Central African Republic

Situation Report

Highlights

  • Clashes in Bambari in mid-February temporarily displaced thousands, left 36 people injured and dozens of shelters burned.
  • A surge in violence has displaced over 276,000 people within the Central African Republic since mid-December.
  • To meet the most urgent needs in 2021, humanitarian partners plan to assist 1.84 million people, for what they will require US$ 444.7 million.
  • In 2021, 2.8 million Central Africans – more than half of the population – will need humanitarian assistance and protection.
  • Humanitarians assisted 1.6 million people in 2020, mitigating the effects of food insecurity and malnutrition, providing shelters and water and protecting the most vulnerable.
A new site with emergency shelters for people displaced by the latest wave of violence that began in mid-December 2020 ahead of the general elections is being set up in Batangafo. ©OCHA/Adrienne Surprenant, Batangafo, Ouham Prefecture, CAR, 2021.
A new site with emergency shelters for people displaced by the latest wave of violence that began in mid-December 2020 ahead of the general elections is being set up in Batangafo. ©OCHA/Adrienne Surprenant, Batangafo, Ouham Prefecture, CAR, 2021.

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Central African Republic

Situation Report

Key Figures

4.9M
Population
2.8M
People in need of humanitarian assistance
1.84M
People targeted for assistance in 2021
1.6M
People assisted in 2020
1.9M
Food-insecure people
2.3M
Proj. food-insecure people (May-Aug. 2021)
725K
Internally displaced people (31 Jan 2021)
641K
Central African refugees
5004
COVID-19 cases
63
COVID-19-related deaths

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Central African Republic

Situation Report

Funding

$444.8M
Required
$35.3M
Received
8%
Progress
FTS

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Contacts

Vedaste KALIMA

Head of Office

Maxime NAMA CIRHIBUKA

Head of Public Information

Anita CADONAU

Reporting Officer

Central African Republic

Situation Report
Feature
Burned to the ground by recent clashes, Fatima looks into the direction of where her hut used to be. ©OCHA/Anita Cadonau, Bambari, Ouaka Prefecture, CAR, 2021.
Burned to the ground by recent clashes, Fatima looks into the direction of where her hut used to be. ©OCHA/Anita Cadonau, Bambari, Ouaka Prefecture, CAR, 2021.

Starting over, over and over again

Life has resumed in Bambari. This is at least the impression one gets when driving through the dusty streets. The latest delivery of trading goods from Sudan adds colour to the shops along the main street, carpenters saw up what will become furniture and motorcycles whizz past pedestrians.

Nothing as it used to be

But life is not as it used to be for everyone. The town in the heart of the Central African Republic is just emerging from its latest crisis. Two days lasted the combats in mid-February that seem momentarily forgotten in the centre of the city.

Not so for Fatima, sitting on a stool at the Elevage site, her home for the past four years and home for 8,500 other internally displaced persons. The site was the scene of fighting for 48 hours. When Fatima heard the first gunshots, the young woman grabbed her children and ran to a nearby building that used to house the local livestock authority. Made of concrete, it promised better protection than Fatima’s makeshift shelter made entirely of straw. The family stayed there for three full days. Children, the elderly, women and men, all crowded close together. « There were many of us, so many… », Fatima closes her eyes as she tries to recount how many families had gathered in the bare building and eventually becomes silent. The youngest were crying because they were hungry. The mothers were crying because they could not give them anything to eat, as the fighting was felt right up to their doorstep.

What little they had

A rocket-propelled projectile hit the roof of their refuge but fortunately did not explode. But the smell of smoke indicated that not everything was in order. Hours after the last footsteps were heard outside their hideout, Fatima stepped into the sunlight and saw the destruction. Her home was gone, burned to the ground, with only a circle of ashes left. So were her neighbours’ huts. In the middle of the battlefield, they probably caught fire from falling projectiles. Of what little they had, everything was gone – blankets, clothes and food supplies – with only a carbonized pot left behind. Left with no more than their lives, Fatima and her children were taken in by neighbours who now share what little they have.

A heavy price to pay

Clashes in Bambari on 15 and 16 February took the lives of more than 10 people. Another 36, including eight women and nine children, the youngest just over a year old, sustained gunshot wounds. They received surgery and care at the local hospital supported by Médecins Sans Frontières. A health clinic at the entrance of the Elevage site for the displaced that serves about thousand people was severely damaged by the fighting and had to close for days, further compromising the already precarious access to health care. Three other health facilities in Bambari suffered heavily from the recent clashes; one was also damaged, and two others looted.

Fatima’s children are running around her as she sits on her stool. The family has been spared from visible injuries. But the fresh experience weighs heavily, particularly on the children. They have been out of school since last December. Violence related to the general elections has since kept schools closed across the region – even across the country, where one in two children is out of school. In Bambari, four schools were vandalized – furniture used as firewood and doors and windows stolen – two schools were even occupied by armed groups. But there is hope for the young ones in Bambari with the planned reopening of schools in March. UNICEF and other humanitarian partners support the local school board in identifying what is needed ahead of the opening, now that the town is relatively calm and armed groups have vacated the schools. The clashes in Bambari also halted the work of humanitarians. As the situation calms, they are now able to assess people’s needs and assist them accordingly.

When the abnormal becomes normal

Not everyone found refuge from the recent clashes in Bambari in the vicinity of their homes, like Fatima did. Thousands of people are thought to have fled into the surrounding bushes, found protection at the hospital, near the UN peacekeepers or with relatives or strangers in other parts of town. Since the situation has become calmer, most of the displaced have returned.

