The Central African Republic continues to grapple with a complex humanitarian crisis despite a decrease in the number of people in need. While security conditions have improved in certain regions, challenges persist, particularly recurrent clashes between conflicting parties leading to displacement and disrupting access to livelihoods. One in five Central Africans is either internally displaced or found refuge abroad due to ongoing violence.

In 2024, the situation remains concerning, with 2.8 million people – 46 per cent of the population – who are extremely vulnerable to the extent that humanitarian assistance alone is not sufficient for their well-being. The refinement of needs conducted early with authorities and affected communities in the interior of the country has shown that some relatively stable areas require the engagement of other actors, such as those involved in development to consolidate gains from humanitarian efforts, and to sustainably support the protection and resilience of vulnerable communities.

In response to these challenges, the humanitarian community aims to provide vital multisectoral assistance to 1.9 million of the most vulnerable Central Africans and calls for the mobilization of US$ 367.7 million. The response strategy is based on addressing multisectoral needs in the face of various vulnerabilities, prioritizing protection throughout all sectors, and localizing humanitarian response for systematic engagement of national actors. The strategy also includes accountability to affected people ensuring humanitarian response meets their expectations, the humanitarian-development-peace nexus to take advantage of stable areas, and thus strengthen the resilience of populations by promoting durable solutions to displacement.

In addition to the already challenging humanitarian situation and recent financial constraints, humanitarian actors faced new crises in 2023, with the impact of the Sudanese war in the northeast and insecurity in the border region with Chad in the northwest. Despite these challenges, and thanks to donors’ generosity, 2 million of the most vulnerable Central Africans received vital assistance in at least one sector, particularly in regions that have long remained inaccessible by road in the central part of the country. However, only 56 per cent of required funds were mobilized, with significant disparities between sectors, notably in gender-based violence and nutrition sectors which received only 6 and 24 per cent, respectively, of required funds.

Faced with the recent ever-changing dynamics of the humanitarian aid funding environment, the Central African humanitarian community is calling for mobilization to support the population, particularly to sustainably support the protection and resilience of vulnerable communities.

For more information, please refer to the Humanitarian Response Plan (French version).

The number of shocks facing populations, such as clashes, has decreased. So have the population movements they entail, following a slight improvement in the security situation. However, one Central African in five remains displaced either within the country or abroad, mainly in neighbouring countries, due to the insecurity generated by conflict. In addition, clashes between various parties to the conflict and attacks on civilians remain recurrent, and new displacements have been recorded, as have violations of Human Rights and International Humanitarian Law by armed men, forcing the population to seek refuge elsewhere. This is particularly the case in the south-east and west of the country. Conflicts in neighboring Sudan and Chad have also impacted the vulnerability of populations, increasing the magnitude of needs in the northeast and northwest regions.

2.8 million people - or 46 per cent of the population - will be extremely vulnerable in 2024, to the extent that humanitarian assistance alone will not be sufficient for their well-being. The drop in this figure compared to 2023 is linked not only to a general improvement in the context, but also to the refinement of needs analysis to highlight those arising from structural problems, which in some cases reach humanitarian intervention thresholds, and those arising from recent shocks suffered by the population. In many regions, humanitarian actors are often the only ones ensuring access to basic social services such as health and education, for which other types of actors, notably development ones, would better suit. In this context, when humanitarian aid, which is intended to alleviate consequences of a recent shock, comes to an end, the lack of a long-term relay by more appropriate actors causes the population to fall into a cycle of dependency.

This is what describes the new 2024 Humanitarian Needs Overview for the Central African Republic (CAR), which is based on the results of a joint multi-sector analysis carried out by the humanitarian community. This analysis was largely affected people-oriented, interviewing 28,000 households, 430 key informants/observers and 280 children across the country's 72 sub-prefectures. Its results illustrate how the current crisis is affecting people's living conditions, services and access to these services, and provide information on people's priority needs.

Magnitude of needs

During the assessments, interviewed households expressed their needs in different sectors, enabling the humanitarian community to get as close as possible to the views of those affected, and to develop a strategic joint response plan. In 2024, the sectors with the largest number of people in need will be water, hygiene and sanitation, food security, health and protection, totaling between 1.9 and 2.5 million people.

Despite the drop in the total number of people in need, some prefectures have seen an increase due to the deteriorating security situation inside the country or in border regions. This is particularly true for Vakaga (+32%), Haut-Mbomou (+16%), Lobaye (+9%) and Mbomou (+4%). However, the five prefectures with the highest number of people in need are Ouaka (348,000), Ouham (229,000), Mambéré-Kadéï (158,000), Nana-Gribizi (156,000) and Bangui (120,000).

The more security improves and access to basic services is re-established by more appropriate actors, the fewer humanitarian needs will be reported in CAR. When emergency aid programs come to an end, other types of actors, such as development agencies, will have to take over or cover the gaps to prevent the population from falling into a cycle of dependency that destroys its resilience.

