Update on the health response to the crisis in the

27 December, 2013 Photo J. Kindra/IRINWHO/E. Kabambi

WHO requires US$ 16.7 million to address the health needs of the population affected by the crisis in the Central African Republic

Situation Health staff are, in some cases, returning to their posts and United Nations agencies are extending The security situation in the Central African their operations outside , in support of the Republic (CAR) remains highly unstable causing International Committee of the Red Cross (ICRC) people to flee their homes and health workers to and NGOs already operating across the country. abandon their posts. There are some 639 000 internally displaced persons (IDPs) in the country Operations to disarm people carrying weapons (over three times as many as in March 2013), continue to be led by French forces and an with some 214 000 in Bangui alone, as well as African-led International Support Mission in the more than 68 000 refugees in surrounding Central African Republic. countries (OCHA, 24 Dec). Half of the country’s 4.6 million people are in need of urgent The security situation is very volatile. Clashes humanitarian assistance. between anti-Balaka, ex-Seleka and international troops have increased in the last few days, The Inter-Agency Standing Committee graded the restricting the movement and operations of crisis Level 3 on 11 December, and on 16 humanitarians in the capital. Health care facilities December the crisis was graded G3 under WHO’s are not safe havens, with yet again recent killings Emergency Response Framework. WHO has and looting. Two UN staff were killed. repurposed the 32 staff in the country office to focus on addressing the crisis and has begun deploying additional staff to expand operations Health situation (details below). The already weak health system in the CAR has The security situation has not allowed the virtually collapsed. Even before the latest upsurge humanitarian community to perform the in violence, the country had some of the worst assessments necessary for a complete picture of health indicators globally. For example, prior to the needs in many affected areas outside of the crisis CAR had the sixth-highest child Bangui. It is likely that the needs will be huge, mortality and the third-highest maternal given the patterns of the current crisis, including mortality rates in the world. A child in CAR the targeting of civilians and cycles of retaliatory already has a 16% chance of dying before his/her violence. fifth birthday.

Assessments among affected populations in recent days indicate that many people are in dire need of health care, including IDPs living in Strategic Response Plan and displacement sites and with communities. Assessments have also revealed the following: 100 day plan

Communicable diseases: The 2014 Strategic Response Plan for the Central • Malaria cases have reached their annual peak African Republic was launched by OCHA on 16 and there have been shortages of anti-malaria December. The need for a rapid scale-up of drugs. Malaria is one of the leading causes of humanitarian capacity to respond to the rising death for children under five years of age, and needs was apparent before the latest attack on recent surveillance in Bangui IDP sites shows Bangui. It was therefore decided to supplement that malaria is the reason for over 50% of the Strategic Response Plan with a more specific, consultations. operational plan for the next 100 days. The 100- day plan has been launched on 24 December, and

• Meningitis cases have been reported in Bangui contains key deliverables and requirements for all paediatric centre. clusters. • Routine vaccinations have been interrupted. CAR has very low immunization coverage; exposing children to diseases such as measles and yellow fever. Health sector priorities and • The insufficiency of safe water and sanitation, beneficiaries and overcrowded conditions will increase the risk of diarrheal disease and other outbreaks. • In November there were already shortages of 1. Access to health services : anti-retroviral and anti-tuberculosis drugs, a) Restore/rehabilitate priority health with treatment interruptions. facilities (primary care facilities and hospitals) for the provision of emergency Health system: and essential surgical, medical and obstetric care, through support for free

• Health facilities have been looted of drugs, healthcare and establishing referral diagnostic tools, and furniture. Most clinical mechanisms. staff have left. Health officials from almost all

rural districts are also reported to have b) Support the return/replacement of departed their posts, seeking refuge in Bangui Ministry of Health personnel through the and elsewhere. The delivery of health services provision of temporary incentives and is almost entirely dependent on international targeted capacity-building. NGO partners and the ICRC. c) Re-stock priority primary and hospital • Of the 117 health facilities assessed to date, health facilities with life-saving and 50% have been looted, 42% damaged, and essential medicines and supplies, 68% have a medicines/supply shortage. laboratory reagents for safe transfusion and universal precautions materials for

