By Dr Unni Karunakara
The Central African Republic (CAR) is a country largely forgotten by the world and to a large extent neglected by the international humanitarian community.
Surrounded by Sudan, Chad and Congo where more high-profile crises are taking place, CAR’s dire and desperate health situation – in which few people have access to health care and many die of easily treatable diseases – has received little attention and even less assistance.
A significant effort needs to be mounted by the government and the international community to address pressing health needs in the country.I have just returned from CAR where Médecins Sans Frontières (MSF) manages nine hospitals and 36 health centres and health posts.
Two years ago, five separate retrospective mortality surveys in different parts of the country showed death rates that indicate a very serious, indeed crisis and situation. In the worst case, in the western town of Carnot, we found death rates higher than those among Somali refugees fleeing the famine in that country in 2011.
MSF’s newest mortality survey, carried out this spring in northwest CAR, shows children urgently need better access to healthcare: of those children who died before their fifth birthday, 60 per cent were found to have died at home.
It should not be this way. This should be a hopeful moment for the country – by all accounts, the country is on the path to stabilisation. But what I heard, from everyone I spoke to, was that there the healthcare system is nearly non-existent and no one believes that any of the health-related Millennium Development Goals will be met before 2015.
Little is being done to confront the spread of HIV, or vaccine-preventable childhood diseases like measles or malaria.
In CAR, every single person gets infected with it at least once each year. It is the major cause of illness – in our own facilities, it accounts for just under half of all consultations. And it is the single greatest cause of death, especially among young children.
It angers me that this can be the case when we have all the necessary means at our disposal to prevent infection altogether.
There are rapid diagnostic tests allowing the disease to be spotted quickly and easily, there are medicines which are effective, easy to take and relatively inexpensive, and there are bednets treated with long-lasting insecticide.
The international community – donor countries, United Nations and other multilateral agencies, humanitarian and development agencies – needs to be more effectively involved in the setting of health priorities and supporting the delivery of health care in CAR.