Already before this latest crisis, Bambari was home to over 15,000 internally displaced persons from the region or other parts of the country. The prefecture, Ouaka, is the fourth most affected by internal displacement with 74,000 displaced women, men and children. Displacement is part of life for so many Central Africans. Preventive, pendular or long-term displacement, each time an interruption of life. One in four Central Africans is currently displaced, either within the country or as a refugee abroad. Since mid-December of last year, the surge in violence related to the elections has newly displaced over 276,000 people within the country and pushed over 50,000 across the borders, according to registrations by the UN Refugee Agency. Over half of the internally displaced have since returned home. A return to a, often, shattered life, to gathering pieces of what remains.

Perpetual new beginning

Starting from scratch after each displacement requires energy. Building a new home, saving to buy household items, replanting gardens and fields. Fatima has done this before. Looking at her children chasing each other around the muddy ground, she knows why she has no other choice. « If it wasn’t for my children, I wouldn’t know where to take the energy from », says the young mother and looks wistfully into the direction of where her home used to be.

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Central African Republic

Situation Report
Background
Ousmane has named his garden "Perseverance". Many of his friends gave up the work because of lack of water or similar challenges, but Ousmane insisted and grew his crops. OCHA/Virginie Bero, Birao, Vakaga Prefecture, CAR, 2021.
Ousmane has named his garden "Perseverance". Many of his friends gave up the work because of lack of water or similar challenges, but Ousmane insisted and grew his crops. OCHA/Virginie Bero, Birao, Vakaga Prefecture, CAR, 2021.

Peaceful periods allow for humanitarian assistance in Birao

Located in the far north of the Central African Republic, on the border with Chad and Sudan, the city of Birao is experiencing relative calm despite the country's instability. This calm has come after an escalation of violence in 2019, which had resulted in dozens of deaths and the displacement of more than 23,000 people. Humanitarian actors, already operational in the city before the 2019 clashes, have further strengthened their presence and stepped up the multisectoral response to urgent needs. Thanks to their mobilization, the level of severity of humanitarian needs has dropped significantly in one year. Thus, the proportion of the population with an acceptable level of food consumption has almost doubled from 39 per cent to 74 per cent, and half of the city’s’ population now has access to drinking water compared to only a quarter in 2019. Today, only 5 per cent of the population is forced to defecate in the open due to a lack of latrines, down from 37 per cent in 2019. Even though emergency assistance has been provided, humanitarian needs remain.

An unwanted dependency

After fleeing her neighborhood in Birao in 2019, Zénaba found herself at an IDP site with her four children. She had no resources to survive, as she was forced to save her life and the lives of her children, leaving behind all her belongings. Being a trader, she found herself at the IDP site without her goods. "If we did not receive aid from humanitarians, my two-year-old son would have died," she said. Being at the site, the population does not have access to the fields due to the presence of armed groups around Birao and they depend, in large part, on humanitarian assistance. The displaced people receive monthly food rations from the World Food Program (WFP), consisting of oil, cornmeal, salt, beans and millet.

A peaceful period in February 2021 enabled WFP to ship 143 tonnes of food from Sudan via Am-Dafock to Birao. A first distribution was carried out from February 11 to 13 to help 2,367 vulnerable families in Am-Dafock (65 km east of Birao), where 28,150 tons of food were distributed in 15-day food rations. From February 16 to 21, internally displaced people from different IDP sites in Birao, such as the Chinese site, the Yata site and the Hospital site, as well as those in host families, estimated at more than 4,000 families, received 66 tonnes of WFP food in 15-day food rations. In order to consolidate its stocks for assistance in the coming months, WFP received 10 trucks from Bangui carrying more than 470 tonnes of food.

Make agriculture a means of resilience

Other NGOs provide other assistance. The NGO Triangle Génération Humanitaire, for example, provides support to 400 people who have formed a group to cultivate vegetable gardens. Support with seeds, tillage tools and technical knowhow from an agronomist enabled them to plant vegetables such as okra, squash, melons, amaranths and onions. These vegetable gardeners have testified that they survive from the sale of the produce they harvest. "I have benefited from the support of the NGO Triangle for more than two years; I can attest to the benefits of the support that this organization has given us. Without this help, I will not know what to do with my family,” said Ousmane, a gardener and father of three children. The NGO Triangle also distributed 12 tons of seeds such as peanuts, sesame, cowpea, sorghum and 15,000 cassava cuttings to 1,000 households on the axes that lead from Birao to Ouada, Djallé, Terfel and Matala. This distribution enabled the revival of agricultural activities, in areas where the security situation allows it. In addition to assistance in agriculture, 10 groups of beekeepers benefited from tools to promote the resumption of their activities, namely beehives and protective equipment, while 30 groups of fishers received canoes, nets and fishhooks. In parallel, Triangle launched a campaign to distribute cattle and donkeys to 45 groups of farmers to enable them to prepare for the next agricultural season. Triangle's intervention also took into account the valorization and processing of local products by providing two peanut oil extraction machines to the village savings and credit association of Birao.

At the end of January 2021, the city of Birao had three sites for displaced people, the largest of which, called the “Chinese site”, is located next to the peacekeepers base, and counts 8,000 people. For these people, even if they benefit from multisectoral assistance, protection remains a major challenge. Free movement and access to the fields is compromised due to the presence of armed elements around the city.

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Feature
A family displaced by recent post-election violence has arrived at a new site for internally displaced people in Batangafo and is unpacking the few belongings it was able to take along. ©OCHA/Adrienne Surprenant, Batangafo, Ouham Prefecture, CAR, 2021.
A family displaced by recent post-election violence has arrived at a new site for internally displaced people in Batangafo and is unpacking the few belongings it was able to take along. ©OCHA/Adrienne Surprenant, Batangafo, Ouham Prefecture, CAR, 2021.

