Central African Republic

CENTRAL AFRICAN REPUBLIC

In 2017, civilians, aid workers, and medical staff suffered one of the worst surges in violence in the Central African Republic (CAR)’s armed conflict since its beginnings in 2012 and 2013. Splinter groups formed from the primarily Muslim Séléka and the mostly Christian and animist Anti-Balaka, as well as from other groups, battled for territory and control throughout the year.[1] From May to September alone, Human Rights Watch reported at least 249 civilian killings and 25 incidents of sexual violence against women and girls by rebel groups.[2] [3] In a country of roughly 4.6 million people, almost 690,000 have been internally displaced, and over 540,000 have fled the country, according to the UN High Commissioner for Refugees.[4]

The UN Secretary-General has called the CAR “one of the world’s most dangerous places for aid workers.”[5]

In 2017, there were 52 attacks on health staff and facilities, and one event (likely among many) where regional instability limited access to care. Armed rebel groups including Anti-Balaka factions; the Lord’s Resistance Army; Youssouf Sy’s militia; the Return, Reclamation, Rehabilitation group (3R); and Union for Peace in Central Africa (UPC) were responsible for six attacks[6] [7] [8] [9] [10] with unnamed armed groups carrying out many more. The majority of perpetrators remain unidentified.

There were 16 incidents of armed entry into a medical facility, three of which occurred in one week in the PK5 area of Bangui, historically a site of multiple clashes between ex-Séléka and Anti-Balaka factions.[11] On February 3, armed men stormed an MSF-supported maternity clinic that had been receiving wounded patients. After retrieving one of the wounded, the men tried to attack another patient and blocked an ambulance for over an hour. On February 7, armed men attacked the same clinic, threatening staff and trying to kill a patient. After the two attacks, MSF suspended activities in PK5 for several weeks.[12] On February 8, armed men allegedly with Youssouf Sy’s militia stormed a UN-run health center in PK5, with no injuries reported.[13]

There were 12 incidents of theft or looting of medical supplies or equipment and nine cases of armed robbery involving health staff, four of which happened during travel on roads. In four other road incidents, armed men or groups held up medical vehicles and staff. On August 21, armed men detained medical staff and a patient for several hours in an ambulance headed for Bangassou, shooting in the air and threatening staff.[14] Afterwards, MSF scaled back to life-saving activities and referrals only at the Bangassou hospital.[15]

Perpetrators killed nine health staff or volunteers in 2017. During a clash on August 3 in Gambo, Anti- Balaka factions and the UPC killed six Red Cross volunteers gathered in the health center for a crisis discussion.[16] [17] In June, an armed group also killed Red Cross volunteer Joachim Ali while he was on duty at an International Federation of Red Cross and Red Crescent Societies compound in Bangassou,[18] and in November, unidentified perpetrators killed an International Committee of the Red Cross (ICRC) driver during a robbery on the road near Kaga Bandoro.[19] Another health worker was reported killed in Bria in July.[20]

Perpetrators assaulted seven health workers and several patients, and also killed three patients and 13 civilians seeking refuge in a health facility. In May, an armed man forced his way into the MSF-supported hospital in Bangassou, assaulted a nurse, and forcibly removed a patient and her caretaker, killing them outside the hospital gate.[21] In September, during extended clashes in Batangafo, an armed group fired on civilians running to seek refuge in Batangafo Hospital, killing a 15-year-old and wounding another. The group also shot a two-year-old and his mother who were inside the hospital gate, killing the child.[22] [23]

Attacks directly threatened multiple health workers. In February, 15 health staff along with patients and civilians were forced to flee Bocaranga Hospital when 3R militants opened fire in close proximity to the facility.[24] In addition, groups threatened staff on at least five separate occasions in relation to requests for medications or health services. At least four health workers were arrested or detained by state forces.

Perpetrators most often targeted health facilities and staff in Ouham prefecture, with 17 attacks in the region, 12 of which were in the city of Batangafo. Perpetrators committed seven attacks in Mbomou prefecture, six of which were in Bangassou.

In 16 cases, security concerns forced health providers to reduce their services. Eight events led to the closure of facilities or the suspension of medical programs, and eight additional instances of reduced health care activities due to restricted staff movement or relocation of staff. Overall, at least five patients died, two health centers ran out of medications, and 26,000 civilians were left without access to pediatric and maternity care as a result of insecurity.[25]

The town of Zemio experienced repeated attacks that severely hindered health care access for the population. On July 11, two armed men entered Zemio Hospital, where 7,000 civilians had sought shelter from violence. Armed men opened fire on one family when they sought cover, killing a baby in her mother’s arms.[26] Armed men attacked the hospital again in August, killing 11 civilians. After this attack, most of the population fled across the river into the DRC.[27] MSF had to suspend its activities, which affected access to antiretroviral therapy for roughly 1,600 patients with HIV. Pierre Yakanza Gouassi, MSF assistant project coordinator and Zemio native, was also forced to flee to the DRC. “We lost a lot,” he said.

“The medications, the community’s goods were stolen; all the houses were set on fire. The children didn’t go to school for the whole year. No authority has come back to Zemio, the people there feel abandoned.”[28]


[1] Dukhan, Natalia. August 2017. Splintered warfare: Alliances, affiliations, and agendas of armed factions and politico-military groups in the Central African Republic. The Enough Project. https://enoughproject.org/wp-content/uploads/2017/08/SplinteredWarfare_A....

