CAR: “We have nowhere else to go”

Despite the worst violence in the Central African Republic being over, many communities are caught up in daily insecurity, and Doctors Without Borders still sees millions facing a critical humanitarian situation.

On the afternoon of the 30 October 2016 in the Muslim-majority PK5 neighbourhood of Bangui, the capital of the Central African Republic (CAR), 26-year-old Farah gave birth to her fourth child.

She was taken to the Gbaya Ndombia hospital – the only maternal health facility in PK5 — that Doctors Without Borders (MSF) opened with the ministry of health this year.

“The birth went very well, and I was transferred to a room to rest,” Farah says. “Then suddenly we heard gunshots. I wondered what was happening. I heard someone knocking on the gate, and then wounded people started streaming in. There were lots of them, and they were everywhere. All the beds were occupied except mine. I was scared.”

CAR experienced most acute violence in the aftermath of the coup there in 2013, but there has been sporadic conflict between the Muslim Séléka faction and Christian anti-Balaka group since then.

Although CAR is no longer in the midst of all-out war, and the elections this year were meant to end the crisis, three years since the peak of the conflict MSF says millions still face a critical humanitarian situation.

In the PK5 neighbourhood, where most of Bangui’s Muslim population lives, “insecurity is permanent,” Farah says. “Gunshots can often be heard, and every two or three days there is a fight. People get into an argument and then pull out their weapons; the person who has the most powerful one is the winner.”

‘There was blood everywhere’

Bouhari Zoulemahamat, an assistant midwife at Gbaya Ndombia clinic, also lives in PK5. She was on duty the night Farah gave birth.

“I arrived at the clinic at around 18:30. There was blood everywhere, and three bodies on the ground in a small consultation room. Each time there is an influx of injured people, that is where we put the corpses so that they aren’t in everyone’s view,” she says.

“The men in PK5 do know that this is a maternity ward and that our primary activity here is to take care of women and their babies. But they also know that we are the only structure to offer healthcare in the neighbourhood 24 hours per day. They know we will not send them away.”

“In these situations, we put the injured people in the postpartum room in order to stabilise them. When they start arriving, we ask the new mothers to move into the delivery room so they aren’t mixed in with the trauma cases,” she says, explaining that it is often a balancing act between offering treatment to everyone who comes in to the clinic, while also ensuring the maternity patients are not stressed out.

“The women are definitely aware of what’s going on around them in these moments. Generally, they keep their cool as they know the context. Some of these women haven’t left this neighbourhood since December 2013. They are used to seeing these kinds of violent episodes,” she says.

Across the country, including in Bangui, ongoing conflict has meant that many health structures are not functioning at optimal level. In many places, MSF — which runs 17 projects across CAR, including in Bria and Boguila – are the only ones present to provide good, free medical care around the clock.

MSF’s Gbaya Ndombia Maternity Clinic is in PK5, the neighbourhood where most of Bangui’s Muslim population live. Sandra Smiley/MSF

‘I’m here to save lives’

Bouhari has worked at the MSF clinic since it opened. “I’m here to save lives,” she says, adding that she has wanted to be a midwife since primary school. A few years ago she registered at a university in Bangui to deepen her knowledge.

“But since the crisis of 2013, I can no longer get to the campus,” she says, even though it is just 4km away.

“I am a Muslim woman, and I worry about leaving this neighbourhood. People can see that I am a part of this community. When I leave PK5, I feel threatened, and so I do not do it very often. The other women in this neighbourhood have the same problem,” she says.

During the 2013-2014 crisis period, PK5 became an enclave cut off from the rest of Bangui. While it is now more connected to the rest of the city it remains volatile in terms of security, and access to healthcare is particularly difficult for its inhabitants.

“We can no longer leave PK5,” Farah says. “And today it is not possible for us to live and feel safe in another neighbourhood of the city. We have nowhere else to go.”

“I worry about my children. What will happen to them? Sometimes they can’t even go to school because of the insecurity. Life is going to be hard for them. I just want peace in this country, and here in PK5.”

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