Alarming rise in displacement across the Central African Republic

A surge in violence has displaced over 276,000 people within the Central African Republic. More than half of the displaced have returned in recent weeks but 129,000 people remain displaced inside the country. Most live in deplorable conditions in the bushes surrounding their villages in fear of renewed attacks. And new people are forced to flee almost every day with no end in sight to the current crisis. In addition to the internally displaced, the UN Refugee Agency (UNHCR) has registered 54,300 newly arrived refugees in the Democratic Republic of Congo, Cameroon, Chad and the Republic of Congo.

This new wave of violence and displacement began in mid-December ahead of the general elections and adds on to decades of armed violence, which was topped last year with the Covid-19 pandemic, increasing humanitarian needs in the Central African Republic to new heights. While this latest armed offensive was launched in the west, attacks and displacement have since spread across the country, affecting also the center and south-east and sparing only few regions.

Deplorable living conditions and urgent humanitarian needs

Most displaced people have found temporary refuge in fields and forests near their towns, which they consider safer. Some return to their homes during the day to fetch household items or personal belongings or in search of food and water, only to return to the fields for the night. Others have found protection at schools, in churches, near the bases of UN peacekeepers or with host families.

In view of ongoing violence, protection is among the displaced people’s most urgent needs. Sexual violence against women and girls and child protection issues such as unaccompanied and separated children and forced recruitment have been reported. Humanitarian assessments further show that food, primary healthcare, water and sanitation, basic household items and shelter are the most pressing humanitarian needs. Even before the most recent displacement crisis, one in four Central Africans, nearly 1.3 million people, were displaced in the country or across its borders.

Saving lives under most difficult conditions

Despite the growing insecurity in many parts of the country, humanitarian partners have been scaling up their efforts to save lives and provide emergency response assistance to the displaced and those most in need. They support hospitals with medical teams and essential medicines, supply people with drinking water, distribute food and build latrines to prevent the spread of diseases. The volatile security context demands highest flexibility and readiness from humanitarians.

In early January, obstructed road access to Dékoa in the central Kémo Prefecture was overcome thanks to a helicopter and 2,000 families displaced by armed groups’ attacks could be provided with water purification tablets, high energy biscuits and medicines. A rapid needs assessment under the lead of the UN Office for the Coordination of Humanitarian Affairs (OCHA) during the same mission provided the basis for other humanitarian partners who scaled up the response in Dékoa in the days after. The UN World Food Programme (WFP) provided food assistance to over 10,000 families, the NGOs Médecins d’Afrique (MDA) resumed its nutritional support and Médecins du Monde (MDM) established a presence in Dékoa to support access to health care and psychosocial services and to support survivors of sexual and gender-based violence, including the most vulnerable displaced outside the city. In addition to Dékoa, humanitarians have reached four other hard-to-access areas by helicopter since mid-December – Bouca and Batangafo (Ouham Prefecture), Dimbi (Basse-Kotto) and Ouango (Mbomou) – to deploy rapid assessments teams and to deliver much needed humanitarian cargo.

In the western town of Bouar in Nana-Mambéré Prefecture, humanitarian organizations assist 12,500 newly displaced people, the majority of whom now live in churches and parishes. Water pumps are being repaired and bladders installed to cater for the increased demand of drinking water at those displacement sites. High energy biscuits, flour, beans, oil and salt are being distributed, health facilities are supplied with essential medicines and nutritional supplements to treat children suffering from malnutrition.

And in Bangassou, in the south-eastern Mbomou Prefecture, humanitarians await with stoical calmness each safety window that allows them to reach displaced people. They have already assisted 15,000 people with food and water, shelters and emergency latrines and nutrition support for malnourished children, including at the Cesacoba sites and other displacement sites in and around Bangassou.

In Batangafo in the north-western Ouham Prefecture, where 30,000 internally displaced people had been living at sites before the current crisis, over 600 people arrived since January 2021, fleeing the upsurge of violence in Bouca, where most of them were already displaced. Thanks to access by helicopter, humanitarian partners ensured that those people have access to water and received essential household items and hygiene products.

Humanitarians face more challenges than ever

Despite major achievements in assisting people in these difficult times, the work of humanitarians is getting more and more challenging. While the population is the main victim of the conflict, humanitarians have been increasingly targeted, including with offices being looted and vehicles stolen. The month of December 2020 has seen 59 incidents against humanitarian personnel and property, including an aid worker killed and five others injured – almost double the monthly average of incidents recorded in 2020. January 2021 has continued in the same precarious way with 66 incidents recorded, the highest ever.

The disruption of the country’s main supply route connecting the capital Bangui with Cameroon prevents the safe and timely delivery of vital aid. Over 500 trucks with critical UN and partners’ supplies, including food and medicines, have been stuck at the Cameroonian border since mid-December, along with over 1,100 trucks transporting commercial goods. These constraints on an already fragile food supply are again driving up the prices of basic food commodities and jeopardize the lives of those 1.9 million Central Africans already food insecure. Furthermore, the state of emergency declared on 21 January 2021 has been extended for six months until early August, in addition to a countrywide curfew (20:00 to 5:00) put in place after an attempted attack on the capital Bangui on 13 January, with restrictive effects on humanitarian access to people in need.

As of 26 February 2021, only 8% of the Humanitarian Response Plan for the Central African Republic were funded, at a time when humanitarian needs are more pressing than ever. Urgent funding is required to sustain principled and effective humanitarian response.

