CAR: Doctor at the heart of a humanitarian crisis
Dr. Wilfried Komoyo is the Medical Director at Bouar Provincial Hospital in the west of the Central African Republic.
“I will never forget 31 January 2014,” says Dr. Komoyo. That’s the day when gunfire broke out in the hospital compound between two armed groups, trapping hospital staff and patients inside.
“A hospital is supposed to be a safe haven, so I still cannot understand how it became a battleground, terrorizing both staff and patients,” he goes on. “While I was trapped in the ward, I kept thinking about my four-year-old daughter and wondering what would happen to her if I was killed.”
The political crisis in CAR began in December 2012 and is still continuing. Over the past fifteen months, government offices and health services were looted as the security situation deteriorated. In many parts of the country, people are still reluctant to go to work or send their children to school. Some 940,000 people have fled their homes, 290,000 of them crossing borders into neighbouring countries to escape the violence.
One of the worst health systems in the world
Even before the crisis, the health system in CAR was one of the worst in the world. It is in the bottom ten countries for life expectancy (48 years) and hasthe world‘s fifth highest death rate from infectious and parasitic diseases, according to the World Health Organization (WHO). In 2010, the under-five mortality rate was179 per 1,000 live births and the infant mortality rate was 116 for every 1,000 live births.
Health services were already severely overstretched. The hospital in Bouar serves nearly 300,000 people living in Nana Mambéré Province and conducts between 80 and 100 consultations per day.
In the past fifteen months, this fragile health system has collapsed because of insecurity and shortages of essential drugs and supplies. Many doctors and nurses have fled. Meanwhile demands have increased with many people seeking treatment for bullet wounds. The most common illnesses are malaria, respiratory tract infections, diarrhea and malnutrition.
Medicines and equipment urgently needed
Security in Bouar has improved since the arrival of the African-led International Support Mission to CAR (MISCA) and French forces (Sangaris), but it is still unpredictable. Some of the people who fled the area are slowly beginning to return and trying to rebuild their lives. Joint patrols have been organized so that humanitarian aid and commercial goods can be transported safely, particularly along the road that runs from the Cameroonian border to Bouar.
UN agencies and international NGOs are providing support to the hospital and to three other health centres so that they can provide free healthcare to their patients. This is crucial because most people have lost the means to support themselves as the economy has collapsed. These services will become even more vital with the rainy season approaching, bringing a likely increase in water and vector borne diseases including malaria.
But much more needs to be done. Health facilities need constant supplies of medicines and equipment, particularly anti-malarial drugs and refrigerators to store them.
Money is urgently needed
“I am glad patients are given access to free healthcare,” says Dr. Komoyo. But he adds that this is not sustainable in the long-term .
“A long-term strategy should be established now; the top priority must be to pay salaries,” he adds. Dr. Komoyo and his colleagues are surviving on allowances from humanitarian agencies in Bouar, while WHO and health partners conduct a country-wide assessment as the first step towards a more financially sustainable system.
Funding is a serious problem.The Strategic Response Plan for 2014 calls for $56.4 million for health activities but only $6.6 million or 12 per cent of this amount has been received.
During a visit to Bouar, the Humanitarian Coordinator in CAR, Mr. Abdou Dieng, called for donors to step up.
“The population is facing extreme poverty,” said Mr. Dieng. “I urge the international community to provide urgent assistance because peace can only reign when social and humanitarian issues have been addressed.”
Dr. Komoyo and his colleagues are left trying to help their patients with severely limited resources.
“I would leave in search of greener pastures,” says Dr. Komoyo. “But my love for humanity keeps me in CAR.”