• Of the four hospitals in Bangui, the Hôpital de infection prevention and control. l’Amitié was emptied following executions of

patients and is still non-operational. The other three are only partly functioning, offering 2. Prevention and control of communicable basic surgical care. Of the 20 health centres in diseases: Bangui, 6 are not functioning. Fourteen have a) Increase population awareness through restarted services last week, providing health risk communication. minimal services. b) Strengthen/re-establish an early warning • Shortage of health care workers have been disease surveillance system for the early identified as one of the main impeding factors detection, laboratory confirmation and to maintain a functioning health system in and rapid response to outbreaks of outside Bangui. communicable diseases. c) Support immunization against vaccine- preventable diseases with priority for

2 measles vaccination and vitamin A population and patients referred from IDP sites. supplementation for children aged Four ambulances have been deployed to support between 6 months and 15 years. the referral of patients with the support of MSF

and a “green” phone number has been 3. Coordinated needs-based response: disseminated by the Ministry of Health and a) Strengthen and decentralize cluster Central African Red Cross for patient referrals.

coordination teams in Bangui and Apart from the services provided by partners, establish up to 5 sub-national hubs. government health services are fee-paying under

b) Conduct joint needs assessments to the national cost recovery programme, which has develop and implement related response limited access to care. Health partners are strategies. working with the Ministry of Health and donors c) Provide information on the health status to find a short-term solution for free care for life- and needs regularly through health saving interventions. cluster and Early Warning And Response Network bulletins. Drugs and medical supplies for 200 000 people d) Improve coverage of services, monitor were provided by Health Cluster partners to IDP effectiveness and address gaps, including sites and health facilities in the two months prior through engagement of additional to the recent escalation in crisis. international operational health partners. In response to the increase in violence in early December, in Bangui, WHO provided sufficient medicines and medical equipment (Trauma kits, Health Cluster activities Reproductive Health kits, Interagency Emergency Health Kit (IEHK) Basic Units, Surgical Supply kits, IEHK malaria modules) to treat a total of 36 000 Health service delivery patients for one month for common diseases, Despite on-going insecurity, humanitarian including malaria, and to ensure 600 surgical agencies, including the ICRC, NGOs and the UN, interventions for trauma, at the following six IDP are operating in Bangui, , , Zemio, sites in Bangui: Saint Paul dispensary, Saint Jean Kaga Bandoro, Batalimo, and . de Galabadja health centre, the Red Cross Throughout the country, Health Cluster partners dispensary, the Castor, Notre Dame de Fatima (listed below by areas covered) are carrying out and the Grand Seminaire health centre. UNICEF trauma and obstetric surgery, and are providing provided medical supplies and medicines to cover medicines and medical supplies to hospitals, the needs of an additional 10 000 people as well health centres and dispensaries, including surgical as providing 7000 consultation kits to the kits, malaria kits, individual delivery kits, delivery Paediatric Hospital, and the St Jean de Galabadja beds, condoms and dignity kits. There still and St Paul dispensaries. From 8 to 11 December, remains a gap in hospital care for conditions UNFPA distributed medical supplies consisting of other than trauma and caesareans in Bangui, and individual delivery kits, delivery bed, condoms, there are gaps in geographical coverage of medications and dignity kits to the following primary and hospital services throughout the additional four IDP sites: St Paul, St Bernard, country, especially in the north-centre and south- Airport and the Monastère. east of the country. In addition, WHO has (received in country or has In Bangui, in response to the recent escalation in in the pipeline to arrive by 2 January), medicines crisis, all 37 IDP sites have been covered by health and supplies to treat an additional 200 000 partners with a primary health package. patients for common diseases for three months Médecins Sans Frontières (MSF), the ICRC and the (or 600 000 people for one month), up to 2800 Central African Red Cross are carrying out trauma diarrhoea cases and ensure 400 surgical and general surgery in the Hôpital interventions (through four complete IEHKs, 140 Communautaire, but service availability in other IEHK basic units, two IEHK supplementary units, public health facilities (primary and hospital) is four Diarrhoeal Disease Kits, four trauma A and still insufficient to cover the non-displaced four trauma B kits).