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Situation Report
Feature
Planted fields now surround the abandoned and tree-lined main avenue that had been a main traffic route between the capitals of Chad and the Central African Republic (N'Djamena and Bangui). IDP can walk on the route but all the buildings are abandoned after being destroyed. ©OCHA/Anne Kennedy, Batangafo, Ouham Prefecture, CAR, 2020.
Planted fields now surround the abandoned and tree-lined main avenue that had been a main traffic route between the capitals of Chad and the Central African Republic (N'Djamena and Bangui). IDPs can walk on the route but all the buildings are abandoned after being destroyed. ©OCHA/Anne Kennedy, Batangafo, Ouham Prefecture, CAR, 2020.

“Here We Do Not Go to the Fields”

A salary that may be stolen from you, a commute with the threat of rape, a workplace in 35-degree heat. Farming in Batangafo, in the north of the Central African Republic, is one of the hardest jobs in the world. If Rosalie Fiobona* [48] and Antoinette Ngaïnam* [25] seem both incredibly tired and incredibly tough, it is clear why.        

They, along with many displaced women in Batangafo, have always been farmers. Both inherited their farms from their fathers, one on land so flat it is near where aeroplanes land and the other in the rich, damp soil near the Ouham River. But today she says:

“I have fear because we go to the fields and on my return the armed men can attack us, rape us … assault us”

Antoinette Ngaïnam, Farmer.

They, and 35,000 other displaced people, have been forced to flee from their homes in Batangafo, a large portion of whom live on just 1km². Within this small space there are MINUSCA peacekeepers and humanitarians distributing food and supplies who try to create a safe area. But there are only three dirt roads surrounding this triangle of land and endless entry points. The violence is not localised nor continuous; its seasons are not predictable. Months of farming work can be lost when armed groups appear on land worked beyond its borders.

“At the start I made an effort to go to plant, but I had no time to harvest…if I went to the fields the armed men chased me and said the displaced had no right to go there”

Rosalie Fiobona, Farmer

Even those attempting to help the displaced people in Batangafo are, themselves, becoming targets. Batangafo is one of the sub-prefectures most affected by incidents against humanitarian workers in a country already listed as one of the most dangerous countries in the world to be a humanitarian. On several occasions emergency aid work had to be suspended as humanitarians were forced to withdraw. Every day an average of at least one act of violence is registered against humanitarian workers in the Central African Republic. Batangafo was the fourth most affected sub-prefecture with 39 incidents against humanitarian personnel or property in 2020. In January 2021, 66 incidents were recorded across CAR – more than double the monthly average in 2020.

Neither Rosalie nor Antoinette have any property within the triangle. And even if they did, every inch has a shelter, a person, a purpose. Both women’s properties are less than 3km away. Most of the displaced people have homes that are heartbreakingly close. An afternoon’s walk, a simple stroll across the road, a short hour away. There, there are houses with burnt roofs and grass where crops were planted before. Most still visit their homes despite the danger. Not just for food but also to be, for an hour or two, in their own homes. The lure of the memory of a time when they had control of their own lives, when they could work to feed themselves, surrounded by their neighbours and families, is so great that even the threat of rape and death cannot always conquer it.

As the evening closes in Rosalie and Antoinette walk back into the centre of the displaced people’s site. When everything they want and have worked so hard for: independence, control and home, lies, impossibly, in the opposite direction.

*names have been changed to protect the interviewees

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Overview of population movements as of 31 January 2021

OCHA CARTE DISPLACEMENT ENG JANUARY 2021

About 725,200 people were internally displaced in the Central African Republic at the end of January 2021, according to the Commission on Population Movements (CPM). This figure reflects a 6.3 per cent increase, or 43,263 more internal displaced persons (IDPs), compared to December 2020 when the IDPs were estimated at 681,930. The crises linked to the general elections in December 2020 continued to maintain people on displacement. The flux of displacements reached 61,686 people in January. Short-term displacements were mainly reported in the towns of Bossembele, Baoro, Alindao, Bocaranga and Bangui. In deducting the returns reported by its partners, the CPM estimates that 45,355 newly displaced people are still in displacement in January. These new IDPs are mainly located in the prefectures of Nana-Gribizi, Basse-Kotto, Mbomou, Nana-Mambere, Ombella-Mpoko, Ouaka, Ouham and Ouham-Pende, on sites or host families.

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Humanitarian dashboard 2020

Humanitarian dashboard 2020

In 2020, humanitarian actors in the Central African Republic assisted 1.6 million people, 88% of the people targeted for emergency assistance. This included mitigating the immediate effects of food insecurity and malnutrition, providing shelters, water and hygiene services to populations displaced by armed clashes and natural disasters and protecting the most vulnerable. The humanitarian community relied on the air and road cargo services which transported 3,243 MT of goods across the country and nearly 9,000 passengers by humanitarian aircraft to the most remote and hard to reach areas.

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Overview of incidents affecting humanitarian workers in January 2021

Overview of incidents affecting humanitarian workers in January 2021

The civilian population remains the primary victim of the renewed tensions and violence observed in the Central African Republic since the end of 2020. The significant increase in incidents affecting humanitarian workers in January 2021 reflects the acute insecurity in several prefectures where armed confrontations took place, such as in Lobaye, Ombella M'Poko and Mbomou. In January, nearly 90% of the 66 incidents (the highest monthly figure since 2017) involved robberies, burglaries and lootings. Armed confrontations were not the direct cause of incidents, but the absence of security forces in several towns encouraged opportunistic criminal acts. During January, four humanitarian vehicles were stolen, two of which were later recovered.

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Emergency Response
©OCHA/Anita Cadonau, Bangui, CAR, 2020.
©OCHA/Anita Cadonau, Bangui, CAR, 2020.

