Addressing the medical needs of pastoral groups in the Central African Republic: MSF's experience

The focus of medical humanitarian NGOs such as Médecins Sans Frontières (MSF) is human health. For pastoralists, however, life is organised around the herd, and the needs of animals are prioritised over those of people. This article outlines MSF’s experience of working pastoralist groups in Ndele, a town in the north-east of the Central African Republic (CAR), close to the border with Chad, in 2013. This is a mixed area: all of the local farmers and some sedentary and transhumant pastoralists are CAR nationals, while the majority of pastoralists are Arabic-speaking Chadian or Sudanese nationals who consider themselves Arabs. Farmers regard themselves as African and largely speak Sango, the CAR national language. Understanding the relationship between these groups helped MSF to gain acceptance by both groups and avoid exacerbating tensions between them.

Pastoralists consider their health and the health of their herds to be directly related. During a meeting at which MSF introduced the organisation and its activities, delegates from the Arab Misseriya in Ndele asked: ‘If MSF takes care of our health, does MSF also take care of the health of our cows?’. This question was repeated in other meetings with other pastoralist groups. The bond between pastoralists and their animals is strong. When cattle fall ill, the pastoralist’s income is directly affected as the animal is no longer easily marketable, and money may need to be spent on veterinary care. Moving sick and weak animals during seasonal migrations can also be difficult. The animal might even need to be isolated in order to prevent the spread of disease. Finally, if part of the herd dies from disease, the owner loses the asset and income that the animals represent.

These issues regarding animal health are rarely taken into consideration by medical NGOs, which are usually not interested in animal morbidity and mortality unless there is a corresponding major impact on human health. They aim to alleviate suffering and save (human) lives in accordance with humanitarian principles. For example, during the malaria season in CAR the priority of medical NGOs may be to provide support to prevent malaria and treatment for people who contract the disease. However, the pastoralists concerned may have other priorities related to their animals. When working with pastoralist communities, it is necessary to understand the important roles animals play in their lives and livelihoods, and to discuss conflicting priorities openly with them.

MSF’s programme in Ndele included eight health posts in 2013 and four in 2014, a hospital and a number of outreach activities in surrounding communities. A significant number of nomadic pastoralists (or transhumants) from Chad or Sudan regularly come through the area to graze their cattle. In May 2013, there was a case at the Tiri health centre of a Chadian patient with an injured leg who required additional treatment. However, the patient left the facility before recovering because his group was returning to Chad. If MSF had carried out health sensitisation the patient might have better understood the need to stay longer. Although he probably still would have had to leave, an understanding of migration routes may have enabled the agency to send information and medication to the patient with other transhumant groups passing through Ndele. Since then, MSF has held regular meetings with transhumant groups in order to better understand their perspectives and migration patterns, and to explain MSF’s objectives and activities. This has facilitated greater understanding and acceptance of MSF, and greater uptake of the medical and health services it provides.

It is also important for NGOs to understand the wider context in which pastoralists live, including potential sources of conflict. There can be competition for space or over grazing land between groups of pastoralists and between pastoralists and farmers. Longstanding tensions between the transhumant and local populations around Ndele have been exacerbated by the current conflict in CAR. Both local populations and pastoralists carry arms to protect themselves and their land and cattle, fuelling suspicion, mistrust and feelings of insecurity among these communities. To avoid adding to conflict, MSF employed community health workers from both pastoralist and sedentary farming communities. This enabled MSF to understand the different perspectives of these communities and better monitor issues which could lead to conflict.

Despite the fact that medical NGOs aim to address the needs of all affected people in a community, they still need to understand how the needs of specific groups can differ according to context and as a result of their different livelihood strategies. In Ndele, MSF tried to address this by adopting a conflict-sensitive approach and adjusting its programme to promote the inclusion of pastoralists. The hiring of community health workers from both the Arab pastoralist and sedentary farming communities has provided a pastoralist perspective within the organisation which was previously lacking, and has strengthened the links between MSF and pastoralists. To ensure that pastoralists also benefited from its medical activities, MSF developed a better understanding of pastoralist livelihoods and priorities by establishing and maintaining regular contact with pastoralist representatives. Gaining acceptance from everyone within the community is essential for the sustainability of programmes and the security of humanitarian personnel in such volatile contexts.

Alvaro Mellado Dominguez was formerly MSF Field Coordinator in Ndele. The views expressed in this article are the author’s and do not necessarily represent those of MSF.