem right now is that we can­not go be­yond Bos­san­goa as we are un­der­funded,” says Pablo de Pas­cual, emer­gency co­or­di­na­tor for the UN Chil­dren’s Fund (UNICEF), which has a $20 mil­lion deficit in fund­ing for CAR.

UNICEF has car­ried out a mas­sive vac­ci­na­tion cam­paign for un­der-fives, and MSF is also join­ing the fight against dis­eases such as measles, which have flour­ished in CAR in re­cent months.

Ou­de­naar­den, whose last post­ings were Syria and South Su­dan, says that her team is do­ing “six or seven blood trans­fu­sions a week, which is very high com­pared to other projects I’ve worked with. We also see a lot of mal­nu­tri­tion, and mal­nu­tri­tion is go­ing up quickly.”

“We are plan­ning to ad­dress high lev­els of mal­nu­tri­tion in the com­ing months,” says de Pas­cual. As the rains end, the coun­try will start its lean sea­son with­out any­one to har­vest crops.

With vi­o­lence rag­ing across the coun­try’s tra­di­tional bread­bas­ket in the north, Martin is also con­cerned about the lack of food, both for peo­ple there and in the rest of the coun­try. Most mar­ket mech­a­nisms through­out CAR have col­lapsed, and there is the block­ade on trucks mov­ing to the cap­i­tal.

Time bomb

Each day, around 40 peo­ple ar­rive at Bos­san­goa’s Catholic Mis­sion, a site span­ning only 19 hectares, spark­ing fears about dis­ease out­breaks. Hu­man­i­tar­ian norms rec­om­mend 160 hectares for its cur­rent pop­u­la­tion.

De Pas­cual says liv­ing con­di­tions have been “de­te­ri­o­rat­ing since the be­gin­ning due to a lack of ac­cess of ba­sic pub­lic ser­vices and in­creas­ing num­bers in the IDP sites,” spark­ing fears of cholera.

Re­nate Sinke, MSF’s project co­or­di­na­tor in Bos­san­goa, de­scribes the liv­ing con­di­tions as “hor­ren­dous” and thinks the scene is set for an epi­demic.

“My non-med­i­cal opin­ion is that I think it’s a time bomb,” she says.

The site has two open defe­ca­tion fields, no hand-wash­ing points and not a sin­gle shower. Still, di­ar­rhoeal dis­eases are so far low.

“We have now seven litres of wa­ter per per­son per day. Last week we had four litres – and it should be 15,” says MSF wa­ter and san­i­ta­tion co­or­di­na­tor Rink de Lange. There are only 65 work­ing la­trines. “That means that, at this time, we have one la­trine for 450 peo­ple, when the stan­dard is one in 20. So that’s a mas­sive gap that has to be filled. And of course the lo­ca­tion of the camp is so dense that it’s hard to find places to build la­trines,” he says.

And peo­ple do not dare to leave for fear of en­coun­ter­ing the ex- Seleka.

“We still hear sto­ries of peo­ple liv­ing only 500 m away from this place and don’t dare to go back into their houses,” says Sinke.


In­sta­bil­ity has pushed 70% of the na­tion’s chil­dren out of ed­u­ca­tion, and seen 3,500 re­cruited into rebel forces, and an unknown num­ber re­cruited into the anti-bal­aka.

“There are no chil­dren com­ing to school be­cause of their bru­tal­ity. How can they come to school? Kids can’t, par­ents can’t. We just have to stay like this,” says teacher Lau­rent Nam­neonde, who is now tak­ing shel­ter in the mis­sion’s school, where he taught for 10 years.

Lu­cien Rekoi is luck­ier than most in Bos­san­goa, who fled only with the shirts on their backs. With a heav­ily preg­nant wife, he made it to the mis­sion with pots, pans, clothes and his iden­tity cards.

His daugh­ter was born six days ago. He now scours the site look­ing for in­ter­na­tional aid work­ers who will lend her a west­ern name, in the vain hope that this and his de­ceased father’s ca­reer in the French mil­i­tary might af­ford them a pass­port out of CAR.

“I just want to go there [to France]. There’s noth­ing for this place now,” he says.

Many of the vil­lages south of Bos­san­goa are ru­ined and de­serted.

Around 36,0000 peo­ple have made a tem­po­rary home of the Catholic mis­sion in Bos­san­goa.

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