Foundation for humanitarian response in 2024

The Humanitarian Needs Overview presents a common understanding of the crisis within the humanitarian community, including the magnitude of needs, the most urgent needs, and the number of most vulnerable people. As such, it provides a factual basis to inform joint strategic planning of the response, through the Humanitarian Response Plan.

Download the 2023 Humanitarian Needs Overview for CAR here (in French).

Internally displaced persons (IDPs) from Batangafo in the Ouham Prefecture in the west of the country will soon be spending 10 years at dedicated sites. The latter had been created in 2014 at the height of the Central African conflict, to host the population of Batangafo and neighboring villages seeking refuge. With this extended stay at IDP sites, some of them are calling for assistance to return to their place of origin and resume a normal life, but the decision is not easily coming. Due to insecurity, one in five Central Africans is currently internally displaced or has found refuge abroad, mainly in neighbouring countries.

Violence against civilians and insecurity outside urban centers continue to impact the well-being of several million Central Africans, who see their livelihoods deteriorate and their access to food, drinking water and many other basic services, including healthcare, drastically limited. In 2023, 3.4 million people - 56 per cent of the population - are so vulnerable that humanitarian assistance alone is not sufficient to guarantee their well-being.

Born and raised in a site for internally displaced persons

Reine Koutigué will soon celebrate her tenth birthday, at the same time as the Baga site in Batangafo where she was born and still lives. Thanks to humanitarian actors’ support at the health center set up inside the site, Reine's mother was able to receive the care she needed from the antenatal period through delivery. But on her birthday, she won't be blowing out candles like other children, or receiving best wishes messages. Unfortunately, it will be a day like any other, punctuated with promiscuity that is destabilizing for a child of her age. The little girl has never lived in a traditional habitat, such as the village where her parents' home was located.

Currently in 4th grade, Reine dreams of a career in health care to look after her brothers and sisters. "I don't want my brothers to die. I'm going to look after them when I grow up. That's why I'd like to work in a hospital," she said. Like Reine, many other children were born and are now growing up in the Baga site. According to testimonies, some of these children do not act like those born in a traditional habitat and behave somewhat differently.

"I sometimes find him lonely, sometimes aggressive, and I think this could be linked to the environment in which he's growing up", explained Emmanuel Mokpême, father of little Edouard, who like Reine will celebrate his tenth birthday soon. The youngster dreams of becoming a teacher, but his father has some doubts about his child's ability to concentrate compared to other children born and raised in a classic village. "It's the lack of landmarks, of games, of role models, of a normal day-to-day life that's doing all this," continued Emmanuel, who would like to see his son reach his 10th birthday out of the IDP site.

Plans to return tested by resources and insecurity

The decision to return is not without its difficulties for IDPs. Following improvement in the security situation, some IDPs decide to return to their villages, but need resources to resettle. During displacement, homes are either dilapidated or looted and sometimes burnt down by parties to the conflict. In other situations, IDPs have to choose between staying at the sites, returning to their places of origin because they are tired of living in precarious conditions, even if security conditions are not very reassuring, or staying at the sites because they have nothing left in their places of origin. "We no longer have a house. We came from the town of Bouca, 90 km from Batangafo. And going back is no longer possible because of insecurity," said Sabé Isaï, who has been living on the Baga IDP site for almost 10 years. In August 2023, some 489,000 IDPs were registered in the Central African Republic (CAR). 120,500 are living in sites, and 368,300 other in host families. A total of 227,000 people have returned to their villages in the last 12 months, mainly as a result of improved security situation.

Adapting the humanitarian response

Based on specificities of each region, the humanitarian community implements emergency assistance and/or support for the voluntary return of IDPs, in partnership with other actors. The humanitarian situation in the CAR is volatile, and regions once considered stable can suddenly shift into humanitarian emergency zones. Humanitarian actors are adapting their response based on this context, and are collaborating with other actors, notably on programs to support voluntary return.

Support for voluntary returns is one of the four axes of the intervention strategy of the 2023 Humanitarian Response Plan. Since the beginning of the year, humanitarian actors have supported voluntary return of 4,600 households in the prefectures of Haute-Kotto and Nana-Gribizi in the center of the country, notably by providing transitional shelters, rehabilitating water, hygiene and sanitation facilities, supplying essential household items and supporting income-generating activities for returning households. Alongside the US Agency for International Development's (USAID) Bureau for Humanitarian Assistance (BHA), the Humanitarian Fund for CAR is one of the key donors for this vital initial support for returnees. To date, it has disbursed over US$ 2.6 million. Once resettled, returnees have other needs for which emergency assistance is no longer adapted, requiring intervention of other types of actors, notably to rebuild basic social services.

The civilian population in the Central African Republic (CAR) continues to pay a heavy price, in a country ravaged by conflict and subsequent violence for over a decade. Located in the south-east of the Haute-Kotto prefecture, the sub-prefecture of Yalinga, with an estimated population of 10,650 remains one of the most vulnerable and isolated in the country. Yalinga is very difficult to access, where roads exist, and the cellular network does not cover this city located nearly 600 km from Bangui, the capital. Access to basic services such as water and healthcare is very poor, while food insecurity is among the most severe in the country. Most of its residents are spontaneous returnees, having been displaced for years following atrocities committed by armed groups.