The Humanitarian Response Plan 2021 for the Central African Republic

To meet the needs of the Central African population in 2021, humanitarian actors plan to provide an inclusive, protective and humanitarian-based response to 1.84 million extremely vulnerable people. The response, based on a common understanding of humanitarian needs, will primarily target people affected by shocks linked to violence and natural hazards, and those living in areas with the most urgent humanitarian needs, including in hard-to-reach areas. To achieve this, humanitarians will require US$444.7 million. The strategy that will guide their response is detailed in the Humanitarian Response Plan 2021. As of 21 January 2021, only 9% of this plan are funded at a time when humanitarian needs are extremely alarming. Since violence and tensions related to the December 2020 elections erupted, almost 200,000 people have been internally displaced. Half of them have returned, but 100,000 people are still displaced.

The Humanitarian Needs Overview for the Central African Republic, published in October 2020, tells us that more than half of the Central African Republic's population needs humanitarian assistance and protection in 2021. Among them, 1.9 million people have acute needs related to their physical and mental survival.

The Humanitarian Response Plan 2021 is structured around three strategic objectives. Each of them aims to address one of the three most critical humanitarian consequences identified in the Humanitarian Needs Overview. The response will mitigate the impact of the crisis on people's physical and mental well-being, living conditions and protection. Within this framework, 1.4 million people will benefit from timely and integrated multi-sectoral emergency assistance, in cash or in kind, needed to address the most critical issues related to their physical and mental well-being. Some 1.2 million women, men, girls and boys affected by the crisis will improve their living conditions through dignified and tailored assistance provided in a timely and protective environment. And thirdly, the protection and respect of the human rights of 1.3 million crisis-affected people will be ensured.

The humanitarian response in the Central African Republic in 2021 will be developed as close as possible to and with the people affected, listening to their concerns, priorities and grievances. Humanitarians will pay particular attention to the voices of women, people with disabilities and the elderly to ensure that their specific vulnerabilities are considered and interventions are adapted.

To find out more, see the Humanitarian Response Plan 2021 for the Central African Republic.

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Scale-up of cash-based initiatives in 2020

Scale-up of cash-based initiatives in 2020

Humanitarian actors have scaled up cash-based initiatives (CBIs) in 2020, with 48 per cent more people assisted compared to 2019, in line with the Humanitarian Response Plan 2020. Between 1 January and 31 December 2020, some 848,000 people received 29.2 million USD through cash transfers, vouchers or electronic transfers, the vast majority in emergency response. 44 per cent of the people assisted benefitted from COVID-19 related CBIs. The UN Cash Common System (UNCCS) continues to collaborate with the Cash Working Group on further CBI scale-up in 2021, in line with the Humanitarian Response Plan 2021, particularly in urban areas such as Bangui and Kaga-Bandoro. Find out more about the Humanitarian Response Plan 2021: http://bit.ly/3jaKYWq

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Forecast
The Humanitarian Needs Overview 2021 reveals a further deterioration of the humanitarian situation across all sectors. ©NRC/C. Igara, CAR, 2020.
The Humanitarian Needs Overview 2021 reveals a further deterioration of the humanitarian situation across all sectors. ©NRC/C. Igara, CAR, 2020.

The survival of 1.9 million people in the Central African Republic is at risk

In 2021, 2.8 million Central Africans – 57 per cent of the population estimated at 4.9 million – will need humanitarian assistance and protection. Of those, three-quarters have acute needs. In other words, the survival of 1.9 million people, or 39 per cent of the population, is at risk. The Humanitarian Needs Overview 2021 for the Central African Republic, the result of an unparalleled data collection and extensive analysis, shows a further deterioration of the humanitarian situation across all sectors.

The figures reveal the dramatic consequences of a pandemic in a country already ravaged by decades of armed conflict, underdevelopment and where natural disasters are becoming more frequent and severe. The figures also reveal the grim daily life the majority in the country, who live in such difficult conditions that they are struggling to feed themselves. Even those who have enough food find it difficult to find decent housing or to get their children an education. The data also shows that there is a danger of humanitarian actors disengaging when development actors are slow to take over.

The humanitarian situation continues to worsen

Since last year, the number of people in need has increased from 2.6 million to 2.8 million (+8 per cent). Meanwhile, the number of people with acute needs is 12 per cent higher than in 2020 (with 1.9 million people in 2021 compared to 1.7 million in 2020). In the past five years, there have never been as many people in humanitarian distress in the Central African Republic as today. This increase is a direct consequence of the downward plunge of the economy, the spreading of the violent conflict, rising food insecurity and the COVID-19 pandemic.

The Central African Republic continues to face a serious protection crisis, with a steady increase in violations of human rights and international humanitarian law despite the signing of the Political Agreement for Peace and Reconciliation in 2019. Those who suffer most are not those fighting, but rather the civilians. One in four Central Africans are displaced either within the country or in a neighboring country, and the return of internally displaced people and refugees has slowed down considerably.

Gender-based violence is a plague, with one incident reported every hour by the humanitarian alert system, which covers only 42 per cent of the country – and these figures are only the tip of the iceberg. Humanitarian actors have recorded an almost two-fold increase in the number of cases of violence against girls and women as a result of restrictions related to COVID-19. Across the Central African Republic, children continue to be exposed to risks. One in four families fears for the safety of its children, mainly in relation to sexual violence, forced labor and recruitment by armed groups.

The sector with the most people in need is thus protection, followed by health, water, hygiene and sanitation and food security. 40 per cent of Central African households are in a situation of acute food insecurity. In the capital of Bangui, the number of food insecure people has almost doubled since last year, now affecting 45 per cent of the population. The number of people in need in 2021 has increased in all sectors except nutrition, where there has been a slight decrease.

The Central African Republic is also one of the most dangerous countries for humanitarians in the world. On average, more than one incident per day affecting humanitarian workers was recorded in 2020 (424 in total), with three aid workers killed and 29 injured.

