Poverty, Disease, and Malnutrition Remain High in CAR’s Northeast

By Lotte Lenaers

Photo: IMC

IMC screens children for malnutrition and distributes food.

Sam Ouandja, Central African Republic, December 2007 – When International Medical Corps began working in one the most remote areas in northeastern Central African Republic in July 2007, the health centers were totally dilapidated, most people had fled ongoing violence into the bush and the little existing infrastructure was destroyed. Schools were abandoned, wells had been demolished or were contaminated, and seeds and tools destroyed or looted. IMC started running mobile clinics in seven villages and took on the support of two health centers in Ouadda Djelle and Sam Ouandja. IMC also set up a health post for 3,000 Darfurian refugees who had arrived in Sam Ouandja two months earlier.

After more than a decade of neglect, political instability, rampant crime, and armed conflicts inside the country and in neighboring Chad and Sudan, large parts of northeastern CAR have been devastated. Despite a recent peace agreement and a slight increase in basic services a significant number of people are still living in the bush with little to no access to safe water, food, or health care services.

The Humanitarian Consequences
In Sam Ouandja for example, 8,000 of the 18,000 inhabitants have yet to return to their homes. “We don’t see the ‘typical displacement’ here,” says Guy Yogo, IMC Country Director in CAR. “The displaced do not gather in fixed sites but rather move from place to place. Some come to the villages during the day but hide in the bush at night. Recently, our mobile clinics discovered 22 sites around Ouadda Djelle, with people living in very dire circumstances.” IMC’s mobile clinics have successfully reached thousands of displaced but others remain beyond reach.

Many displaced and returnees live in makeshift shelters with difficult or no access to safe water. These living conditions expose them to serious health risks, especially to malaria which has become the most common health problem. According to government officials, 40 percent of all infant deaths occur during the first month of life. Most of these deaths are due to the lack of prenatal care and to preventable conditions like pre-term births, asphyxia, congenital diseases, and unsafe abortions.

Photo: IMC

Refugees from neighboring Darfur have come to CAR for safety and assistance.

The closest hospital to IMC’s programs is around 350km away, a trip that can take days. IMC therefore handles caesarean sections and other emergency obstetric cases in its health centers. As many as 40 percent of all IMC-assisted deliveries involve complications. For example, 45 percent of children born at the health centers have a low birth weight (under 2,500g) indicating the need for nutritional support of pregnant women.

During the recent fighting in March 2007 the looting of seeds, tools, and stocks resulted in a failed harvest. IMC is now seeing signs of high acute malnutrition; in some villages it’s topped 30 percent and IMC expects that food security will remain a problem over the next couple of months. IMC received more than 1,500 patients in its therapeutic and supplementary feeding program in Sam Ouandja over the last months, including over 100 severely malnourished children. “The word of our services is spreading to other villages and to people in the bush. We have seen mothers walk from villages as far as 125km away to register their children in our feeding centers,” says Felicien Djamby-Sangui, IMC nutrition assistant in the therapeutic feeding center in Sam Ouandja.

Overcoming Obstacles
The austerity of northeastern CAR is a serious barrier to humanitarian assistance. Roads are accessible only outside of the rainy season, which lasts about six months, and even then the 700km trip from the capital Bangui can take over a week. IMC and other NGOs are heavily dependent on air transport for personnel and supplies, increasing operational costs for an already under-funded mission. What’s more, finding qualified local staff in the area where they are needed most is extremely difficult as most professionals have fled the region and there is scant government staff stationed outside the bigger cities.

Today in Central African Republic many humanitarian needs are still unmet, yet one can choose almost any village on the map in the northeast and find a compelling reason to deliver services there. This remote region does not capture headlines, so it is only because aid organizations have remained committed that the need is being discovered at all. Increased involvement and a serious commitment of the international community are essential to make a lasting difference, and to let the thousands of people in this region know they have not been forgotten.

Lotte Lenaers is a program officer who visited IMC’s field sites in remote northeastern CAR in December 2007.