Major obstacles to humanitarian access

Difficult to access due to armed groups activities, as well as physically due to the deterioration or absence of roads, particularly during the rainy season (April-October), Yalinga has always faced a worrying humanitarian situation.

Clashes between different armed groups over control of resources are recurrent. The population continues to suffer extortion, illegal taxation and other human rights violations on a daily basis. Humanitarian organizations are also affected by robberies and kidnapping attempts when they try to help the most vulnerable. This was the case in December 2022, when staff from a Non-Governmental Organization (NGO) on a mission to install a vaccine conservation system in a health center in the Yalinga region were held hostages by armed men, before being released following negotiations with local authorities. In 2021, a private transporter working for an NGO was robbed, and three months' worth of medicines for the Yalinga Health Center were taken by armed men. The presence of armed groups since 2020 and insecurity have made humanitarian activities and multi-sector assessment missions by road impossible, leading to the temporary withdrawal of humanitarian organizations until April 2023.

For the first time in over three years, a humanitarian mission by road comprising OXFAM, INTERSOS, AURD, BRIA-LONDO, ESPERANCE and the World Food Programme (WFP), under the leadership of the Office for the Coordination of Humanitarian Affairs (OCHA) visited Yalinga from 18 to 22 April 2023. The mission assessed the needs of the population and prepared a response plan covering the period from April to December 2023. Preliminary contacts with authorities and civil society actors in Yalinga and the region helped in identifying and mitigating risks associated with road travel in the area.

Multi-sectoral needs

According to the results of assessments carried out in April 2023, significant needs have been identified in almost all sectors, including protection, health, food security, nutrition, education, water, hygiene and sanitation.

More than 120 protection incidents were documented, including cases of torture, kidnapping, destruction of property and 50 cases of gender-based violence (GBV). The presence of armed groups, unfavorable economic conditions for parents, lack of school infrastructure and qualified teachers have caused over 60 per cent of children to drop out of school. Access to drinking water remains a major challenge for the population, who continue to use water from rivers and traditional wells in the absence of any developed water source. "Our community lives in precarious conditions, and this mission is a ray of hope. We are very happy to see that humanitarian organizations have returned to bring us the help we need", declared Jean-Irénée NGUIMENDE, mayor of Yalinga.

A timely humanitarian response

To meet the urgent needs of the population, the assessment mission was coupled with an initial humanitarian assistance package. With the support of the NGO Bria-Londo, a batch of communications equipment was handed over to the Yalinga authorities for the reinstallation of the VHF radio, which will enable them to communicate with the outside world, in particular on the protection of the residents. No cellular network covers the area.

11 GBV survivors received cash assistance from INTERSOS, in particular to cover their food needs. To mitigate the risks of GBV, which particularly affect girls and women, nine group awareness-raising sessions on GBV issues were organized for around 240 women and girls. 40 vulnerable women and girls with specific needs received hygiene kits from OXFAM. To support children's education, the NGO COOPI distributed teaching kits to six of the 10 schools in the sub-prefecture.

With the support of the World Health Organization (WHO), 300 insecticide-impregnated mosquito nets were distributed and some 5,380 people were sensitized to menstrual hygiene, home water treatment techniques and environmental hygiene. The NGO Bria-Londo trained the Yalinga Peace Committee members in income-generating activities and provided them with micro-project kits to increase the availability of basic necessities in the region, thus supporting food and nutritional security of residents.

Already one of the prefectures most affected by a decade of conflict and structural problems, Haut-Mbomou has seen its security and humanitarian situation progressively deteriorate since March 2023. Two armed groups have been clashing against the backdrop of community conflicts and control of resources, with devastating consequences for the population. Already at the beginning of this year, almost 80 per cent of the Prefecture's inhabitants were in urgent need of humanitarian assistance and protection.

Civilians paying the heaviest price

In May, following clashes between these armed groups, an unknown number of civilians were killed, houses were burnt and more than 7,500 people were displaced from Bambouti, Kadjemah and Mboki and are currently taking refuge in the region of Zémio, Mboki and Bangassou in the neighbouring Mbomou prefecture. Some 2,500 of these people are said to have crossed the border into the Democratic Republic of Congo. In Kitessa and Maboussou on the Zémio-Mboki axis, civilians fleeing insecurity are unable to freely move due to numerous barriers erected by armed men. Some 30 civilians have been abducted by one of the armed groups, against the backdrop of reconstituting its ranks and contesting peace-building initiatives between the communities. Although some of them have since been released, similar risks still hang over the population, restricting their freedom of movement. As a result of persistent insecurity, access to markets and basic services such as healthcare is currently very limited for the population, whose humanitarian needs remain among the highest in the country, particularly in terms of food security. Added to this are problems of physical access to several villages during the current rainy season (April to October), due to flooding and associated high risk of population movements.

