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Central African Republic (CAR) is roughly as large as France, but has 15 times fewer people (4.5 million inhabitants). It is rich in natural resources, including gold, diamonds, uranium and timber. 

Since its independence in 1960, CAR's history has been punctuated by periods of relative calm and upswelling of violence and political instability. The most recent conflict took place in 2013  ̶  2014, when coalition from the north-east of the country supported by neighbouring countries, overthrew the government. The conflict soon spread to the whole country and, by the end of 2014, thousands of people had been killed, 438,500 were internally displaced and 308,700 were refugees in Cameroon, Chad, Republic of Congo and Democratic Republic of Congo. 

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Men are too afraid to leave their homes, as they fear being targeted by armed group if they go to town. Photo: Lali Cambra/MSF

There are 14 recognised armed groups in the country. Not all armed groups are active today and many exist only on paper. There are also “Auto-defense” forces or groups – armed civilians whose stated goal is to protect their villages (though their agendas and potential political affiliations are often unclear). 

Armed groups run parallel administrations in various areas, including parallel taxation systems to fund their activities. The division of territory between these armed groups, and their fight over political agendas and/or the control of wealth and road access, mean that many areas of the country are volatile. Outside Bangui, the central government has very little military power or police  strength, and administrative officials often return to Bangui at the first sign of conflict.  

Stagnation and sliding back into violence – an overview of the past 10 months

Since September 2016, the security situation has been deteriorating again in CAR. This new cycle of violence started in Kaga Bandoro with a small incident between a local “auto-defense” group and members of the MPC (Mouvement Patriotique pour la Centrafrique), which quickly led to the whole town being set on fire and to 19,000 people being displaced. 

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The conflict in CAR has caused more deaths, more wounded and more displacement amongst the civilian population. Photo: Colin Delfosse/Ouf of Focus

In October 2016,attempts to bring about unification of the different factions failed in Bria. Tensions escalated for weeks triggering heavy fighting. Conflict spread from Bria towards Bambari, while Ndassima, Bakala and Ippy were taken over by coalition led forces. 

In the second half of February 2017 Bambari was declared “a town free from armed groups” However, while Bambari is touted as a success in peacekeeping, the effect of its intervention has resulted in fightin spreading outside Bambari and into areas of the east that were previously less volatile. 

MSF's Response to the Recent Violence: 

November 2016 – Bria: 

Civilians came under attack in November 2016 and the fighting spread spread over to other villages and locations. Thousands of people were forced from their homes. In collaboration with the NGO International Medical Corps and the Ministry of Health, MSF teams responded to the situation by supporting supporting surgical trauma care and setting up mobile clinics. Fifty-four wounded were treated at Bria hospital in November, 22 in the mobile clinics, and many more remained out of our reach. MSF’s surgical team remained in Bria until February 2017, taking care of the most direct victims of violence during the following months.

January 2017 – Mbres (Nana-Grebizi):

MSF deployed its emergency team to assess the situation of IDPs fleeing fighting around Bambari. Four wounded patients were referred to Kaga Bandoro and the team reinforced Mbres hospital and conducted an emergency multi-antigen vaccination campaign for 1,200 children. 

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MSF supports Bambari’s hospital and two health centers, Kidjigra in the Christian part of the city, and Elevage in the Muslim area.
Photo: Sylvain Cherkaoui/Cosmos for MSF 

February/March 2017 – Maloum (Ouaka): 

MSF launched a response for the people who had fled Bria and Bambari and regrouped at a site in Maloum. MSF distributed over 15,000 essential relief items to displaced people. The team also organised a multi-antigen vaccination campaign for over 5,000 children and for pregnant women. 

May 2017 – Alindao, Bambari: 

On 8 May 2017, clashes in Alindao caused the displacement of 16,000 people both within the town and towards Bambari. An MSF team started supporting Alindao hospital and health centre on 24 May, and admitted 63 patients to the hospital in two and a half weeks, including 32 who had gunshot or knife wounds and 11 who needed to be transferred to Bambari for more extensive treatment, where another MSF team had scaled up its activities since October 2016 to address the increased needs there. MSF also vaccinated 5,675 children against measles and 2,555 with a multi-antigen vaccine. Currently, 60% of the population of Bambari are IDPs, totalling 57,000 people, 10,300 of whom have arrived since mid-March this year. In May, MSF’s team in Bambari treated 22 people with war-wounds, including four children. Most suffered gunshot wounds with open fractures. In total, the team treated 162 war-wounded from November 2016 to May 2017. 

May 2017 – Bangassou: 

Bangassou had been relatively stable since 2014, However, all this changed on 13 May when the town was attacked by an unknown armed group: bridges were destroyed, phone lines cut and the neighbourhood  of Tokoyo was targeted. Since 13 May, MSF’s team has provided care to 133 wounded people and consultations to 1,100 patients during mobile clinic in places where displaced people have gathered. The team has also vaccinated around 420 children.

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MSF also launched mobile clincis in Bria and the surrounds villages, providing 860 consultantions to IDP's.
Photo: Sylvain Cherkaoui/Cosmos for MSF

May 2017 – Bria: 

Fighting erupted in Bria on 15 May between coalition led members and and local “autodefense” forces. This led to the 41,000 people being displaced in and around Bria out a total of 47,000 inhibitants. Most are now gathered in PK3 IDP camp, which  was initially planned to accomodate 3,000 people and today hosts 25,000. Some 6000 displaced people sleep in the hospital compound each night. 

The Ministry of Health, InternationalMedical Corps and MSF teams in Bria launced a contigency plan. Between the 15 May and 18 May, a total of 41 casualties received treatment in Bria. Hospital. Durinf the last two weeks in May, there were1,100 outpatient consultantions linked to the crisis. MSF also launched mobile clincis in Bria and the surrounds villages, providing 860 consultantions to IDP's. MSF also supplied water to PK3 camp and helped build laterines. 

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Consequences of the violence on humanitarian needs 
The violence has led to over 600,000 people being internally displaced nationwide, the highest number since April 2014. The renewed fighting has also forced 60,000 people to cross into Democratic Republic of Congo since the end of April 2017. Alindao, Bria and Bangassou (among others) have seen the overwhelming majority of their populations displaced (16,000 displaced people in Alindao out of a population of 18,000, and 41,000 displaced in Bria out of a population of 47,000). In Bangassou, 2,000 displaced people still live on the site of the Catholic church and 7,000 people sought refuge on the site of Zemio health centre when fighting started in June. Those sites are not adapted to their needs and lack basic services such as water, latrines and shelters, increasing the risk of epidemics.

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People are seeking refuge in hospitals, churches and mosques, but are also hiding in the bush for long periods of time. In addition to war wounded people, MSF sees the direct consequences of violence on the health of civilian populations: children not able to reach medical facilities during malaria season; regular vaccination campaigns, HIV and tuberculosis (TB) treatment interrupted; pregnant women left without assistance when they deliver.