CAR: Supporting a battered health system

23 June, 2014
June 2014, Bangui, CAR: A young girl outside a health clinic on the outskirts of Bangui. The clinic has been rehabilitated with funding from the OCHA-managed Common Humanitarian Fund. Credit: OCHA/John James
June 2014, Bangui, CAR: A young girl outside a health clinic on the outskirts of Bangui. The clinic has been rehabilitated with funding from the OCHA-managed Common Humanitarian Fund. Credit: OCHA/John James

The new ambulance bounces along the red earth roads and into the church yard. Five children ate poisonous wild mushrooms and need to be evacuated immediately.

Six months ago, their situation would have been perilous. Free emergency health services simply didn’t exist here on the outskirts of the Central African Republic’s (CAR) capital Bangui. But then, six months ago the Mission Carmel church yard didn’t have 10,000 displaced people (IDPs) packed together in giant hanger-style tents with hungry children searching for food.

“The crisis has really disrupted health services and many health centres were completely vandalised,” said Dr Ernest Dabire from the World Health Organisation, the head of the Bangui health cluster.

Whether it is poisonous mushrooms or giving birth, two thirds of CAR’s population have no access to health care. Half of the 117 assessed health facilities had been looted in the current conflict, and 80 per cent of health workers are estimated to have been displaced.

A $500,000 grant

The five children are carried into the ambulance and transported to the nearby Bimbo health centre. The centre was recently refurbished by the international medical NGO Alliance for International Medical Action (ALIMA), with US$500,000 from the OCHA-managed Common Humanitarian Fund (CHF).

“We’re really thankful,” said Silvie Kongombe, sitting next to her seven-year-old daughter who’s being treated for malaria. Hospital charges are a painful memory for Silvie. Before the crisis, she lost two children – a boy (3) and a girl (2) – to illnesses because she did not have 4,000 cfa francs ($8) to pay. “We just farm fields and we had no money to pay medical bills.”

More than 32,000 free consultations

Thanks to the three-month CHF grant, ALIMA have rehabilitated facilities at four state health centres, including Bimbo, and two health posts at IDP sites.

ALIMA rehabilitated buildings, installed water tanks, provided staff training and subsidized free consultations and medicines. During the period the CHF grant paid for more than 32,000 consultations as nearby residents and IDPs made use of the services.

One of the key facilities at the Bimbo health centre is the maternity ward. Before ALIMA arrived, the ward was poorly resourced and inadequately staffed. It would only see 20-30 consultations a week, despite covering a resident population of 31,000 and tens of thousands of IDPs. Now prenatal consultations are up to 200 a week.

“There are more staff and we can give a much better welcome to patients,” said Georgette Kozimongo, a government mid-wife at the centre. “When women give birth at home or in the village things are often really unhygienic and there’s a major risk of infections and death. Sometimes the umbilical cord can be cut in the wrong way, and tetanus infections are also a hazard.”

Sanitary concerns

Sanitary conditions at IDP sites in Bimbo are a cause for concern especially as displacement becomes prolonged.

“Lots of people fled to this area and at the IDP sites they are living in very close proximity to each other. Access to clean water and adequate latrines and hygiene is an issue. There are regular problems with parasites and malnutrition,” said Kozimongo.

School teacher Eulalie Mayne-A-Ndja has been living at the Carmel IDP site for several months with her children, with whom she shares a partitioned area of a tent.

“What’s difficult here is first of all the problem of hygiene because health comes before everything,” she said. “Everyone here on this site has to use the same toilet. What can we do? We have to put up with it because we don’t think peace has returned to the areas we live.”

Health services critical, but underfunded

The Bimbo sous-prefecture (district) has more than 100,000 IDPs as of 10 June, according to figures from the Commission for Population Movements (CMP).

“Before people were fearful about coming to the health centres,” said ALIMA’s project coordinator Antonina Chernysheva. “With all the security incidents that have taken place, health services have been overwhelmed. And without staff, medicines and equipment, there wasn’t really much reason to go to the health centres before.”

Aid groups like ALIMA are trying to provide 878,000 people with basic health care. They need $64.3 million to achieve this in 2014. But so far, they have only received about 29 per cent of this funding.

The free health services in south-west Bangui will continue at least. The CHF grant gave the initial impetus to the project, which is now being supported till the end of the year by the European Commission’s Humanitarian Office and the UN Children’s Fund.

“We knew when we started the project that one day we will leave,” said ALIMA’s Chernysheva. “But we work with the health personnel that are there to make sure when we leave, there can still be a quality service.”

The crisis in CAR – and its impact on neighbouring countries – will be the focus of a High-Level Meeting later today at the 2014 ECOSOC Humanitarian Affairs Segment. For more visit

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