“You’ll see, it’s hell here…”

Violence in Central African Republic has forced over a hundred thousand people to leave their homes and livelihoods behind and take refuge in M'Poko

Even before touching down in Bangui, the scene is set. Flying over the city, you first see the suburbs. You can clearly make out vehicles and residents wandering about, however, it is far from the hustle and bustle typical of so many African capitals. Then there is a neighbourhood that is completely empty. No people and no movement… Finally, we arrive at the airport of the capital of the Central African Republic.

The sight of M’Poko is staggering. It is the largest IDP camp in Bangui. 100,000? 150,000? It is difficult to estimate the number of people who have fled here from the violence in recent weeks. One thing is certain, the density of people at this makeshift camp, located right alongside the runway, is beyond comprehension. Once the plane has landed, the crowd resumes its comings and goings on the runway.

In total, there are hundreds of thousands of people who have fled violence in their neighbourhoods to find refuge in one of many camps of varying sizes and this in a city of fewer than one million inhabitants. With the checkpoints, military convoys and the sometimes-deserted streets, you can understand that there is a constant tension.

My first contact with M’Poko comes the day after I arrive, when I accompany the medical team on the projects MSF has set up in no time: a clinic and two health posts. In the vehicle that takes us there, Francesco, the MSF medical coordinator in the camp, does not mince words. “This is your first time in M’Poko? You’ll see, it’s hell here…”

To reach the clinic, the 4×4 has to crawl along a narrow dirt road; such is the density of the crowd. After 200 metres, the clinic appears. It was set up a few weeks ago on the edge of the camp, when it still contained ‘only’ 30,000 people. With violence rife in the city, it continues to grow and has absorbed the clinic.

On foot, the feeling of having entered some form of giant, living organism is even stronger. Running alongside either side of the path are improvised stalls, shelters, hung sheets, corrugated iron or tents packed tightly side by side. In a post-apocalyptic vision whilst going round a hangar, I see families gathered under the wings of neglected planes which have not flown among the clouds for ages. The living conditions are appalling. There is crowding and a lack of water, food, proper shelter and toilets. The smell of some places is unbearable and there are flies everywhere. I wonder how these families have, for weeks now, been able to live like this…

With the health posts in tents and the clinic located partially in tents and partially in a building, the MSF system is functioning well. Serious cases are referred to the clinic, which has a maternity department, an inpatient area, an emergency department, a consultation area, etc.

The majority of the local MSF doctors and nurses are themselves living in the camp. Passing by each other in these facilities are victims of stray bullets, malaria – which affects even more people than the violence – dehydration or respiratory infections. The most severe cases are sent to the city, primarily to the referral hospital where another MSF team provides the only trauma surgery services in Bangui.

A dilapidated room has been fitted out as far as possible to act as a delivery room. “We deliver 10–12 babies per day,” says Juliane, a midwife. This is equivalent to a large hospital in a mid-sized European city, but without the staff and equipment they would have available. “We have managed to not lose any mothers to date, however I am seeing increasing numbers of miscarriages and premature births due to the living conditions and stress…”

In order to better respond to the needs of the people, MSF is building a hospital right from start to finish on the other side of the camp. Andrea, a logistics specialist, working with over 100 local workers, is busy working to achieve this feat in 10 days, looking occasionally at a plan sketched on a piece of cardboard.

While it is the largest and most striking, M’Poko is only one of many IDP camps in the city and in the country. It is a country plunged into an appalling crisis, which is often forgotten about by the outside world. Christian, a German photojournalist, shows me superb negatives, taken during his travels across the country over several months. “I offered my reports to the major German media organisations,” he says, disheartened. “Their response: ‘not interested’…”