Health particularly affected

The base and pharmacy of the NGO providing health care in Mboki were looted by armed men in May, resulting in a total shortage of essential medicines. The Kadjemah health post was also looted and destroyed. Following the resulting insecurity, the NGO teams were evacuated from Mboki. There is currently no humanitarian physical presence in Mboki. This insecurity also led to a drop in the use of health services, including in displacement areas such as Zémio and Mboki. Reproductive health services and vaccination activities are particularly affected, while risks of a resurgence of measles epidemics and peaks in malaria cases are high. Assisted childbirths have fallen by over 55 per cent, in a country with the fifth-highest maternal mortality rate in the world (829 deaths per 100,000 live births). Armed men have also issued death threats against health personnel and humanitarian workers. A midwife was killed in May for allegedly supporting one of the parties to the conflict.

An emergency humanitarian response

Since the end of May, humanitarian organizations have been providing health care to internally displaced persons in Zémio, particularly in primary and reproductive health care. Among other things, they have provided the Zémio Health Center with medical supplies to meet the needs of around 1,400 people for a period of three months, notably for the treatment of sexually transmitted infections and post-rape situations. Humanitarians also distributed cash to 845 displaced families in Mboki, enabling them to purchase essential household items of their choice. 11 boreholes and wells were rehabilitated to enable displaced persons access to drinking water. 300 displaced persons from the CEEC church site in Mboki lack latrines and showers, and 230 displaced families in Zémio need assistance with essential household items. Given the scale of the needs at national level and the context that is undergoing new developments, notably with the impact of the Sudan crisis in the north of the country, the crisis in the border region with Chad in the west of the country and the crisis on the Bria-Yalinga axis in the center, the capacity to absorb additional needs is becoming increasingly limited.

Fragile protection

Despite ongoing assistance, protection remains the main priority for populations who can no longer access their fields, the main source of their survival. The return of people currently displaced continues to face a number of protection challenges, particularly in terms of freedom of movement, including the risk of being used as human shield by parties to the conflict, and access to means of subsistence. Civilians also continue to suffer reprisals, including killings, for allegedly supporting one or other of the parties to the conflict.

38, 014 people, mostly women and children, including 6, 235 Central African returnees arrived from Chad in the Central African Republic (CAR) in April in the Sub-prefectures of Paoua, in the Lim-Pendé Prefecture, and Markounda, in the Ouham Prefecture in the north-west of the country, fleeing incursions by a Chadian armed group. They are staying with host families, themselves living in one of the country's most vulnerable situations. To provide better protection to asylum-seekers, the government has identified Betoko as the site for their relocation, and its development is underway in partnership with humanitarian partners.

A protection crisis

Since the end of 2022, incursions by this armed group, against a backdrop of inter-community tensions particularly related to transhumance, have undermined the protection of the region's populations. Several civilians have been killed, among others for belonging to one or the other of the communities close to one or the other of the parties to the conflict. Commercial transactions in this border region is disrupted by insecurity resulting from various armed incursions and the levying of additional taxes, increasing price of food and non-food products by up to 50 per cent. Food insecurity in the region is among the most critical in the country, and access to fields for asylum-seekers and residents remains severely limited. In mid-May, CAR and Chad launched joint military operations to protect civilians on both sides of the border. On 9 June, a high-level delegation comprising the Prime Minister and Senior Officials from the United Nations and Non-Governmental Organizations (NGOs) visited Bedaka in the Paoua Sub-prefecture to assess the scale of the situation.

Humanitarian needs have exploded

This population movement is taking place in a region where humanitarian needs were already among the most severe in the country, and resources to cope with additional needs are becoming increasingly limited. Between 2022 and 2023, humanitarian needs in Lim-Pendé increased by 34 percent, making it the prefecture with the highest number of people in need of assistance in 2023. According to the Humanitarian Needs Overview, 464,000 people were already in need of humanitarian assistance and protection in Lim-Pendé, and the arrival of asylum-seekers further increases the caseload. Pressure on existing infrastructure and basic services in host communities has also increased. According to local authorities, the number of inhabitants in some villages has increased almost tenfold. As a result, access to water, hygiene and sanitation (WASH), as well as health, is becoming problematic. In the locality of Bembere, Sub-prefecture of Paoua, the minimum distance to the nearest health facility is 7 km. Faced with this situation, which can lead to tensions between host communities and asylum-seekers, strengthening mechanisms for the prevention and management of inter-community conflicts is necessary for the implementation of emergency aid programs.

Deploying the response

Since June, the humanitarian community has been providing multi-sectoral assistance in the Sub-prefecture of Paoua, as well as in Markounda, regions hosting asylum-seekers. This response also covers host families. Between June and September, humanitarian workers distributed food rations to 29,200 asylum-seekers and host families. These rations covered 30 days' worth of food. There are still unmet needs in the distribution of seeds to provide asylum-seekers' families with alternative food sources. 840 families in Bedaka received non-food items (NFI) including tarpaulins, soap, water purifiers, buckets, sanitary towels, clothes and shoes. Some of these families also received emergency shelters. There are still unmet needs in the NFI and shelter sectors for several hundred asylum-seeking families and their host families.

