Since May 2017, about 80,000 refugees from the Central African Republic have fled across the River Oubangui to the Democratic Republic of the Congo, according to MSF data. The conflict in their home country, which is an often forgotten crisis, does not rest. Violence between rebel groups, who also deliberately target civilians, characterises the region. Young children and women are among those most affected, but really all civilians who just want to live in peace often have no choice but to choose a side, if they don’t want to be killed instantly.
MSF reaches the villags of Gunza, Ngai and Bombo, on the Congolese side of the River Oubangui. Photo: Melanie Tribalet/ MSF
The 80,000 refugees comprise about 80 per cent of the people who had been living in the region on the Central African side of the border, north of the districts of Gbadolite and Mobayi-Mbongo in DRC. Further east though, there are still many more. There are in total 167,000 refugees from the Central African Republic in the north of DRC, according to OCHA.
I arrived in Gbadolite in August, as part of MSF’s emergency unit. We found many people were living in makeshift camps, while others had found refuge with friends and relatives in host families.
All civilians who just want to live in peace often have no choice but to choose a side
Access to healthcare, safe drinking water and sanitation was difficult or absent, malnutrition was widespread in children under the age of five, and malaria was the number one cause of disease. That basic information had prompted MSF to send in our team.
Vera on the River Oubangui. Photo: MSF
Support for the refugees (and the local population) barely exists, though the need is immense and obvious. But before we began any healthcare activities, we collected information to evaluate the situation, to ensure that any intervention would kick off in the right place and with the right measures.
Need to know…
Once on site, we recorded the situation as quickly and efficiently as possible.
How is people’s health? How many people died last month? And how many of those were children under five? Children under five are one of the most vulnerable groups, and are usually the first to show signs of the effects of precarious living conditions.
What are the causes of illness and death? Is there a high number of cases of diarrhoea – a possible indication of precarious hygiene conditions such as lack of access to clean drinking water or latrines?
What are people eating and are there cases of (severe) malnutrition?
And finally, what are the possibilities for access to health care? The strategic and geographic distribution of health centres in the Gbadolite region is generally not bad, but drugs and consultations need to be paid for by the patient, and so are mostly unaffordable for the refugees.
The team at work repairing a water pump in the village of Limozia. Photo: Melanie Tribalet/ MSF
We also collected information on people’s access to safe drinking water and latrines. Many residents source their drinking water from the large Oubangui River, where dead bodies are sometimes found floating, victims of the ongoing conflict in the Central African Republic.
Latrines, on the other hand, are almost non-existent.
For shelter, most people have constructed simple huts in which several families often live at the same time – but whether these huts can withstand the region’s heavy rains is in doubt.
Huge needs, huge plans
Information gathered, let's go?!
Unfortunately, in reality it’s not that easy. Here in Gbadolite, our assessments showed that the needs of the refugees were huge. Which meant we needed to plan accordingly.
Basically, to ensure access to primary and secondary health care, as well as various preventive measures to minimise health risks.
It is not a small plan – but it is not impossible
Specifically, we decided to provide: support for two strategic hospitals in the region, especially for children, pregnant women and emergency cases; access to free primary healthcare in 13 peripheral health centres; support for four mobile clinics in places without other access to healthcare. All this with a special focus on severely malnourished children.
On top of this, we planned a vaccination campaign, plus logistical activities such as building wells for access to safe drinking water and constructing latrines.
It is not a small plan – but it is not impossible.
Canoes used for the mobile clinics upriver. Photo: Melanie Tribalet/ MSF
Up and running
The activities in the two hospitals have been running since September. Here we support the paediatric ward, including the special unit for severely malnourished children. We also work in the maternity ward. Our outreach teams are supporting eight peripheral health centres so far. The four mobile clinics also take place regularly. They are carried out in those places which are accessible only by pirogue (canoe) or by foot and are further away from existing health structures.
More than 360 children have already been admitted to our outpatient nutrition programme for severely malnourished children, and those with complications are being treated at the hospital.
The construction of latrines has also begun and is mostly finished in about 25 locations, and three wells for drinking water have been completed. Our water and sanitation team have also repaired water pumps and completed some other works to improve the local drinking water supply.
More than 360 children have already been admitted to our outpatient nutrition programme
As well as all this, the vaccination campaign is about to start and will provide about 25,000 children and pregnant women with the most important vaccinations. These include polio, measles, pneumococci and a five-fold, pentavalent vaccination against Hepatitis B, tetanus, diphtheria, whooping cough, Haemophilus influenza) for the target group of children under five years and under two years. Pregnant women will receive the tetanus vaccine.
There are still some obstacles, large and small, to overcome in the day to day work. But the stones have started rolling and several hundred patients have already been treated either in the hospitals or the peripheral health centres.
Seeing a mother recovering and holding her newborn baby, after having delivered him safely in a hospital, without which she certainly would have lost him and maybe her own life – makes every challenge worth it.
It is not a small plan – but it is not impossible.