3 The National Voluntary Testing and Counselling Scaling up WHO operational capacity service opened on 10 December. Patients can Following the grading of the crisis as G3 on 16 now receive antiretroviral drugs and treatment December 2013, WHO has mobilized for tuberculosis. The main gaps are pouches for organization-wide support for the country. blood donations. Emergency operations centres across the three levels of the organization have been activated Communicable disease prevention and control and performance monitored against WHO's Surveillance has been set up through health Emergency Response Framework. partners in Bangui to monitor disease trends. Surveillance in the rest of country has collapsed, Initial deployments to the Country Office have and requires urgent strengthening. already commenced to strengthen WHO’s leadership, coordination, assessment, Mass vaccination campaigns against measles information, logistics, programming and have been halted with the recent crisis and need communications capacities. WHO has repurposed to be urgently resumed as measles outbreaks are its 32 staff in the Central African Republic and still on-going: 500 000 children were vaccinated established an Emergency Response Team under in recent months and given vitamin A and the direct supervision of the WHO Country deworming tablets. Representative. Approximately 40 additional experienced francophone staff are also being Coordination mobilized through the WHO regional and global surge mechanisms, as part of a 3-month initial The national Health Cluster in Bangui has been staffing plan that will be regularly reviewed. As of strengthened with the arrival in-country of a 18 December 2013, nine of the surge team staff Level 3 capable Health Cluster Coordinator and were already in country, including a Level 3 the creation of a crisis committee focussing capable Health Emergency Leader, Health Cluster specifically on the needs and response in Bangui. Coordinator and Information/Assessment Officer.

An additional six staff arrived on 24 December for Rapid assessments had been conducted by health public health and logistics functions. partners previous the recent escalation with plans to redo assessments in other parts of the An Emergency Support Team has been country as soon as security and funds allow. WHO established in the WHO Regional Office for Africa and health partners are participating to the multi- in Brazzaville to coordinate WHO technical and sector/cluster initial rapid assessment (MIRA) in operational support, with further support Bangui that started earlier this week and the provided by a team established at WHO same should be conducted next week outside Headquarters. Bangui. Health facility damage and stock mapping had been conducted in 8 out 16 Regions Staff recently evacuated from the two previously. subnational health cluster hubs in

Bouar/Bossangoa and Kaga Bandoro will be 37 spontaneous IDP settlements have been redeployed as soon as security allows and these mapped in Bangui and Health Cluster partners hubs further strengthened. Additional Health allocated at each site to ensure health services Cluster hubs will be established in Bambari and and referrals. Mapping of partners and gaps in two other potential sites. the rest of the country is on-going. International partners are being approached to Rapid Response Funds have been released from scale-up or start health service delivery the WHO Regional Office for Africa and WHO operations to address service delivery gaps. headquarters to initiate operations.

Advocacy and solutions for the protection of health care workers and facilities against violence and looting is on-going through inter-cluster coordination mechanisms as well as through the Government.

4 Health partners: Funding requirements Prefecture Organizations Prior to the recent crisis and within the Bangui ICRC, EMERGENCY, MDM framework of the Strategic Response Plan for MSF -E, PU -AMI 2014, the Health Cluster requested US$ 5.4 Bangoram million for immediate support to restoration of Basse Kotto IMC, MSF -F critical health services, implementation of a Haut ICRC, CSSI, JUPEDEC, disease early warning surveillance and response MERLIN, MSF-H system, and health cluster coordination. Haute Kotto IMC, MSF -F Kemo JUPEDEC, VITALITE PLUS With the recent escalation of the crisis, the MERLIN Health Cluster is requesting US$ 16.7 Million to Mambere Kadei MSF -E, MSF -F, PU -AMI be able to restore access to health services, Mbomou ICRC, COHEB, MERLIN, support the prevention and control of JUPEDEC communicable diseases, and provide a Nana Gribizi ICRC, IRC, SCI, VITALITE coordinated, needs-based response. On 20 PLUS December, WHO submitted a US$ 1.5 million Nana Mambere MERLIN, CORDAID proposal to the Central Emergency Response Ombella Mpoko ACF, AHA, JUPEDEC, MDM, Fund. EMERGENCY Pende ACTED, MI, MSF -F Ouham ACTED, JUPEDEC, MI, MSF - E, MSF-H IMC, SCI, VITALITE PLUS Sangha Baere - ICRC, IMC

WHO Country Office Dr Mamadou Lamine Kone, Head of WHO Country Office [email protected] WHO Regional Office Dr Lucien Manga, Programme Area Coordinator Disaster Preparedness and Response [email protected] WHO Headquarters Ms Cintia Diaz-Herrera, Coordinator External Relations Emergency Risk Management and Humanitarian Response [email protected]

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