Civilians pay the price of renewed, brutal fighting in the Central African Republic

In the past weeks MSF teams have witnessed summary executions and terror among civilians

Wednesday, April 12, 2017 — Bangui - As conflict spreads and intensifies in the Central African Republic (CAR), dozens of civilians are being killed and wounded. Thousands are being forced to flee for their lives and are receiving little to no humanitarian assistance, the international medical humanitarian organisation Doctors Without Borders/Médecins Sans Frontières (MSF) warned today.

“Our teams have witnessed summary executions and have found mutilated bodies left exposed to terrorise populations. Civilians are traumatised and many have fled to the bush where they are surviving on whatever they can find”, says René Colgo, MSF’s deputy head of mission. He has been leading the team providing medical care in the areas of Bakouma and Nzako since 26 March.

In the past few months, in-fighting among parties from the 2014–2015 conflict has resulted in splinter groups and has triggered a conflict for control of territory and resources, especially in the centre and east of the country (Ouaka, Haute Kotto, Basse Kotto and Mbomou prefectures). When cities change hands, civilians are the first to suffer. In Bria paediatric hospital, for example, MSF teams have treated 168 people for violence-related injuries since November.  

“During the weekend of 24 to 26 March our paediatric ward received around 24 badly injured people. Among them was a three-year-old girl who had a gunshot wound. It was chaos, and I remember having to leave one wounded man because I needed to urgently focus on another who just arrived with his intestines hanging out. We had limited technical equipment, but our surgeon managed to save his life”, says Dr Katie Treble, who was working for MSF in Bria hospital at the time.

The conflict is spreading to areas that had been considered relatively stable for the past two years. In Bakouma and Nzako (Mbomou province), towns and mining areas are being contested by rival armed groups, with devastating consequences for the civilian population.

“What was already one of the most acute humanitarian crises in the world is worsening. The Central African Republic is spiralling into levels of violence that have not seen since the peak of the conflict in 2014”, says Emmanuel Lampaert, MSF’s representative in CAR.

In recent months there has also been an increase in the number of targeted attacks by armed groups against specific communities, which in turn leads to retaliation and a quick escalation of violence. “The nature of the conflict is evolving and traumatised and helpless civilians find themselves trapped in the crossfire, kicked out of their homes, and cut-off from their fields and livelihoods. At the very least all parties need to stop attacking non-combatants and allow a minimum of assistance to reach those in desperate need”, says Caroline Ducarme, head of mission in CAR.



Last year the Central African Republic organised general elections and settled into an uneasy peace, punctuated by sporadic but often localised episodes of violence. Since the 2014–2015 war between the Séléka and anti-Balaka, the eastern half of the country has remained out of government control, but a precarious status quo allowed some normalcy for the civilian population. However, in the past few months the ex-Séléka and anti-Balaka have splintered into different and loosely affiliated armed factions that are currently fighting each other over control of territory, particularly in the eastern part of the country. As the balance of power is contested, the turf wars leave civilians to suffer.

According to UN Office of Coordination for Humanitarian Affairs (OCHA), half the 4.6 million people living in CAR rely on humanitarian assistance. An additional 100,000 people were displaced between September 2016 and February 2017 due to the renewed fighting, bringing the total number of people internally displaced to over 400,000 and the total number of registered refugees to over 460,000. So far only 5.4% of the funds needed in the UN humanitarian response plan have been pledged.


MSF has worked in the Central African Republic since 1997, delivering emergency medical care to those most in need across the country. In 2016, MSF provided 947,000 medical consultations (in a country of 4.6 million people), treated 580,000 people for malaria, administered 490,000 vaccines and assisted over 21,000 births. MSF relies 100% on private donors for its work in CAR.