The next steps

To meet the population’s needs in 2021, humanitarian actors in the Central African Republic in collaboration with the government develop a common strategy to guide their interventions, detailed in the Humanitarian Response Plan 2021, published in December 2020.

Despite generous donor contributions, as of October 2020, the current Humanitarian Response Plan is funded at just over half of the US$ 553.6 million required. To enable humanitarians to meet the ever-growing needs of the population in 2021, they are counting on donors’ commitment to stand by those Central Africans who cannot meet their basic needs.

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Feature
The mixed Congolese and Central African surgical team performing its first fistula surgery at the Hôpital de l’Amitié in Bangui. ©Mukwege Foundation, 2020.
The mixed Congolese and Central African surgical team performing its first fistula surgery at the hôpital de l’Amitié in Bangui. ©Mukwege Foundation, 2020.

Holistic care for survivors of sexual violence in the Central African Republic

The inauguration of the project Nengo on the eve of the first day of «16 days of activism to end gender-based violence» in Bangui could not have been timelier. «Nengo» in the local language Sango means dignity. And dignity is what the project aims to restore for thousands of women and girls, but also boys and men who survived violence directed at them based on their gender.

One of the country’s darkest chapters

Every single hour in the Central African Republic, a case of gender-based violence is reported. And the situation is certainly worse, since the respective information management system (GBVIMS) supported by humanitarians covers only 42 per cent of the country. Widespread insecurity in the country maintains a context conducive to gender-based violence, but also deeply rooted gender inequalities, the abuse of power and harmful norms contribute to this crime. The COVID-19 pandemic has further increased existing vulnerabilities, particularly during its first months. As lives retreated inside homes due to lockdown measures introduced by the government, an alarming increase in violence against women and girls was reported in the Central African Republic. Women and girls had to stay at home with their abusers – often spouses, partners or family members – increasing cases of violence by at least by 10 per cent, while limiting survivors’ possibilities to seek protection and assistance.

Project Nengo sets up a centre for the holistic care of victims within a public hospital in Bangui, the Hôpital de l’Amitié, and within the Central African Women Lawyers Association, two recognised referral centres for survivors of sexual and gender-based violence in the country. After months of preparation, teams from the gynaecology-obstetrics and maternity department at the Hhôpital de l’Amitié and the Women Lawyers Association, with the support of international partners, launched the holistic care programme for survivors of sexual violence.

A «one stop centre» to rebuild lives

The newly established centre provides a single point of reference, a «one stop centre» for survivors of sexual and gender-based violence to receive a comprehensive response to their needs. This holistic care model was developed by 2018 Nobel Peace Prize laureate Dr Denis Mukwege and his team at the Panzi hospital in Bukavu in the eastern Democratic Republic of Congo (DRC). It structures around four pillars, which respond to the essential healing needs of victims and their empowerment:

The response includes medical care and the treatment of severe gynaecological injuries, which may include surgery. Survivors often show signs of depression, fear, behavioural disorders and self-shame. They face social exclusion and troubles rebuilding trust and relationships. The second pillar of the response therefore centres on psychosocial care, an integral part of the healing process that both anticipates and complements physical treatment. The survivors also receive legal assistance to demand justice, including judicial counselling and an accompaniment throughout the judicial process. And fourth, survivors are empowered socio-economically, for example, through literacy training, small business management and microcredit programmes and scholarships. Economic reinsertion and rebuilding independent livelihoods are particularly important for those survivors whose subsistence depended on their aggressor.

Having all services united underneath one roof is practical for those seeking assistance and it makes referrals between services easier. But it is also an important component of victim protection. It avoids that the survivor has to tell her or his story over and over again, reliving the atrocities.

Project Nengo will also contribute to the prevention of sexual and gender-based violence in the Central African Republic through advocacy, strengthening of the rule of law and reducing structural causes of these types of violence by promoting gender equality.

South-south skills transfer

Faced with the grave situation in the Central African Republic, a consortium of four international institutions – the Pierre Fabre, Panzi DRC and Dr Denis Mukwege foundations and the Francophone Institute for Justice and Democracy – joined forces and with financial support from the French Agency for Development, replicate Dr Mukwege's holistic care model from the DRC in Bangui.

The «one stop» model for survivors of sexual and gender-based violence is also being replicated in other countries, including Guinea, Colombia and Uganda. The transfer of skills between Congolese and Central African actors will strengthen the capacities of the public hospital and the local lawyers association for the benefit of people in the long run. Improving the quality of care in the gynaecological-obstetrics department of the hospital will moreover benefit the entire population and not only survivors of violence.

Beyond the capital

Over 3,000 survivors will be able to receive treatment and support at the new centre over the course of the next four years. Although located in Bangui, the centre will also be accessible for survivors from outside the capital through a referral system between the Nengo project and NGOs, health care providers and civil society organizations located throughout the country.

On the eve of project Nengo’s inauguration, the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) intervened at the project's Strategic Steering Committee workshop to present mechanisms for the prevention of sexual abuse and exploitation within the humanitarian community, and will continue to bridge the project with humanitarian actors working in the areas of protection, health care and empowerment.

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Central African Republic

Situation Report
Emergency Response
Health workers from the Bogoula Health Centre take part in the practical session on disinfection and the preparation and use of a chlorine solution.  © Gloria Demarchi/Concern Worldwide, Ombella M’poko, CAR, 2020.
Health workers from the Bogoula Health Centre take part in the practical session on disinfection and the preparation and use of a chlorine solution. © Gloria Demarchi/Concern Worldwide, Ombella M’poko, CAR, 2020.

