Report of Rapid assessment (Grimari--)

3 May to 6 May 2013

By:

Marion Baudry, Susanna Brown and Alain Lapierre

1. Summary

Save the Children team undertook a rapid assessment mission in Bambari 3-6 may 2013 with the aim to provide an overview of the situation in key affected areas and to assess current humanitarian responses to the situation, as well as to determine whether there is a need for SCI to respond to this humanitarian situation.

The mission identified several humanitarian needs, including the immediate needs in health sectors, child protection, education and Wash.

The most concerning aspect of the situation is the inability to provide the minimum health service to the population in Bambari and outside. Child Protection is the other area where there is an alarming immediate need response to ensure to girls and boy have the right to protection from abuse, exploitation, violence through proper interventions. Education also emerged as a sector with an urgent need to intervene to ensure the children have access to school, and it’s protective factors, with a minimum standard.

2. Background

Since the 24th March and the takeover of , the Seleka in the Ouaka still present in the areas it occupies. A large part of the population is still at large and still frightened by the situation. The means of communications, telephone networks, and access are still not really functional and some elements of Seleka (assisted by the population) continue looting and harassment of the population including children, which only maintains the feeling of insecurity in controlled areas.

Until today, the strategy of Seleka on the ground is that they will stay for the transition and the security of the population, and become the new military force CAR. Their wishes to bring back the people to resume normal activities again run public administrations, with a priority for schools. In practice, nothing will happen until the new governments restore the security at the national level.

Most of the Ouaka is control by the General Tom Ben laden, for the moment the security is back slightly, but it’s very weak and abuse, looting is ongoing at a small scale, but at any moment, the situation can switch back to conflict situation.

3. Overall situation

3.1. Health Ouaka district is composed of 17 public centres de santé (Health Centre), 27 postes de santé (Health Post, minimum health package) and 4 private health centres. Ouaka district has 334,026 inhabitants. 5 Heath Facilities (HF) were assessed with Dr Bama Joseph, Bambari’s Hospital Director and actual interim Health Regional Director. Choice of HF has been done regarding security context, geographical repartition and performance of the HF on the axis Grimari-Ippy.

- Centre de Sante de Grimari (80 km from Bambari) cover 44 993 inhabitants - Poste de Sante de Modomale (37 km from Bambari) covers 3 094 inhabitants - Regional and Universitarian Hospital of Bambari - Centre de Sante de Seko (62 km from Bambari) cover 9 213 inhabitants - Centre de Sante de Ippy (143 km from Bambari) cover 48 813 inhabitants Centre de Sante d’Agoudoumonga has been cancelled because of security reasons.

Information of others Ouaka Health facilities

According to the prefecture statistician, vaccination and reproductive health staff oral reports, 5 health facilities were completely looted (Mbagolo (verified), CRPR, Bokolobo, Awatche and Liwa) and in others, quasi all PEV (Plan Elargi de vaccination) motorbikes were stolen. PEV Grimari centre had 2 of their motorbikes back.

Fortunately, the Hospital of Bambari has never stopped functioning during the crisis and was not affected by Seleka. However, the place of the hospital in the city is still complicated to access because lots of Seleka continue to shoot and frighten the population.

General Health situation

Health situation was already weak, and the Seleka events affect indirectly health situation. A decrease in the frequency of visits has been observed in the Bambari Hospital (e.g. pediatry only 62 consults in December 2012, 198 consults in August 2012), but now starts to become normal. Based on MSF Spain assessment in January 2013, the services offered by each peripheral centre remain the same in theory but visits’ frequency is still decreasing in all peripheral HF assessed because of:

- Access limited because fear of people who hide in fields. - Run-away of most of state infirmier d’Etat (nurses). Few ones were beaten up. - Shortages of essential medicines and stop of the cold chain for vaccines (lack of petrol and increase of prices)

Vaccination - No vaccination campaigns (measles, polio) since October 2012 and of routine vaccination since December 2012. Focus on Bambari district for measles campaign only - Totality of vaccines destroyed because of lack of petrol or de fridges… - No rumours of epidemics in the axis Grimari-Ippy (cholera, measles) - No more motorbikes (stolen) for advanced strategies.

