Since the presidential and legislative elections of December 2020, a new wave of violence has swept over the Central African Republic (CAR). Over the weeks, armed clashes between the coalition of non-state armed groups and government forces backed by foreign troops erupted in many parts of the country, often taking a heavy toll on the civilian population and regularly affecting the security and work of humanitarian organizations and health facilities. In a country already plagued by decades of civil war, this new outbreak of violence exacerbates an already alarming humanitarian situation: today, more than half of the population needs humanitarian aid.

The impact of the current crisis is particularly visible on the health front. Before the new crisis broke out, the sanitary system was already very weak, with a limited access to many services and facilities. Access to health was already a daily challenge.

Obviously, the latest cycle of violence made things even worse. Movements of patients and medical staff are reduced, the supply of essential medicines is limited, and the spike in food prices reduces the ability of families to access healthcare as paid healthcare is the norm –including for pregnant women and children under five who, on paper, should officially benefit from free care. A key issue in a country where 71% of the population lives below the extreme poverty line.

This worsening health crisis disproportionately affects displaced people and refugees, whose numbers have skyrocketed since December. Currently, 1.3 million Central Africans - more than one in three people - are internally displaced or refugees abroad, often in very precarious living conditions. A displacement situation comparable to that experienced by the country during the 2013 civil war.

On January 3, 2021, about 13,000 people fled Bangassou, in the south-east of the country, and crossed the Mbomou river to find shelter in the small village of Ndu, in the Democratic Republic of the Congo, where MSF is supporting the local health centre since 2017. On the same day, on the Central African side, over 800 people - most of them women and children - took refuge in the compound of Bangassou University Hospital, supported by MSF since 2014. Day after day, the number of people seeking shelter at the hospital kept on growing. At one point, the hospital compound housed up to 2,000 displaced persons to whom our teams have ensured access to care and water.

MSF immediately increased its support to the local Ndu health centre by bringing in extra medicines, vaccines and additional staff. Out teams also installer water purification systems. The number of medical consultations exploded, with more than 110 patients seen each day, on average, mainly women and children suffering from malaria, diarrhea and respiratory infections. In view of the needs, MSF continued to increase its medical capacity in the health centre, as well as its capacity to respond to potential epidemics by reinforcing routine vaccination.

In the context of CAR, women’s health status is particularly at risk. Even outside of periods of acute violence, their socio-economic status, their exposure to violence and the very limited access to family planning- a source of close pregnancies, high-risk deliveries and major health issues - make them particularly vulnerable. Unsurprisingly, the country has one of the highest maternal mortality rates in the world, and times of crisis and displacement only exacerbates this reality.

In Bangassou and Ndu, access to free maternal care is one of MSF's priorities. Every day, our teams provide pre- and post-natal support for women, supervise childbirth in good sanitary conditions, manage obstetric complications, provide access to family planning and provide care to victims of sexual violence.

Just weeks after the January 3 offensive on Bangassou, photojournalist Alexis Huguet went there and met women who had fled violence and where supported by MSF. For many, the January flee from Bangassou was not the first one. Many had already fled, alone or with their children. Then as now, the presence of MSF on either side of the Mbomou River has proven to be crucial, if not vital.