Central African Republic

Decades of political unrest and violence among armed groups have fueled a massive crisis in CAR, leaving more than half of the country's 5.5 million citizens in need of humanitarian aid. The country's life expectancy is a mere 54 years. Pregnant women face a substantial risk of death or severe illness due to the scarcity of gynecologists. And child mortality rates rank among the highest globally.

While there was a slight decrease in armed clashes between government forces and opposition armed groups in 2023, violence continued unabated in some regions of the country, leading to extreme poverty and massive displacement and exacerbating the decades-long health care crisis. CAR has one of the lowest access rates to health care in the world: Less than half of the country's health facilities were considered functional in 2023 and there is a severe lack of medical professionals.

In addition, we provided smaller health facilities and community health workers with training and medical supplies to treat malaria, respiratory infections, and waterborne diseases, which are leading causes of death among children. We also facilitated access to care for HIV, sexual violence, and non-communicable diseases such as diabetes and sickle cell. Meanwhile, we handed over to the Ministry of Health our health care initiatives and HIV-related activities in Zemio, Haut-Mbomou prefecture and Boguila, Ouham prefecture, where we successfully introduced a community-based, patient-centered model of care.

Unfortunately, yet again humanitarian workers and patients have not been spared from violence. The UN recorded 169 violent incidents involving threats and attacks. This includes assaults against medical care. In September we were left with no choice but to suspend outreach support in the periphery of Batangafo for several months following a series of critical incidents.

MSF also assisted people affected by violence in neighboring countries who had sought refuge in CAR. In Vakaga and Mbomou prefectures, we provided emergency support to refugees from the conflict in Sudan, and in Ouham-Pendé prefecture, to people fleeing violence between herders and farmers in Chad. Other emergency interventions included vaccination campaigns to curb measles outbreaks in Mbomou and Haute-Kotto prefectures.

In the capital, Bangui, our teams continued to run trauma surgery and post-surgical services at SICA Hospital, the primary facility for surgical emergencies in the city. While at CHUC hospital, our support ensured the only free access to lifesaving care for women with obstetric complications and newborns, as well as for patients with advanced HIV. Our teams also strengthened the provision of sexual and reproductive care and HIV testing and treatment in smaller health facilities.

Tongolo clinic, located next to CHUC, remained a lifeline for survivors of sexual violence, offering essential medical and mental health support alongside guidance for legal recourse and protection.

In October, the release of a report, which compiles figures collected over five years of MSF’s care and commitment to addressing sexual violence in CAR, shed light on the invisible emergency of sexual violence and on the urgent need for comprehensive care and support for survivors.