To improve access to drinking water and sanitation in Bedaka, humanitarian actors have rehabilitated 16 boreholes, built latrines and showers, distributed water purifiers and hygiene kits, and conducted awareness-raising activities for communities on good hygiene and sanitation practices. In six other villages, water facilities need rehabilitation. Humanitarian partners have also provided health centers in Begouladje, Bedaya, Bedam, Betoko and Markounda with medicines and medical equipment to treat asylum-seekers free of charge, including for malnutrition. Among other things, this support helped vaccinating through mobile clinics children under five. In this region, this age group was not vaccinated in 40 per cent of households. It has also helped to contain the peaks in malaria cases typical of the rainy season (April-October), through the distribution of insecticide-impregnated mosquito nets.

There are still unmet needs in emergency education, as six schools are non-functional, and those that are functional have low intake capacity. Asylum-seeking children lost at least three months of schooling during their flight. 5,000 children need to be reintegrated into school.

To respond to cases of gender-based violence, particularly rape, humanitarian actors are raising awareness of prevention among asylum-seekers and host communities, supporting referral of survivors to dedicated care facilities and distributing dignity kits. Most asylum-seekers, including children, have no civil documentation, and humanitarian actors plan to provide necessary support. The implementation of community-based protection mechanisms is also one of the protection needs to be addressed.

Only 56 per cent of the US$ 533 million required to cover the most pressing humanitarian needs in 2023 has been mobilized, and resources to meet additional needs are becoming increasingly scarce.

26, 421 people, mostly women and children, including 4,701 Central African returnees, crossed the border from Sudan to take refuge in CAR in the Vakaga (Birao and Am-Dafock), Bambingui-Bangoran (Ndele) and Haute-Kotto (Sam-Oundja) prefectures, fleeing clashes between the Sudanese Armed Forces and the Rapid Support Forces. The new arrivals have stabilized. In August, the Central African government signed a decree granting prima facie refugee status to Sudanese fleeing the ongoing conflict since April.

Economic consequences

As a result of insecurity along the border area, traffic between Sudan and the Central African Republic (CAR) has been severely disrupted, causing a sharp increase in the price of basic commodities. Sudan supplies several towns in CAR, particularly Birao in the Vakaga Prefecture and Ndélé in the Bamingui-Bangoran Prefecture. During the rainy season from April to October, access is very challenged and supplies largely depend on Sudan. For some items, prices have doubled. A 50-kg bag of sugar, which sold for XAF 40,000 before the conflict is now worth XAF 80,000 in Birao. A small bowl of millet that used to cost XAF 500 is now worth XAF 1,000. The northern region of CAR was already experiencing acute food insecurity, a situation that is projected to reach one of its most severe stages if an adequate response is not forthcoming.

Facing additional needs

Following the extent of humanitarian needs and the specific dynamics of the region hosting Sudanese refugees and Central African returnees as established by the assessment mission led by the Humanitarian Coordinator in early May, the humanitarian community has developed an addendum to the 2023 Humanitarian Response Plan to adapt the response. Of the 130,000 people in need in the northern region of the country, the addendum targets 25,000 people most affected by the crisis in Sudan in need of immediate assistance, namely IDPs and the host population, complementing the Regional Refugee Response Plan (RRP) of the United Nations High Commissioner for Refugees (UNHCR). The humanitarian community will now need to mobilize US$ 533.3 million in 2023 to meet the most urgent needs of 2.4 million of the most vulnerable people, or US$ 68.3 million more than forecast in the initial Humanitarian Response Plan published in January 2023.

Humanitarian response

In May, the humanitarian community airlifted emergency multi-sector assistance to Birao, as part of the stock pre-positioning plan implemented every year in northern CAR, where access is extremely limited during the rainy season from April to November. Since the beginning of June, the UNHCR has been relocating refugees and spontaneous returnees from Am-Dafock to Birao, a safer area identified by authorities further away from the border with Sudan. So far, 2,286 people have relocated to the Korsi site in Birao, and authorities have granted 300 hectares of farmland to refugees to facilitate their integration. Assisted relocation has been suspended, as the road between Am-Dafock and Birao becomes impassable during the current rainy season, but spontaneous relocation movements are sometimes recorded.

The humanitarian response is ongoing on the site Korsi in Birao, in Ndele and Sam-Ouandja. NGOs, UN agencies, and other international organizations are distributing food, essential household items, providing clean water, building emergency shelters and latrines, providing health care, education and protection support.