Malaria - No mosquito nets distribution since 2 years (next one plan in October by UNICEF), stop of sensitisation campaigns. - Lack of antimalarial drugs in all peripheral centres (ok for Bambari Hospital) - No mosquito nets in all hospitalization beds

Nutrition - The centre supported by IMC also recorded cases where children have left treatments or because of fear in Bambari town and no more WFP support for accompanied mothers (looted warehouse). - ACF would like to put in place a national surveillance through NGOs and partners.

TB/HIV - Bambari Hospital services still operational even if decrease of patients since events - CDV (Bambari) no functional and shortage of ART in Ippy Health centre - RECAPEV Association of Ippy totally looted and Women Association against HIV occupied by Seleka in Bambari

Key Needs and Recommendations

The Main concerns which increase the vulnerability of people are: - Overexposure to parasitosis, IRA and malaria because of the lack of access to HF and limited hygiene in the field. Particular vulnerability of children. To be noted that the “peak” malaria is starting in May to October and there is also no blood bank in all district - Total stop of routine vaccination and vaccination campaign since 6 months - Weak access for pregnant women to CPN and delivery services - Drugs shortage: no reopening of the regional agency (UCM Unite de Cession des Medicaments de Bambari) and no distribution since December 2012 => shortages of antimalarial, antibiotics, vaccines, ORS, antipyretics in all peripheral HF.

There are urgent needs in support MoH structure with a focus on: - EPI support: Vaccination reactivation in coordination with UNICEF; routine EPI + measles, polio campaign. - 5 main killers on children: malaria associated with anaemia, ARI, parasitosis, diarrhoea in coordination with Global Fund for CTA oral drugs (coartem) and mosquito net distribution in coordination with UNICEF + sensitisation + deparasitis campaigns - Capacity building and sensitisation on reproductive health. (No recycle of TBAs since 2006) - Departmental Health Direction support for supervision and data collection. - Support of drug distribution and follow up in coordination with UCM (Unite de cession des Medicaments). A SCI buffle stock should be added because of difficulties of procurement/transport in this region. - Minimum standard package: equipment for Hospital and health Facilities and WASH facilitations.

Area of intervention: Support of 4 health centres on Grimari- Ippy axis and the Maternity and pediatry service of Bambari Regional Hospital + Possibility of development on the northern axis (to Mbres road (Nana Grebizi district))

3.2. Child Protection

Ouaka is a district that has been affected significantly by the Seleka take over since December. Continued insecurity and a complete absence of protection actors (at both the government, nongovernment and community levels) have led to a variety of protection risks for children of which the most urgent are: Child Associated with Armed Groups, lack of access to basic services, especially education, and significant psychosocial distress among children.

Children Associated with Armed Groups - In both Ippy and Bambari, small numbers of children (adolescent boys) were seen in uniform, carrying weapons, and participating in Seleka patrols. Young boys were also seen out of uniform in Seleka camps or at Seleka posts. Children themselves reported being harassed by Seleka, and boys noted that they were frequently asked to conduct menial tasks for Seleka troops and could not refuse for fear of reprisals. - In Grimari, adolescent boys were observed carrying arms, though their affiliation with Seleka is unclear. - Community members reported that recruitment of children into armed groups was “unforced”. Children were said to have followed Seleka for the opportunity to gain money or possessions, or in some cases, to protect livestock from being taken during Seleka pillages. - Children being recruited were reported to be mostly boys ages 14 and older. Children separated from their families and street children were said to be the most vulnerable to recruitment, largely for socioeconomic reasons. - There are no functioning child protection mechanisms in the area, either at the community, government or NGO level. Children are extremely vulnerable to recruitment because of this gap, combined with significant Seleka presence in all areas, a general proliferation of arms, and a lack of educational or recreational activities.