Joining forces in the fight against COVID-19

Since the first case of COVID-19 was recorded in March 2020, the Central African Republic (CAR) has recorded 5,004 confirmed cases; including 63 deaths (as of 22 February 2021). Faced with this emergency, the NGO Concern Worldwide immediately adapted two of its current projects and launched two new projects, in collaboration with other NGOs, along the roads connecting the capital of the Central African Republic, Bangui, to the Cameroon city of Douala – a region which was most affected by the pandemic. 400,000 people across western CAR will benefit from this robust NGO mobilization.

Strengthening health centers

Before the country was hit by the pandemic, Concern Worldwide was already working with 13 health centers in Ombella M’Poko and Lobaye, thanks to funding from Irish Aid, by strengthening their capacities to deal with malnutrition, especially among children. With the arrival of COVID-19, the NGO quickly trained health workers, based in these centers, on how to prevent and control infection and provided the centers with protective equipment, hand washing devices and materials for cleaning and disinfection, as well as communication materials to sensitize the community on barrier actions against the virus.

Since July, this same approach has been extended to 62 other health centers, thanks to two new financial projects by the Bureau for Humanitarian Assistance of the United States Agency for International Development (USAID BHA) and the United Nations Children’s Fund (UNICEF). These health centers are located along the main roads of the prefectures of Ombella M'Poko, Ouham, Ouham-Pendé, Nana-Mambéré and Mambéré-Kadéï in the west of the country, which lead to Cameroon – CAR's main trading partner.

Joint efforts

The BHA-funded project is being implemented as a consortium alongside the NGOs International Medical Corps (IMC), Danish Refugee Council (DRC) and Oxfam, which are coordinating their efforts to fight the spread of the pandemic, in support of the Ministry of Health and Population.

As access to water and adequate sanitation infrastructure is essential in the fight against the spread of the pandemic, additional support will be provided under the project financed by UNICEF to construct 30 latrines and rehabilitate 20 water points among the 62 health centers which are to be supported.

Involving the community

To provide essential information on the risks and prevention of COVID-19, the NGO relies on community intermediaries (RECO) and mothers, called ‘Mothers of Enlightenment’ in order to reach communities, including isolated villages, and to support the epidemiological surveillance in these communities. RECOs and the Mothers of Enlightenment act as role models in the community, motivating others to adopt good practices to reduce the risk of transmission. This approach has been used for several years already in the context of projects targeting health centers. Around 100 RECOs and more than 600 Enlightened Moms work with more than 13,000 families every day, in their respective areas, in order to improve hygiene, health and nutrition practices. In April and May, these RECOs and Mothers of Enlightenment were trained on the prevention of COVID-19 and equipped with protective and didactic material for awareness raising. As part of the two new projects to fight COVID-19, 400 additional people are also being trained as RECOs, and will then go on to support the health areas of the 62 health centers.

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Central African Republic

Situation Report
Analysis
The NGO Médecins d'Afrique trains community health workers on the treatment of COVID-19 patients. ©Médecins d'Afrique. Sibut, Kemo Prefecture, CAR, 2020.
The NGO Médecins d'Afrique trains community health workers on the treatment of COVID-19 patients. ©Médecins d'Afrique. Sibut, Kemo Prefecture, CAR, 2020.

The Central African Republic faces health and humanitarian consequences of COVID-19

First case: 14 March 2020

Total cases: 5,004 (22 February 2021)

Total deaths: 63

Affected regions: All seven health regions of the country. The epicentre of the pandemic is the capital Bangui where an estimated 17% of the population (947,829 people) live.

Transmission: The Ministry of Health and Population indicates that the virus is predominantly spread through community transmission. Only one in five deaths occurred at hospitals, the others within the community. Given limited testing capacities, the government’s diagnostic strategy, since July 2020, limits tests to suspected cases and people at risk. Thus, the observed decrease in new confirmed cases should be interpreted with caution. For illustration, 37,104 people have been tested as of 21 February 2021, resulting in a 14 per cent rate of positive cases, which is relatively high compared by international comparison. Nearly three quarters of positive cases are men.

Schools: Schools started to gradually reopen in mid-July after they were closed countrywide on 27 March. Classes in an examination year continued in July, August and early September whereas all other classes resumed with the start of the academic year 2020-2021 on 19 October. According to the education cluster, an estimated 1,4 million students were affected by the school closure. Fear persists that some of them will never return to school, adding a further layer to the already poor level of education marked by the lack of qualified teachers and school infrastructure. In addition, analysis shows a rise in sexual violence against children in Bangui during the school closure.

Borders: Bangui Airport resumed commercial flights on 13 July after its closure in late March. Employees from international organizations, NGOs and diplomatic missions arriving by international flights are subject to a 14-day quarantine. Land borders are open and the provision of commercial goods that arrive predominantly from neighbouring Cameroun is assured, however, delays are reported.

Containment measures: The government imposed the closure of bars and night clubs, limited the number of people for gatherings and imposed the mandatory wearing of protective face masks in public spaces. However, the country is facing important challenges in reinforcing these measures in the capital Bangui, as well as in the prefectures. Places of worship have reopened after a temporary closure.

Situation

Since the first case was detected in the Central African Republic (CAR) in mid-March, the Ministry of Health and Population confirmed that 5,004 people have contracted COVID-19, including 63 who died as a subsequence (as of 22 February 2021). All seven health regions of the country have reported cases, with the capital Bangui being the hardest hit by the pandemic.

According to the World Health Organization (WHO), CAR is one of the least prepared countries to face the COVID-19 outbreak, with 2.8 million people already in need of health assistance and about 70 per cent of health services provided by humanitarian organizations. The country’s health system, marked by a chronic lack of medical equipment, critical medicines, qualified personnel and poor road infrastructure that disrupts supply chains, was under extreme stress prior to the pandemic and has been further stretched to prevent, contain and treat COVID-19.