According to the UNHCR’s Regional Refugee Response Plan (RRP), US$ 34.5 million are required to respond to preliminary needs of 25,000 people coming from Sudan, including 15,000 returnees, for six months. The RRP will cover in its first phase the most urgent needs at entry points including protection, namely pre-registration, protection and border monitoring, advocacy and training to preserve the humanitarian and civilian character of asylum, identification of and assistance to people with specific needs, including unaccompanied children, older persons and pregnant women; hot meals and food distribution; emergency and community shelters; mobile clinics, medical consultations, psychosocial support, nutrition screening, treatment and prevention of malnutrition; emergency education services, including child-friendly spaces, school supply support, advocacy for school registration and exams; provision of drinking water, latrines, hygiene and sanitation; and distribution of core relief items. In its second phase, the RRP will consist of relocating asylum-seekers away from the border to mitigate protection risks, and implementing protection and assistance activities.

On a flexible basis, Canada announced a CAD$ 10 million grant to allow partners in CAR to adapt and scale-up the humanitarian response as the situation evolves. The funding will help people meet their basic needs, including by providing food assistance, protection, water, sanitation and hygiene services and health services.

Resources under pressure

Humanitarian needs were already severe in CAR with 3.4 million people - 56 per cent of the population - in need of assistance and protection. The 2023 Humanitarian Response Plan (and its addendum), which aims to assist 2.4 million of the most vulnerable Central Africans, is only 56 per cent funded. The capacity to absorb additional needs is very limited.

Accidents involving landmines and other explosive ordnance have taken on increasing proportions in the Central African Republic (CAR) since April 2021, particularly in the west.

An alarming rise

As of 13 November 2023, 23 people, including 18 civilians were killed in 65 incidents and accidents involving explosive devices. This year, the number of people killed has already doubled compared with 2022, while the number of incidents has risen by 15 per cent. In 2021, 44 incidents and accidents were recorded, killing 30 people. Both 2022 and 2021 show a significant increase compared to 2020, when only two incidents with no casualties were registered.

Civilians are the main victims of explosive devices in CAR. More than three quarters of the victims in 2023 are civilians, including 15 children. The most affected region over the past two years remains the western part of the country, notably the prefectures of Ouham, Ouham-Pendé, Nana-Mambéré, and Mambéré-Kadei.

For the first time in CAR, anti-personnel mines were discovered in April 2022 near Bambari in the Ouaka Prefecture. The population found them and reported them to the United Nations Mine Action Service (UNMAS) and MINUSCA, which destroyed the devices before they could harm someone. Anti-personnel mines are prohibited under the Anti-personnel Mine Ban Convention, which has been in force in CAR since 2003.

In July 2020, the suspected use of anti-vehicle mines was first reported in the country since the UN peacekeeping mission MINUSCA was established in 2014. One of the suspected devices damaged a MINUSCA tank near the border with Cameroon.

Without distinction

The victims are diverse: a family, children, farmers, a humanitarian worker, merchants, armed elements, UN peacekeepers, soldiers and a priests. Explosive devices that detonate by the presence, proximity or contact of a person cannot distinguish between civilians and combatants, raising important concerns about the principles of distinction and proportionality under international humanitarian law.

Restricting humanitarian access and socioeconomic activities

The presence and suspected presence of explosive devices severely limits humanitarian access to vulnerable people in a context already marked by access restrictions due to armed conflict and physical access constraints.

In the prefectures of Ouham, Ouham-Pendé, Nana-Mambéré, and Mambéré-Kadei in the west of the country, nearly 940,000 people in need targeted by humanitarian actors in 2023 are at risk of having their assistance delayed or suspended, particularly in the sectors of food security, nutrition, access to drinking water, and protection, including against gender-based violence. Yet, in 2023, these four prefectures are showing an increase in the number of people in need of humanitarian assistance and protection. Even if assistance by air can be considered, it remains limited due to its high cost and operational priorities.

Civilians who use various roads and pathways to run their income-generating activities and to access livelihoods, such as farming, are severely restricted in their movements in this region where food insecurity remains critical.

In this context, the presence of security and demining actors remains essential for the protection of civilians and the implementation of humanitarian operations.

Protecting civilians and humanitarian workers

Thanks to funding from the CAR Humanitarian Fund, the NGO Humanity & Inclusion (HI) conducted in 2022 and 2023 awareness-raising sessions on the danger of explosive devices for the most vulnerable people in the area of Bocaranga and Koui (Ouham-Pendé Prefecture), one of the most affected regions in the country, and taught them safe behavior to reduce risks they face. Education sessions in villages reached 5,560 people, including 2,900 children. Special attention was given to the inclusion of people with disabilities, women, girls, and the elderly, and language barriers and illiteracy were addressed, for example, by adapting outreach materials and methods to ensure that all people have access to vital information about explosive devices. In addition, HI trained 118 humanitarian workers in Ouham-Pendé on the risks associated with explosive devices.

As of 9 June 2023, UNMAS reached 13,467 people, including 3,847 children, with an awareness-raising campaign on the threat of explosive devices in Bouar and Bambari. Information signs were set up at strategic locations and drawings and photos showed the precautions to take to avoid explosive devices, how to mark and report them to demining organizations. UNMAS also organized explosive device awareness-raising sessions for more than 428 humanitarian and UN staff.

