The Central African Republic (CAR) has finally found a place on the geopolitical map of the region, mainly due to the wave of violence that has engulfed the country since September 2013. However, even before then the country was gripped by a silent and chronic crisis that deserved but failed to get international attention. Years of ignoring the dire humanitarian conditions endured by people in CAR prepared the ground for the difficulties being experienced in responding to the current crisis.
A silent crisis
Recent events in CAR come on top of a slow-burn but long-term crisis. In 2011, Médecins Sans Frontières (MSF) reported mortality rates above the emergency threshold, especially for children under five, even in areas not affected by conflict.+Central African Republic: A State of Silent Crisis, Médecins Sans Frontières, 13 December 2011. It also found high mortality and morbidity caused by easily treatable and preventable diseases (malaria, HIV/TB and malnutrition) and a phantom healthcare system, lacking facilities, skilled medical staff, diagnostic and treatment tools, medical supplies and disease surveillance.
At that time, few international NGOs were working in the country, and those that were were mainly in conflictaffected areas such as the south-east, which attracted attention because of the presence of the Ugandan Lords Resistance Army. It is common opinion that UN agencies played a very marginal role and were short of both qualified international staff and funds (the Consolidated Appeal was funded at just 48.4% in 2010 and 45.9% in 2011). Formal and informal gatherings of international NGOs in Bangui were characterised by a general feeling of resigned hopelessness in the face of the frequent diversion and mismanagement of international funding. As a result, in a country largely dependent on external assistance, new initiatives were limited, leading the main donors to either leave the country or drastically reduce their presence.
A humanitarian vacuum
The rapid takeover of power by the Séléka in March 2013 was followed by weeks of chaos, with robberies and looting across the country. All the international NGOs and UN agencies working in CAR at the time were affected. Six UN offices were attacked in April 2013 and all lost significant quantities of goods. The near-unanimous response was immediately to evacuate all national and international staff from their bases outside the capital. The UN closed down bases in Bouar, Paoua, Kaga-Bandoro, Bambari and Ndele. Some organisations (such as OCHA, UNICEF, PAM and WHO) remained in Bangui with a reduced team and higher security (for example wearing bullet-proof jackets); other organisations (such as UNHCR) withdrew from the country completely.
Despite the increasing insecurity, it was possible to remain in the field. For instance, although MSF offices and houses were robbed and seven of its vehicles stolen, and some teams were evacuated, health facilities supported by MSF were never completely shut down. Continuing to work in this environment was especially important due to the increase in humanitarian needs: in the summer of 2013, OCHA estimated that there were 400,000 people displaced across the country four times as many as before the crisis. As a result of their displacement, people had increased exposure to diseases, particularly malaria, the primary cause of morbidity and mortality in the country. In MSF health facilities, malaria cases increased by 33% in the first quarter of 2013 compared to the same period in 2012.
Aid agencies withdrawal from areas outside the capital not only left thousands of people without assistance, but it also led to them progressively losing touch with the pulse of the country and forfeiting their understanding of the context. The presence of new and unknown armed groups was taken as justification for not basing staff in remote areas, instead of sending analysts to better understand the context, or sending experienced international staff to engage with these groups.
In AugustSeptember 2013, especially in the Ouham region, self-defence groups known as the anti-Balaka started to attack the Séléka fighters and to take revenge for months of abuses. Aid agencies present in Bangui were starting to carry out some assessments in the field, but the poorly funded Consolidated Appeal for 2013 (at only 35%) did not allow them to set up permanent bases. This period also marked the beginning of an unprecedented protection crisis: extended human rights abuses committed by all the parties to the conflict inflicted deep and potentially longterm damage on Central African social structures. The most affected was the Muslim community, forced to either leave or die: it is estimated that almost 150,000 Muslims have fled Bangui and western regions, mainly by plane or truck, towards Chad and Cameroon. Many of them have died on the road; thousands are sequestered in enclaves, schools and religious compounds, under the protection of international forces.
The fact that most international NGOs were still absent from the field had two consequences: first, there were very few actors able to respond to the needs of the displaced; second, the simple fact of their absence may have contributed to the insecurity felt by civilians exposed to the conflict. Bossangoa, a town to the north of Bangui, is emblematic of this: following anti-Balaka attacks in September 2013, some 30,000 people were forced to leave their homes, seeking refuge in the compound of the Catholic Church, which put in place the very first relief intervention. The displaced, terrified by the violence they had experienced, were left for weeks without any basic humanitarian assistance. ACF and MSF were the first to assess the towns camps, where people were living without shelter, without an adequate water supply (just 7.8 litres per person per day, when the minimum standard should be 1520 litres), and without sufficient latrines (one for each 166 users, instead of one for each 20 users and no showers). It took almost two months, and extensive advocacy and media coverage of these living conditions, before other aid actors mobilised their resources, despite the fact that Bossangoa is only 300km from the capital and is connected to it by one of the very few tarmac roads in the country.
The UN response
It took the dramatic escalation of the conflict in December 2013 with an anti-Balaka attack on Bangui and the brutal communal violence that followed to make everybody finally realise the magnitude of the crisis. Throughout 2013, MSF progressively expanded its advocacy and lobbying efforts to keep the situation in CAR on the international agenda and to call for an immediate scaling up of humanitarian assistance. In parallel, ECHO significantly strengthened its capacity to respond in the country and took over important coordination tasks from the UN. MSFs efforts culminated on 12 December 2013 with an open letter to the UN Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator+See http://www.msf.org.uk/article/car-open-letter-united-nations. that severely criticised the UN aid systems response to the tragedy unfolding in CAR.
