News Address extreme violence in Central African Republic now: MSF he Central African Republic’s cussion on how to qualify what’s going deep and extremely violent sec- on, but she says it isn’t genocide. “No T tarian crisis has been effectively one is encouraging people to attack abandoned by the international commu- their neighbours,” she said. nity, reports Médecins Sans Frontières While the death toll is unknown, stor - (MSF), which has provided health ser- ies of atrocities, such as lynching and vices in the country since 1998. drowning, are emerging. A Feb. 7 online “I’ve never seen such a high level of video shows the brutal mob-slaying of a violence,” said Dr. Joanne Liu, MSF Muslim man who tumbled from an over- international president at a Feb. 11 crowded truck while fleeing. media teleconference. “This needs to International aid has ramped up. As be addressed now.” The Montréal, Que- of Feb. 20, there were 5500 peacekeep- bec physician criticized the “shocking ers from the African Union (4000) and lack of engagement and mobilization” France (1500). In addition, the Euro- from political leaders in the United pean Union has promsed to send 500 Nations (UN) Security Council, and the soldiers and France said it would send limited response from African countries another 400 to its former colony. and the African Union to the crisis in UN Secretary-General Ban Ki-moon the Central African Republic (CAR). told the Security Council on Feb. 14 As of mid-February, close to that the UN must live up to the promises 100 000 Muslims had fled the country, to “act swiftly and robustly in the face primarily to neighbouring Chad and of such bloodshed.” In December, the Cameroon; another 900 000 to 1 mil- UN upped CAR to a level 3 world lion were internally displaced. emergency, the highest level. “The Muslim population is much “We had a lot of hope for fast-track more targeted right now,” said Liu, who aid,” says Liu. “This has not material- recently visited CAR, where she was ized in the field.” head of mission in 2012. “They cannot “This is a huge failure of protection move freely and a lot decide to flee.” and assistance,” adds MSF Canada Exec- Among these were MSF’s four Muslim utive Director, Dr. Stephen Cornish, who staff in Bangui, CAR’s capital. After visited CAR Jan. 7−15. “We’re hearing they left, their houses were destroyed. great words coming from many places, Liu says there has been a lot of dis- but not seeing the action on the street.” William Daniels, MSF MSF medical staff treat a man in M’poko airport camp who was hit by an arrow. Com- batants often use homemade weapons like axes, machetes and clubs with spikes. CMAJ, March 18, 2014, 186(5) 335 News Under the shade of the wing of a decommissioned Russian transport plane, Hercz and his colleagues offered primary care and treated wounds, including burns and machete lacerations. Most of the Muslim patients were injured on the way to the airport; either their convoy was attacked or they got caught in crossfire. Hercz recalls a woman arriving with infected machete wounds across her face and burns across her torso and breasts. She was trying to breastfeed her child. The situation is “totally barbaric,” says Hercz. Before the March coup, MSF pro- Amos Hercz Across the tarmac from the Christian camp at M’poko airport, Muslims await transporta- vided primary care and supported local tion out of the country, primarily to Chad. The site is littered with defunct aircraft, people hospitals, mainly for complicated mater- camped out with their luggage and clumps of human feces frying on the asphalt. nity cases, and sometimes emergency and nutritional support. Staff in Bangui “We’re a witness to this. This is our serious, yet they were all sitting in had quite a nice life, with sports facilities responsibility, to speak out.” silence, bleeding. That’s how terrified and restaurants. It was an ideal mission About 80% of CAR’s 4.6-million res- people are of seeking medical care.” for training new staff. Less than a year idents are Christian, with a sizeable Mus- Given that fear, MSF has decentral- later, it’s all gone, says Hercz. Gone too lim population concentrated in the long- ized health care, delivering it through are schools, sanitation and a functioning marginalized north near the borders of mobile clinics or health points, as well police force. Sudan and Chad. The Muslim people’s as within displaced persons’ camps. “Things are a shambles,” says Hercz, grievances are political and economic, MSF reports that the extreme violence who has also worked for MSF in Haiti, not religious, but fighting has increas- has reached unprecedented levels in early Ethiopia and the Republic of Congo. ingly taken a sectarian tone since a coup February when 9000 Muslims fled to “It’s the most unstable situation I’ve in March 2013. At that time, an alliance Cameroon. Towns on the north−south seen as an MSF doctor.” of Muslim-led rebel groups from the axis were looted and there were rumours Not surprisingly, basic medical ser- North, called Séléka, toppled the 10-year- of village attacks, according to Heather vices, such as the provision of vaccines, old government. Christian rebels, known Thomson, a nurse practitioner from are hard to come by. And that’s a prob- as Anti-balaka (anti-machete), retaliated; Ottawa, Ontario who was MSF’s medical lem in a country where malaria remains Muslim activists hit back. Civilians have coordinator in CAR until Jan. 21. Thom- the number one killer. CAR has malaria been caught in the crossfire and now son has witnessed the aftermath of towns year-round, but during the peak rainy some appear to be actively engaged. being burnt and seen pockets of people season, due in May, up to 90% of the The fighting escalated following living in the bush. population can test positive. Among the street battles that began Dec. 5 between In Bangui, some 413 000 people are 400 000 people in the city of Bossan- these two rebel groups in Bangui, the living in makeshift sites. About 100 000 goa, about 1000 die annually of capital city. Since then, MSF has treated Christians are living at M’poko airport malaria; 60% of those are under age more than 3600 wounded people. with less than four litres of water per per- five, says Thomson. MSF has 250 international and 1800 son per day when the norm is 20, and few MSF is also seeing severe malnutri- local staff in 16 locations in CAR, and is sanitary facilities. tion in patients in that city, says Thom- likely the biggest humanitarian aid pres- “Their conditions are appalling,” son. And that may spread as many ence in the country. These days, its pri- says Dr. Amos Hercz, a general internist farmers have fled. Crops are due to be ority is treating the wounded, as well as from Montréal who worked in CAR in planted in a month. hiding and protecting patients. January. “It’s all fallen apart,” says Thomson. “When we’re absent, our patients Across the tarmac is a second camp, “With the coup, our work is gone. It’s are at risk, which is unusual,” said Liu. housing a few thousand Muslims await- frustrating.” — Barbara Sibbald, CMAJ As an example, she tells a story that ing flights out of the country. They’re liv- took place in the city of Bozoum. MSF ing inside an abandoned hangar sur- CMAJ 2014. DOI:10.1503/cmaj.109-4733 staff were called to a small courtyard rounded by derelict aircraft. “It’s 37 where 17 people with wounds from degrees on the tarmac, there’s no water, More News online gunshots, machetes and a grenade were no latrines. Helicopters are taking off hiding. “They were too scared to go to and landing,” says Hercz. “It’s a surreal To read more CMAJ news articles, the hospital in case they were targeted environment in which to expect humans visit cmaj.ca/site/home /news.xhtml again,” says Liu. “Their injuries were to exist.” 336 CMAJ, March 18, 2014, 186(5) © 2014 Canadian Medical Association or its licensors.