Health care one of the first casualties of the conflict

26-08-2014 Article

The fighting between various armed groups, which has wrought havoc in the lives of people across the Central African Republic, has not spared the country’s health-care system. “Unfortunately, the hospital is facing enormous security problems,” explained JoélNganafeï, chief of the emergency surgery unit at Bangui Community Hospital.

Community hospital, Bangui, Central African Republic. A nurse is taking care of a patient. © ICRC/R. Mazboudi

Bangui hospital is the only referral hospital for trauma care in the entire Central African Republic, and one of the few places still operational despite the violence. Nevertheless, patients and staff are not completely safe there, and buildings have been damaged. This is by no means an isolated case. Government buildings, schools and other hospitals have been ransacked. In addition, the impact of the conflict on the health-care system is not limited to regions directly affected by the violence. Recent fighting has added to the extreme burden borne by the country’s already dysfunctional system.

The main challenges to access to health care are a lack of security and qualified staff, and insufficient infrastructure. The pillaging of hospitals in Mbrès and Dékoa in 2013 is a case in point. Armed men entered the hospitals, looted the offices and stole medical and other equipment, including the refrigerators needed to keep drugs at the right temperature. Most of the medical staff fled as a result of the attacks, bringing the hospitals to a near standstill. Civilians, the main victims of the chaos, now face the spectres of malnutrition and disease, as well as ongoing violence. In the provinces, the previously creaking medical supply system has now completely collapsed. Fear and the unstable situation place further obstacles between people and access to health care.

It is vital that wounded people be protected and have rapid and unhindered access to medical care. Health-care workers and facilities must  also be respected. Only by ensuring that everyone protects and respects health-care workers and facilities can the fate of patients in the Central African Republic improve.


Between December 2013 and the start of July 2014, the International Red Cross and Red Crescent Movement worked to:

Community hospital, Bangui, Central African Republic. A man victim of the clashes receives medical treatment. 

Community hospital, Bangui, Central African Republic. A man victim of the clashes receives medical treatment.
© ICRC / R. Mazboudi

  • evacuate more than 1,000 injured or sick people;
  • perform over 1,500 operations at Bangui Community Hospital;
  • carry out over 21,000 medical consultations from its mobile units in the Kaga-Bandoro region;
  • treat 3,000 patients, mainly women and children, from the French Red Cross’s mobile clinic in Bangui;
  • provide care to 200 people in the west and 1,400 in the south-east of the country;
  • examine and treat 7,200 patients at the health-care centre at Saint-Sauveur in Bangui;
  • build 1,000 latrines in camps for displaced people and in schools in Bangui, and deploy 50 volunteers to teach good hygiene practices;
  • provide follow-up care to 3,000 patients living with HIV at the outpatient clinic of Bangui Community Hospital;
  • provide psychosocial support to 291 volunteers working for the Central African Red Cross;
  • raise awareness among 14,500 people in camps in Bangui of the effects of stress and gender-based violence;
  • refer 248 victims of gender-based violence to specialized care centres;
  • broadcast six public service announcements in the Bangui region, calling on all parties to the conflict to respect health-care staff and facilities.

Health-care activities carried out by the Central African Red Cross Society were supported by the International Committee of the Red Cross, the International Federation of Red Cross and Red Crescent Societies and the French Red Cross.

Humanitarians with a passion

In the Central African Republic, violence against health-care staff and facilities has reached unprecedented levels.

“One day, as we were transporting an injured patient in a pick-up truck, we were stopped and our patient was stabbed to death right there” said an angry Antoine Mbao-Bogo, the president of the Central African Red Cross. “This kind of situation is completely unacceptable: patients and first-aid workers must be protected.”

The Central African Red Cross’s mission is to alleviate the suffering of the most vulnerable people. In such a dangerous environment, it is a difficult ask. For many months, they have been doing their utmost to bring aid to victims of the deadly violence in the country; its volunteers readily head out into the streets, where they risk being caught in the cross-fire. Their task requires a great deal of courage, especially given the high price that the volunteers themselves are paying.

The 250 Red Cross volunteers are often among the last health-care workers to come back in off the streets, where they evacuate and care for the wounded, recover dead bodies and take them to the morgue for burial. In the provinces, where the volunteers’ task is often even harder, they do everything in their power to bring aid to those who need it most.

Volunteers work to avoid potential health-care crises. Universal trust and confidence are vital to ensure that the Central African Red Cross is able to support all victims of conflict, without discriminating against any community. Every day, Red Cross volunteers demonstrate real passion for their humanitarian mission: their dedication is essential given the extreme need on the ground. It is therefore even more vital for all parties to the conflict to respect and protect them.

>> HCiD newsletter, August 2014