  • In Bria (Haute Kotto province), MSF runs a 51-bed paediatric hospital that admitted 3,600 patients in 2016, 90% of them children under the age of 5. Between November and December 2016, the teams also treated 138 victims of violence, and another 151 between January and March 2017.
  • In Bambari (Ouaka province), MSF provided healthcare to 45,000 people affected by violence in 2016 and scaled up its activities starting in October 2016 to address the increased needs there.
  • In Bakouma and Nzako (Mbomou province) MSF teams provided more than 400 consultations to the population by reintroducing free care and referred 10 wounded to the 118-bed hospital it supports and is currently expanding in Bangassou.
  • Mbrés (Nana-Grebizi) MSF deployed its emergency team to Mbrés to assist the displaced population fleeing from the fighting in Bambari and Bria. MSF staff treated and referred war wounded from Mbrés to Kaga Bandoro. The team also reinforced the capacity of Mbrés hospital to ensure access to healthcare for the people in the area and also conducted emergency vaccination campaigns.
  • Maloum, (Ouaka) MSF distributed 15,515 essential relief items to displaced people who fled the conflict in Bria and Bambari and vaccinated more than 5,000 children and pregnant women. 
Credit Colin Delfosse. Abdou, who lived in Ippy. The fight between the UPC and FPRC (supported by self-defence militias) was intense. “Militias don’t want any Fulanis (Peuhls) in villages between Ippy and Bria. We spent more than 10 days in the bush before getting to Maloum. "
Credit Colin Delfosse. Catherine, 16, fled her village with her parents and her fourteen brothers and sisters after it was burned. They found shelter in the village of Ngoubi's school, 18km from Bria.
Credit Colin Delfosse. Gervais, 25, from Ippy. “A group of five of us went out hunting. After the hunt, we came back to the camp, fixed dinner and got some rest. I was lying down when heavily armed Peuhls (Fulanis) attacked us. They arrived via the river so as not to be noticed and started shooting at us. My four companions escaped and I took the bullets: one broke my arm, the second went through my hip and the third wounded my right leg. They took us by surprise so it was difficult to know how many there were. My companions had abandoned me and I was left with no help. I held my broken arm to my chest. It took me a lot of energy to get back to the village; I vomited and bled, I was tired, worn out. My hunting companions had alerted the village and by the evening, my parents came to look for me”.
Credit Colin Delfosse. Jamila, widow from Bria. “My husband was killed at home on the 21 November 2016 when the neighbourhood was attacked. I stay here with my six children, with no help whatsoever. Without my husband, I don’t know how to feed my family. We’re afraid to leave the neighbourhood, we don’t have freedom anymore. We have suffered a lot in the past four months. At night we don’t sleep, we fear renewed attacks.”
Credit Colin Delfosse. Jean, 84, left Nasima on 6 December 2016 with his family to find shelter at Aviation IDP camp. “There was infighting between the UPC and FPRC near the village and there was a rumour that they were burning villages, so we fled. My son went back later to see what was left. All had been burned. I would like to go back to my village, but I have no money left to pay for transportation”. Karim’s son provides for his survival.
Credit Colin Delfosse. Karim, 26, father of two. “I’ve been disabled for several years now. When the conflict resumed on 21 November 2016, everybody fled to hide, but I couldn’t. I was seated in front of the house. My mother ran to me despite the bullets, and she got me into the house. I was hit by four bullets in the back. My mother risked her life that day. My wounds worsened my handicap: I can’t stand now, even with the help of a stick. Everything has become very complicated for me in the past four months”.
Credit Colin Delfosse. Michel, 38. He was shot on 21 November during the Gobolo neighbourhood attack. . He is now stuck in the enclaved neighbourhood of Bria that he can’t leave.
Credit Colin Delfosse. Solange, 12, Aviation IDP camp, Bambari. She was living with her grandparents when her village was attacked . “They killed whole families, so together with twenty other villagers we fled to hide in the bush. We slept on mats made of leaves and ate what we could find”. She reunited with her mother at Aviation IDP camp. Solange would like to be a nurse when she grows up.