Despite the awareness campaigns that have been organized, there is a need to strengthen risk education given the magnitude of the problem. Additional resources may be needed to expand the reach of risk education projects for children, women, and men in the most affected areas.

Watch a video on the danger of explosive devices in western CAR here.

Due to the underlying socio-political crisis, a large portion of the population of the Central African Republic continues to face a humanitarian crisis with severe humanitarian needs, particularly in areas outside of urban centers, with violence against civilians and insecurity continuing to push Central Africans into displacement. More than one in five Central Africans are currently displaced either within the country or in neighboring countries. People's access to basic services such as health and education, as well as to livelihoods including agriculture, continues to be severely limited as a result of insecurity.

In this context, the protection and well-being of Central Africans remains at risk. In 2023, 3.4 million people, or 56 per cent of the population, will need humanitarian assistance and protection.

Given the scale of humanitarian needs and the anticipated risks, the humanitarian community in CAR, through the Humanitarian Response Plan, aims to assist 2.4 million people in 2023 with vital multi-sectoral assistance. The impact of the crisis in Sudan since May 2023, particularly in the north of the country, has also led to the development of an addendum to the Response Plan.

The humanitarian community will now need to mobilize US$ 533.3 million in 2023 to meet the most urgent needs of 2.4 million of the most vulnerable people, or US$ 68.3 million more than forecast in the initial Humanitarian Response Plan published in January 2023. Extraordinary donor support in 2023 will be needed more than ever, in an environment where the risks of economic recession and new crises around the world will strain on available resources.

In 2022, humanitarians demonstrated flexibility and adaptability over operating environment challenges, and deployed to respond to a variety of new crises including in several landlocked areas, particularly in the north of the country. 1.9 million people received life-saving multisectoral assistance, or 93 per cent of the 2022 Humanitarian Response Plan target.

The response strategy in 2023 will be based on a multisectoral response to various types of needs, localization to strengthen the response by national and local actors, accountability to ensure the response is in line with expectations of those in need, and the nexus to establish a link between the emergency response and assistance to support the return of displaced persons. The humanitarian community will seek to establish a certain balance in the distribution of resources among sectors, for a better response in view of different nature of needs.

For more information, see the 2023 Humanitarian Response Plan (and its addendum) for the Central African Republic.

The Central African Republic (CAR) has been devastated by conflict and violence for decades. Many of the country's 6.1 million people have been traumatized by displacement, often on several occasions. One in five Central Africans is either internally displaced or a refugee, mainly in neighbouring countries. Despite the current crisis, humanitarian and development actors are working hand in hand with the government to enable internally displaced persons (IDPs) and refugees in CAR to resume a normal life where circumstances permit.

Durable solutions to displacement is the key term. This means leaving displacement sites or integrating local community and ending dependance on humanitarian aid. A durable solution, when achieved, means that people no longer need specific assistance and protection linked to their displacement. Durable solutions include voluntarily returning home or place of residence, resettlement in another part of the country or integration into the host community. IDPs and refugees often need support in their efforts to gradually return to a more or less "normal" life. While humanitarian actors are making efforts to respond to urgent and immediate needs of IDPs and refugees, the commitment of partners in the development, peace and security sectors is required to implement durable solutions in the context of the Humanitarian-Development-Peace Nexus.

The integrated village

In Pladama Ouaka, a rural municipality around 10 km from Bambari in the Ouaka Prefecture, former IDPs are enjoying a new life since 2022. In one year, almost 500 families moved to Pladama Ouaka with the support of humanitarian and development agencies and local authorities. Each family has been granted 300 m2 of land where brick houses and latrines were built. Socio-community infrastructures such as classrooms, a market, boreholes for drinking water and plots of land for farming were also made available.

These families had fled violence in various parts of the country and had lived in a site in Bambari for years until it was burnt down in May 2021, forcing the IDPs to leave. Once again displaced, they settled in the mosque, from which they were again evicted, and in different areas of Bambari, where they lived in very difficult conditions and were also exposed to protection risks and epidemics. In this difficult context, a lasting solution had to be found.

Local authorities had identified Pladama Ouaka, a community of 50,000 people, as a favorable location for voluntary resettlement, and had allocated 124 hectares of land to accommodate these people. Around 1,000 families agreed to settle there almost immediately. Initially, around 500 families were supported in their resettlement by various United Nations agencies, including the Office of the United Nations High Commissioner for Refugees (UNHCR), United Nations Development Programme (UNDP), United Nations Children's Fund (UNICEF), International Organisation for Migration (IOM), World Food Programme (WFP), World Health Organisation (WHO) and the Office for the Coordination of Humanitarian Affairs (OCHA), various NGOs including ACTED, AID, APADE, HOPIN, Humanité et Inclusion (HI), Intersos, International Medical Corps (IMC), Médecins Sans Frontières (MSF), Tearfund, Triangle, World Vision and the local authorities.