[2] Human Rights Watch. World report 2018: Central African Republic – Events of 2017. Accessed May 7, 2018. https://www.hrw.org/world-report/2018/country-chapters/central-african-republic.

[3] Human Rights Watch. October 27, 2017. Central African Republic: Civilians targeted as violence surges. https://www.hrw.org/news/2017/10/27/central-african-republic-civilians-targeted-violence-surges.

[4] United Nations High Commissioner for Refugees (UNHCR). January 23, 2018. Unprecedented numbers flee as CAR violence surges. http://www.unhcr.org/news/latest/2018/1/5a673ece4/unprecedented-numbers-flee-car-violence-surges.html.

[5] Guterres, António. “One of the world’s most dangerous pIaces for aid workers.” Inter Press Service, October 19, 2017." http://www.ipsnews.net/2017/10/one-worlds-dangerous-piaces-aid-workers/?utm_source=rss&utm_medium=rss&utm_campaign=one-worlds- dangerous-piaces-aid-workers.

[6] International Committee of the Red Cross. August 9, 2017. Central African Republic: International Red Cross movement strongly condemns killing of Red Cross volunteers. https://www.icrc.org/en/document/central-african-republic-international-red-cross-movement-strongly- condemns-killing-red.

[7] Amnesty International. Central African Republic 2017/2018. Accessed March 18, 2018. https://www.amnesty.org/en/countries/africa/central-african-republic/report-central-african-republic/.

[8] Confidentially shared agency report. 2017.

[9] Confidentially shared agency report. 2017.

[10] LRA Crisis Tracker. Accessed Mar 17, 2018. https://www.lracrisistracker.com.

[11] UN News. October 23, 2017. Central African Republic’s message to UN: ‘The only thing we want is peace.’ https://news.un.org/en/story/2017/10/569122-central-african-republics-me....

[12] Médecins Sans Frontières. November 22, 2017. Central African Republic: MSF suspends humanitarian relief activities following attack in Bangassou. http://www.msf.org/en/article/central-african-republic-msf-suspends-humanitarian-relief-activities-following-attack.

[13] Confidentially shared agency report. 2017.

[14] Médecins Sans Frontières. January 31, 2018. Attacks on medical facilities in Central African Republic are leaving people without options. https://msf-rio-nairobi.prezly.com/attacks-on-medical-facilities-in-cent....

[15] Médecins Sans Frontières. 2017 Central African Republic: Main incidents. Accessed March 18, 2018. https://www.msf.org.uk/sites/uk/files/map/.

[16] International Committee of the Red Cross. August 9, 2017. Central African Republic: International Red Cross movement strongly condemns killing of Red Cross volunteers. https://www.icrc.org/en/document/central-african-republic-international-red-cross- movement-strongly-condemns-killing-red.

[17] Amnesty International. Central African Republic 2017/2018. Accessed March 18, 2018. https://www.amnesty.org/en/countries/africa/central- african-republic/report-central-african-republic/.

[18] International Federation of Red Cross and Red Crescent Societies. June 26, 2017. Central African Republic: Red Cross condemns killing of volunteer in Bangassou. http://media.ifrc.org/ifrc/press-release/central-african-republic-red-cross-condemns-killing-volunteer-bangassou/.

[19] International Committee of the Red Cross. November 5, 2017. Central African Republic: ICRC condemns killing of staff member. https://www.icrc.org/en/document/central-african-republic-icrc-condemns-killing-staff-member.

[20] Confidentially shared agency report. 2017.

[21] Médecins Sans Frontières. September 22, 2017. Escalade meurtrière en RCA. https://msf.exposure.co/escalade-meurtriere-en-rca.

[22] Médecins Sans Frontières. November 22, 2017. Central African Republic: MSF suspends humanitarian relief activities following attack in Bangassou. http://www.msf.org/en/article/central-african-republic-msf-suspends-humanitarian-relief-activities-following-attack.

[23] Médecins Sans Frontières. September 22, 2017. Escalade meurtrière en RCA. https://msf.exposure.co/escalade-meurtriere-en-rca.

[24] Confidentially shared agency report. 2017.

[25] Médecins Sans Frontières. 2017 Central African Republic: Main incidents. Accessed March 18, 2018. https://www.msf.org.uk/sites/uk/files/map/.

[26] Médecins Sans Frontières. July 12, 2017. Central African Republic: Baby brutally killed at a hospital. http://www.msf.org/en/article/central-african- republic-brutal-end-short-life-killing-baby-hospital-cars-east.

[27] Médecins Sans Frontières. September 12, 2017. Central African Republic: “The only people left in Zemio are those who couldn’t run away.” http:// www.msf.org/en/article/central-african-republic-%E2%80%9C-only-people-left-zemio-are-those-who-couldn%E2%80%99t-run-away%E2%80%9D.

[28] Médecins Sans Frontières. February 1, 2018. Central African Republic: Testimonies – Pierre Yakanza Gouassi: “And then I had to flee, and no one was able to distribute medication to the population.” https://msf.lu/en/news/testimonies/and-then-i-had-to-flee-and-no-one-was... distribute-medication-to-the.