Health chaos in Central African Republic

Since December 2013, Central African Republic (CAR) has been torn apart by a conflict with increasingly religious overtones. The escalating violence and displacement have made an already catastrophic health situation even worse. Central Africans are facing food insecurity and spiralling malaria, while the economy and public health system are grinding to a halt. MSF has been working in the Regional University Hospital in Berberati, in the west of the country, since January, helping to plug a serious gap in medical care. 
Thousands of termites are fluttering around the few lights that shine in Berberati. The previous day, a violent storm ushered in the rainy season and swarms of the insects arrived. People were waiting for this moment so that they could begin hunting. When grilled, termites can fill an empty stomach; in such lean times, no source of protein should be overlooked. 
The hospital, the only one in the city, was barely functioning when an MSF team arrived in December. "There was not even any electricity," says a local doctor. "Patients had to bring their own light in order to be examined."
"Most people don't want to pay for poor quality care," says Dr Nicolas Peyraud, an MSF paediatrician. "As a result, we've seen a big resurgence in the use of traditional medicines. Most of the children we see were treated by healers first, sometimes with dramatic consequences."
Two months ago, a two-metre high wall was constructed in front of the consultation area to protect patients and staff from stray bullets. While the risk of getting caught in crossfire has decreased, the hospital's 150 beds are still full of patients with malaria and malnutrition. 
"The rate of malaria is huge," says Dr Peyraud. "Around three-quarters of the children we see test positive. The disease is particularly deadly for patients who are already weakened by malnutrition or diarrhoea." 
Furaha Walumpumpu, an MSF midwife, helps with an average of 10 deliveries each day. "The women in this region had stopped coming to the hospital for giving birth, not to mention antenatal care, which can help detect if there's a risk of complications," says Furaha. "We sometimes receive women in a terrible condition simply because there were no qualified medical staff nearby."
Furaha tells MSF surgeon Yves Groebli that one of her patients, Mariette, needs to go to the operating theatre immediately for an emergency caesarean. "The baby is in distress, you have to act quickly," she says.  A few years ago, 25-year-old Mariette lost a baby because she was unable to afford a caesarean. This time, there is a happier outcome: within a few minutes, Yves pulls a newborn from her womb. 
Since January, most of Berberati's Muslim population have fled the city to Cameroon to escape the violence. The Muslim quarter, Potopoto, once the economic heart of the city, is almost deserted. All of the mosques have been looted. One has been converted into an Evangelical church. 
"The anti-Balaka militias control the city," says Imam Rashid, spiritual leader of Berberati's remaining Muslims, who are sheltering together inside a church compound. "We can't go out without putting our lives in danger," he says. There are now around 350 Muslims in Berberati, protected by the Cameroonian soldiers from MISCA, the African Union forces. "We are grateful for the hospitality that has been extended to us," says Imam Rashid. "We have everything here, except freedom."
In a corner of the courtyard, a nurse is changing the dressings on 24-year-old Issoufa, who lost his arm in recent violence. "I lived near Nola, 100 km south of Berberati," says Issoufa. "When the anti-Balaka arrived, they stole all of my belongings and shot me in the arm. It was too dangerous to go to the hospital in Nola. I had to wait several days before they could take me to Berberati." 
By the time Issoufa made it to Berberati, it was too late to save his arm, and the MSF surgeon was forced to amputate. "I will wait until my treatment is finished, and then I will go to Cameroon to join my family," says Issoufa. "I have no future here."
MSF began working in Berberati in January 2014 to meet the health needs of the displaced and to treat victims of violence. Although violence in the town has reduced since January, health needs remain massive. In May 2014, there were more than 3,000 outpatient consultations, 2,450 of them for patients suffering from malaria. There were 427 patients admitted to the inpatient department, more than 300 surgeries were carried out, and 320 babies were born.