More than two years of sectarian violence have decimated already fragile health systems in Central African Republic (CAR), leading to a rise in preventable diseases like malaria among families still hiding from armed groups in the bush, according to the head of a medical charity.

Laurence de Barros-Duchêne, head of mission in CAR for Médecins Sans Frontières, said disease was wreaking havoc as armed groups that torch homes, rob and loot hemmed people into remote areas. When those affected finally got to health centres, they were already severely ill, she said.

“The insecurity really slows down the delivery of aid,” explained De Barros-Duchêne, “notably in the most sensitive areas like Batangafo in the north and in Kouango [near the border with the Democratic Republic of the Congo] … Children have not been vaccinated for two years, the levels of malaria are unbelievable.”

The UN has warned that the situation in one of the world’s poorest countries risks becoming “the largest forgotten humanitarian crisis of our time” as the plight of 2.7 million people needing aid fails to loosen donor purse-strings.

Despite the ongoing insecurity, efforts are being made to heal the scars left by a conflict that effectively cut CAR, which has a population of 4.6 million people, in half. A national reconciliation forum is due to start in the capital Bangui on Monday to prepare the ground for elections later this year.

De Barros-Duchêne said the conflict had exacerbated years of neglect in a country that ranks 185th out of 187 in the UN’s human development index despite rich natural resources, such as diamonds and gold.



“This crisis has destroyed what little was left. Lots of healthcare facilities have been destroyed, lots of healthcare personnel have left the health centres. The level of healthcare was very, very bad before but now it is almost non-existent,” she said.

“Malaria is the main cause of death here, but it could be treated very easily if it were caught on time. The problem is that when patients, especially children, arrive, they are already in a critical state and require hospitalisation.”

Nearly 900,000 people have fled their homes since December 2013, with about half crossing into neighbouring countries and the rest seeking shelter within CAR. De Barros-Duchêne said militias were still engaged in “scorched earth” campaigns, burning villages so that terrified residents had nowhere to call home and no fields to cultivate for food.



Despite the scale of the crisis, and its duration, CAR has rarely made headlines in the way other humanitarian crises have. That changed last week after French soldiers were accused of sexually abusing starving and homeless children in Bangui during their military intervention at the start of the crisis.

A leaked UN report revealed the alleged sexual abuse of 10 boys aged eight to 15 at a camp for displaced people. The French president vowed to show no mercy if soldiers were found guilty of the charges.



French soldiers were sent to CAR in 2013 after mainly Muslim Séléka rebels ousted the president, seized the capital and installed the country’s first Muslim president, Michel Djotodia.

The Séléka terrorised the majority Christian population, killing men, women and children until they were forced from power in January 2014 and took refuge in the north. The Séléka killings sparked reprisals by “anti-balaka” Christian militia, who drove out tens of thousands of Muslims from the south.

France started withdrawing some of its 2,000 troops this year, handing over to a UN peacekeeping force, known as Minusca.

According to the UN’s Financial Tracking Service, the CAR appeal has received only 14% of the $613m (£402m) needed this year, leading UN officials to urge the world not to turn its back on the country.

“We must prevent the Central African Republic from becoming a forgotten crisis,” Claire Bourgeois, the UN’s humanitarian coordinator, said in late April, adding that the money received so far would not cover “the minimum of what is needed to meet the huge humanitarian needs”.

There are also more than 460,000 refugees from CAR in Chad, Cameroon, Congo-Brazzaville and the DRC.

In April, MSF started an emergency intervention in Kouango after more than 20,000 people fled across the Ubangi river to the DRC because of fresh fighting.



“We found a catastrophic situation that mirrored the rest of the country … It’s the same thing we have been seeing everywhere but because they did not have any access to healthcare, the situation was more acute,” said De Barros-Duchêne.

Bourgeois said that families in CAR needed help to rebuild their livelihoods, while international partners must also provide support for the judicial system to ensure there was no impunity for atrocities.



In April, CAR’s national transitional council adopted a law to set up a special criminal court to investigate war crimes and crimes against humanity carried out since 2003.

The draft law must now be enacted by the head of state, Catherine Samba-Panza, who took over as interim president in January last year to shepherd the country towards elections, scheduled now for August.

The peace forum is meant to bring together Séléka rebels, anti-balaka militias, trade unions, journalists, citizens who have fled their homes, political parties and religious leaders to examine the reasons for the violence and start the painful process of rebuilding trust in a country long plagued by coups, rebels and unscrupulous leaders.