Access to Basic Services - Children have had no access to school or other recreational and educational activities for nearly 6 months. Schools were closed in December due to the Seleka take over, and most NGOs have suspended operations in the area. Very few community groups or national organizations offer child-friendly activities in the area. - Though Seleka has officially stated that schools were to re-open 06 May, this is extremely unlikely as most teachers fled to Bangui during the December confrontations, and many school buildings have been pillaged including the removal of desks, books, and even doors. - Visits to several schools in Bambari on 06 May found buildings in disrepair and no students or teachers present. The leader of a parents’ association living near one school stated that the teacher’s had still not returned and many parents were afraid to send their children to school due to ongoing insecurity. He said they were waiting from official support and communication from Bangui, which they had not yet received. - In the absence of recreational or educational activities, children are extremely vulnerable to recruitment and other protection violations. Most children are now participating in commercial or agricultural activities, increasing the likelihood that they will not return to school this year and that older children may leave school behind permanently.

Psychosocial distress - Children are experiencing significant psychosocial distress due to continuing insecurity and lack of law and order. Many have witnessed their homes and schools being pillaged, and their parents threatened or beaten by Seleka troops. Others have spent significant time hiding in the bush to avoid Seleka raids. - Children reported that they were afraid to leave their home and frequently had bad dreams. Some children said they fell down in fear whenever they heard loud noises. - Families report that Seleka continue to drive through areas at night, shooting in the air and menacing community members. - Some community members report that they were targeted because they are Christian, noting that most Seleka members are Muslim. While pillaging seems to have targeted everyone with wealth, this religious division threatens to aggravate intra-community tension and lead to violence. - Community members reported that they relied on themselves for protection and care of their children. No government or nongovernmental child protection actors are active in the area or responding to the current crisis. The absence of service providers and humanitarian actors means local communities are left without any recourse or support.

Key Needs and Recommendations

- Children are exhibiting signs of psychosocial distress including anxiety, bad dreams, and extreme reactions to loud noises. There is an urgent need for safe places for children to learn and play, and participate in activities that contribute to their development. In accordance with community-specific needs and existing structures, child-friendly spaces and/or youth centres should be established. Priority should be given to educational activities that will support children’s return to school. - Adolescent boys are extremely vulnerable to recruitment due to the continued presence of Seleka and the lack of protective environment. Youth-specific activities should be designed to provide healthy alternatives to armed groups. These should include educational catch-up classes, life and livelihood skills training, and awareness raising on the risks of joining armed groups. - With the fragile security situation and continuing tensions, the possibility of a return to conflict and a new, larger round of child recruitment is high. The opportunity should be seized now to engage Seleka at the field and Bangui levels and provide training on their responsibilities towards child rights and protection. - Information on child associated with Seleka is limited and largely unverified. In coordination with the Child Protection Working Group and UNICEF, standard inter- agency procedures for identifying and verifying children associated with armed groups should be developed and training provided to actors existing in the area. - Child Protection mechanisms in the area are virtually non-existent. Community- based child protection networks should be created and trained in child rights and child protection in emergencies. These networks can play an essential role in raising awareness in the community, reducing stigmatisation and supporting reintegration when children are demobilized from armed groups. - A wider public information campaign should be conducted in coordination with the CPWG on the risks of child associated with armed groups. - Advocacy should be conducted at the Bangui and Bambari levels to establish security and rule of law within the area. Emphasis should be placed on providing teachers, re-opening schools, and re-deploying staff for the Ministry of Social Affairs. When they are in place, training should be providing to build the capacity of teachers and duty-bearers to support children affected by armed conflict.

3.3. Wash

The WASH situation is not very good in Ouaka, despite the relatively advantageous water table in the region. The main problem is the maintenance and repair of existing structures, with many pumps non-functional due to lack of maintenance or the absence of spare parts. We propose to repair existing pumps and also to install new pumps in the health centres where they don’t have access to water.

In term of latrines, many health centres and health posts don’t have enough latrines or lack minimum standards. We propose to build new latrines meeting minimum standards and ensuring that separate facilities are available for men and women. At most of the places we observed water drainage problems, and urgent works need to be done to ensure a proper sanitation.

Water supply

- It is clear that the quantity of water available from the existing water sources can cover the needs of the population if those sources are well-operated, managed and maintained. - The Operation and maintenance of the system needs to be improved by building the capacity of health centre staff and providing their technical manager with the proper tools and trainings in order to take accurate daily, weekly, monthly monitoring tasks.