The previous day, on 11 December 2013, the UN system had reviewed its classification of the Central African crisis and upgraded it to Level 3, the level of maximum emergency. This was meant to allow UN agencies to scale up their interventions by increasing the funds available, simplifying procedures and mobilising senior experienced international staff from other missions. Unfortunately, this was late in coming (nine months after the coup) and was not on a sufficient scale to drastically boost the UNs response where it was most needed.
This became clear during the emergency in Bangui. In January 2014, OCHA estimated that there were more than 500,000 displaced people in the capital alone, comprising about 70% of the citys population. Fleeing the violence between ex-Séléka+The Séléka was dissolved as a rebel group on 13 September 2013. and anti-Balaka forces, civilians were leaving their houses and seeking refuge mainly in religious compounds. Some 100,000 people occupied the airport of Mpoko, feeling more protected because of the presence of international troops nearby. This unprecedented exodus happened in full sight of the humanitarian community, but still the reaction was very modest.
Despite the presence of about 20 of the biggest international NGOs and UN agencies in the capital, initially only a few of them mounted a proper response to the displacement in the town. Later, when it was clear that people were too scared to return home and a massive humanitarian intervention in the camps was needed, arguments began over whose responsibility it was to intervene. In public and private meetings, UN agencies complained about the lack of implementing partners, while international NGOs claimed they needed more support from the UN in needs assessment, security analysis and funds.
The measles vaccination campaign of early January 2014 offers a clear example. Facing the risk of an outbreak, instead of immediately starting a campaign in the citys IDP camps, where some NGOs were ready to intervene, WHO preferred a coordinated, slower approach through the Health Cluster. MSF publicly criticised this delay and began a vaccination campaign in the camps at Don Bosco, MPoko, Monastère Boy-Rabe and Charles Lwanga. It was a similar situation with support to local ambulances: MSF put fuel at their disposal but it was refused by WHO, and it took them two weeks to provide support. Meanwhile, hundreds of civilians were being killed on the streets of the capital.
One of the most concerning situations has been in Mpoko camp. The first food distribution was done by WFP on 12 December 2013, but it was badly organised in terms of location (on the outskirts of the camp) and crowd control. The resulting tensions meant that distributions were suspended for three weeks. By May 2014, with the oncoming rainy season threatening to make Mpoko camp uninhabitable, no alternative solution had been identified for the 40,000 people who remained there. Since the end of February, UNHCR has suspended distributions of shelter, food and non-food items in the camp to encourage people to return to their neighbourhoods, without taking into consideration the reason why people are reluctant to leave namely the visceral fear of further attacks, rather than the privileges of humanitarian assistance, as shown by surveys carried out in the camps. Despite several proposals from identifying alternative sites to the draining of the camp the rains have already flooded the area but no consistent measures have been taken.
Underfunding is uniformly cited as the principal reason for the lack of response to the crisis in CAR, as acknowledged by the Operational Peer Review carried out by the InterAgency Standing Committee (IASC) in March this year.+Operational Peer Review, 23 March 2014: ‘Internal Report: Response to the crisis in Central African Republic – Review mission: 24 February – 4 March 2014’. This is immediately evident from current funding levels: although $254 million was pledged at the beginning of 2014 at the High-level Meeting in Brussels, governments kept delaying its effective disbursement. CAR is going from being forgotten to being ignored.
However, limiting the analysis of the aid response in CAR to underfunding however significant would be to oversimplify the reality. The root causes of the lack of reaction by the humanitarian community to a crisis taking place before everybodys eyes go back to the silent crisis referred to at the start of this article. Even before recent events, CAR was generally regarded as a fragile state, with poor governance, dysfunctional services and a chronic conflict. The Séléka coup added a huge humanitarian crisis to the pre-existing chronic one, in terms of the numbers of direct victims of violence, internally displaced people and refugees in neighbouring countries. Would it be reasonable to say that the humanitarian system was not prepared for this because of its own limitations in dealing with fragile countries?
Historically, humanitarian intervention in CAR has always expanded and contracted like an accordion: an influx of aid organisations during conflict peaks (as in the late 1990s, 20022003 and 20062007), followed by their departure as soon as the acute crises are over. Over the years, however, the baseline of the intervention marked by the fragility of the state system became progressively lower. This has always been justified by the challenge of working in a context oscillating between emergency and development, with humanitarian actors eager to disengage quickly after the peak of the crisis, and development partners reluctant to invest in a country that lacks the capacity to carry out long-term programmes.
In 2012, just before the recent crisis began, the overall picture of the humanitarian presence in the country was distressing: a handful of actors were struggling to provide aid with only half of the requested funds available a situation that goes some way to explaining the enormous difficulties in making the turnaround necessary to respond to the recent humanitarian crisis, which required deploying enormous resources in a short period of time. Considering that the situation is expected to deteriorate further, the aid system should commit to CAR for a longer period, extending beyond the acute crisis. Only in this way will it be able to establish appropriate expertise and presence countrywide, and be able to respond to the enormous needs of the population. The question now is whether donors, NGOs and UN agencies are willing to make this commitment and invest in intervention mechanisms suited to the crisis in CAR.
Enrica Picco is humanitarian affairs advisor for Médecins Sans Frontières.