Stocks of personal protective equipment for health personnel covers less than a third of the estimated need in the coming months. A very limited stock is available in remote parts of the country where access is difficult. There are only four COVID-19 treatment centres in Bangui and seven health isolation centres for the treatment of mild and moderate cases or to provide quarantine outside the capital. This situation makes it extremely challenging for the government and humanitarian organizations to respond to the pandemic and maintain essential services.

Among the most at risk are the 631,000 internally displaced people (IDPs). Risks of transmission are particularly high at overcrowded collective sites such as in Bria, Haute-Kotto Prefecture, where some 50,000 people live.

Aggravating factors include limited access to water in a country where only one in three inhabitant has access to clean drinking water, lack of sanitation facilities and infrastructures and weak and limited presence of national authorities to enforce containment measures. COVID-19 also has direct and indirect impacts on food security and nutrition in CAR. According to the latest food security alert from the Integrated Food Security Phase Classification (IPC), over half of the Central African population (2.36 million) are acutely food insecure (IPC Phase 3+). Some families lost their incomes at a time when they face higher living costs related to the pandemic. The containment measures also have indirect negative impacts, limiting poor households’ physical access to areas where they typically earn income from daily labour or adding increased transport costs. Prices of basic food and non-food items have again increased in July, reaching their highest level since the beginning of the year. A 5 per cent increase compared to June was registered during the latest market analysis.

Response

Humanitarian and development partners have joined the government’s efforts to prevent and respond to the COVID-19 pandemic in CAR. They have been supporting the decentralization of the response strategy at the health district level. Testing is now possible in four regions, namely in Bouar (Nana-Mambéré), Berberati (Mambéré-Kadéï), Bambari (Ouaka) et Bangassou (Mbomou), thanks to the Global Fund that provided GeneXpert cartridges adapted to COVID-19 tests. Laboratory technicians were trained in these towns with the support from WHO and the Pasteur Institute in Bangui.

With the support of humanitarian partners and MINUSCA, two treatment centres for COVID-19 patients have been set up in the capital Bangui and seven in Bambari, Bria (Haute-Kotto), Bouar, Paoua (Ouham Pendé), Bimbo (Ombella M'Poko), Berberati and Bossangoa (Ouham) – regions that were initially prioritized for the COVID-19 response. The humanitarian response is also underway in health districts not included in the initial priority list due to the evolution of the epidemic, such as Bangassou, Ngaoundaye (Ouham Pendé), Bocaranga-Koui (Ouham Pendé), Bégoua (Ombella M'Poko), Baboua-Abba (Nana-Mambéré), Gamboula (Mambéré-Kadéi), Kembé (Basse-Kotto), Kouango-Grimari (Ouaka) and Batangafo (Ouham). In the Begoua health district, for example, the NGO Médecins du Monde has built isolation and triage spaces in five health centres and in collaborating with Humanity and Inclusion trains health workers in psychological support and mental health. A consortium composed of the NGOs Première urgence internationale (PUI), Action contre la faim (ACF) and the French Red Cross has also set up isolation areas for suspected cases of COVID-19 in 14 health facilities in Bangui. In addition, WHO has provided the Ministry of Health with 26 oxygen concentrators, 7,700 COVID-19 PCR diagnostic kits and personal protective equipment acquired with the support of the United Nations Central Emergency Response Fund (CERF). CERF via the International Organization for Migration (IOM) also allocated in July US$5 million to the NGOs International Rescue Committee (IRC), International Medical Corps (IMC), Alliance for International Medical Action (ALIMA) and Médecins d'Afrique (MDA) to intensify the response to COVID-19 in the center, east and north of the Central African Republic, where the selected NGOs have been implementing emergency response programs for several years. This funding allows assisting 220,000 vulnerable people, including 87,000 displaced persons living in deplorable sanitary conditions conducive to the spread of the virus. The funds will enable the construction, rehabilitation and equipment of 19 isolation and treatment centres for COVID-19 patients and improving epidemiological surveillance mechanisms. Medical staff will be recruited, and drugs and supplies will be procured. In addition, psychosocial agents will ensure that the mental health of patients and their families is also taken care of.

Humanitarian actors are setting up water points and handwashing stations at IDP sites and in host communities, training health workers and community volunteers, distributing hygiene kits and protective equipment to attend the needs of health centres. Thousands of people have been reached with campaigns to raise awareness to prevent transmissions.

The World Food Programme (WFP) has launched its support to vulnerable people affected by the pandemic in and around Bangui through cash-based assistance worth USD 532,000 to 51,000 beneficiaries. Furthermore, WFP supported 350 patients in hospitals across the country in July.

Innovative partnerships have also emerged to ensure an inclusive response that protects the most vulnerable. At the end of July, Médecins sans frontières (MSF) and WFP signed an agreement to provide food assistance to 1,245 people living with HIV/AIDS and their dependents in Paoua. In Bouar and Baboua, WFP and World Vision also modified their beneficiary criteria to provide food assistance to people impacted by COVID-19 or chronic diseases.

As part of its decentralization strategy, the Ministry of Health has introduced a community-based surveillance strategy. A pilot project was implemented in the 3rd district of Bangui in July in partnership with the Central African Red Cross and the Directorate General of Civil Protection. The community-based surveillance teams are trained to raise awareness of COVID-19 prevention measures, detect and report suspicious cases and deaths in the communities, monitor simple and moderate cases, refer serious cases to hospitals and trace contacts of infected persons. The implementation of community-based surveillance in the rest of the country will follow. Humanitarian partners will support the implementation through existing networks of the community relays.

In July 2020, the United Nations and its partners updated the Humanitarian Response Plan, a US$152.8 million appeal to address the most immediate and critical health and non-health related needs of millions of Central Africans affected by the consequences of COVID-19.

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