Sanitation and Hygiene - The evaluation showed a low percentage of coverage of latrines in health centres, construction of more latrines is needed, including hand washing facilities

Monitoring: - It was also clear that there is no proper monitoring system in place, which could be also because of the absence of experienced staff, the lack of the required resources.

3.4. Education - Limited numbers of school are looted, though some quick reparations are need in some locations.

- In the absence of schools reopening, an emergency education program is needed for all children to ensure essential learning and development is supported, as well as a return to normalcy for children.

- One of the most urgent elements is the increase the expertise of existing teachers and parent-teachers, refresher courses for children who have been out of school for 2-6 months, and catch-up program, in coordination with the MOE, to ensure children in crucial years are still able to sit for exams.

3.5. Food security

Ouaka prefecture experienced increased civil insecurity since December as well as population displacements, looting, and atypical food price increases. For the moment, the rain is good and people are starting to plant. However, the lack of access to seeds can definitively have an impact, and also security must continue to increase to ensure there is no disruption in the agriculture seasons.

4. Operational environment

4.1. Humanitarian actors in Bambari There are very few humanitarian actors working in Bambari, including only few UN Agencies and INGOs. On the UN’s WFP is present, on the INGO we have IMC (Health and nutrition for refugees) and Mercy corps (protection, especially sexual and gender based violence); however, this is insufficient to meet the needs of populations. There are no child protection specific actors present in the area.

4.2. Security Security situation remains extremely fragile in Ouaka. For the road Bangui--Grimari- Bambari-Ippy, the security is generally good, with few barriers, and no humanitarian actors have been targeted in the last few weeks. However, since the arrival of Seleka in December and during the first few days they took Bambari and the area, looting, physical abuse have been common. All INGO’s, NGO’s, churches and many businesses were looted, middle class and rich people were highly targeted. Arbitrary arrests were also common among the Seleka. Today, the situation seems more in control, and the different criminals acts have reduced significantly, though they still continue. Rule of law and justice mechanisms are virtually non-existent, and many are forced to pay significant sums for supposed crimes. For the moment, sporadic gunfire and abuses have reduced despite an apparent persistence at night.

Two ways of communication are used, including satellites phones (Thuraya) and mobile phones (Orange and Telecel) . The local cell phone network functions in both Bambari and in Sibut, and is the principal form of communication when in the towns.

In general, Bambari is calm and relatively secure, but the situation can change at any moment. The Seleka control the situation, but their chain of command and control over different elements remains unclear. It is not recommended to go out alone during the day and the night is no movement.

4.3. Logistics Bambari is not an expensive town, with costs on the rise as the town is still isolated from the capital. The Catholic Mission guesthouse in Bambari cost $10 USD per night, it is possible to rent a car with driver for $200/day, fuel is approximately $1,5 /liter.

Office and residential space are not very expensive in Bambari; rent can reach $600 USD a month, electricity can be problem and a generator will be necessary (It may be possible to share a generator with the community, seems a good and cheap options).

The road to go to Sibut is good with 190 km (2 hours 15 min ). Sibut and Bambari 120 km (1 hour 30 min) is not very good and will be difficult during the rain season. Bambari-Ippy, the road is good and will be practical during rain season.

Local mobile (Telecel and orange) network seems ok, but is not currently working outside of major cities. In Bambari, we can find the basic things and services.

4.4. Local authorities: Seleka For the moment, Bambari is controled by Seleka and also the town of Grimari, Ippy and Sibut. In Bambari, they are highly present but in the others small town the presence is very low and nearly no presence. On the road, we just see only a few pickup trucks of Seleka and some few on motorbikes. Seleka control all level of the government and local structures. The civil servants, including teachers, judges, and ministry staff, are not present having fled to the bush or Bangui during the crisis. No government services are working at the moment, except customs where Seleka collect tax. The health service continues to work and also to have some relationship with MOH; education sector is not working until now. The Ouaka is totally controlled by the General Tom Ben Laden, and all the decisions come from him, he’s in line of commandment of Bangui, and he has respected Bangui’s decisions until now. The communication and relationship with the General is ok, but everybody has agreed that they can’t trust him. The government in Bangui trying to restart the administration, but until now it is not functioning inside of the country including Bambari.