The 10 km road from Bambari had been rehabilitated to facilitate access and reinforce security through police patrols, and four new neighborhoods had been demarcated in Pladama Ouaka. After an initial phase during which people moved into transitional shelters, brick houses with straw roofs were built, one for each family with one toilet per household.

"I'm so happy to have a house, because a man without a house is considered as nobody in the community," says Ibrahim Hassan, who had been displaced for 10 years after fleeing Kouango in 2012, and who was one of the first families to move into the new brick houses in Pladama Ouaka. "This house and the large plot of land give me back the dignity I had before the conflict. They give me the strength to get up every morning, bring food to my family and do my business. My children's future will be filled with joy and not pain, and that makes me very happy", says this father of seven.

An additional hangar had been built at the local health center and a school building rehabilitated. School supplies and learning materials were distributed to teachers and students, and benches and tables were provided to the school. Three boreholes had been drilled in the integrated village and are now providing drinking water to its inhabitants and the surrounding communities. 20 solar panels have just been installed to provide lighting in the village and will be connected to the boreholes to effectively operate. Community management structures have also been strengthened to resolve conflicts and promote social cohesion. The local authorities had allocated agricultural land to the new residents to support their livelihoods. Food security partners had distributed gardening kits to help them grow vegetables.

To ensure the sustainable resettlement of these populations and to consolidate the achievements made, 14 village savings and credit associations were formed and have been operational since April this year. In addition, income-generating activities will be set up for 300 households. This programme will enable these populations to get new livelihoods through self-employment, to create profitable and sustainable sources of income that will strengthen their capacity for resilience and self-financing of projects.

Resettling an entire town

In May 2022, a similar durable solutions project was launched in Bria, in the Haute-Kotto prefecture, where the country's largest IDP site is located. 33,000 IDPs live at a settlement 3 km from the town (PK3), in a commune tant counts 75,000 residents. Many of them fled the violence and insecurity from central Bria to the site in 2017 and 2018. Since 2021, the security situation in Bria has been continuously improving and state authorities, including the police, armed forces and justice have returned. Today, the prefectural authorities are supporting the voluntary return of the first 150 families, around 900 people, in two neighborhoods of Bria, with the support of humanitarian and development partners. The latter are providing building materials to rebuild the ruined houses. Support in the form of cash and materials, including brick presses, is helping to facilitate production so that returnees can make their own bricks and build semi-durable shelters and houses. In 2022, the NGO OXFAM had completed 10 water boreholes, which now benefit the newly returned. Since the beginning of the pilot project, the number of IDPs living on the PK3 site continue to decrease, from around 37,000 at the beginning of the programme in May 2022 to 32,100 in February 2023. Nearly 6,000 IDPs have voluntarily left the sites following the improvement in the security situation in their areas of origin.

Although much work remains to be done to find durable solutions for the 32,100 IDPs still living on the PK3 site, there is now a sense of hope for a more normal life outside the IDP site.

Additional resources required

Thanks to funding allocated by the Humanitarian Fund in CAR, Oxfam, IOM, UNHCR and new partners such as the NGO DCA will continue their efforts to promote sustainable solutions for nearly 6,000 returnee families waiting to be resettled in Bria, Bambari and Kaga-Bandoro. The assistance provided by humanitarian actors is only the first stage of support for return, the full realisation of which requires interventions of a different nature. This can be achieved in particular with the involvement of development actors and the government, and requires additional funds for a specific period.

A major displacement crisis

The crisis in CAR remains a major displacement crisis. One person in five is displaced. 490,066 people are internally displaced and 743,000 Central African refugees are living in neighboring countries, mainly in Cameroon and DR Congo. New displacements are recorded every month, and always outnumber returns. Displacements are continuing because the conflict is not over. However, this is not an obstacle to durable solutions programmes, as the situation has relatively stabilized in certain regions of the country, provided that IDPs freely decide to return to their places of origin.

This Wednesday afternoon in the ward of Bocaranga Hospital, a town located in the Ouham-Pendé Prefecture in the west of the country, mothers can be seen at their children's bedsides with worried faces. On the beds lie seven children with subcutaneous infusion, obviously having lost a lot of weight and too weak to move. Six of them are suffering from malaria, a potentially fatal disease caused by bites of infected female Anopheles mosquitoes, if not detected or treated in time. In 2021, 619,000 people died of malaria worldwide according to the World Health Organization (WHO). Sub-Saharan Africa was the most affected with 96 per cent of deaths, 80 per cent of which were in children under five.

A major public health challenge

In the Central African Republic (CAR), the under-five mortality rate is the fifth highest in the world (113 children per 1,000) according to the United Nations Children's Fund (UNICEF). Malaria is the leading cause of death among children under five and a major public health concern, particularly during the rainy season (April to September) when the number of cases sharply increases. « In 2022, we received 1,070 sick children and more than 60 per cent were suffering from malaria. Cases are recurrent and constitute the main pathology diagnosed in the region », explains Osias Yandi, Head Doctor of the Bocaranga Hospital.

CAR's already fragile health system has suffered many shocks in recent years, including the resurgence of armed violence, structural challenges and the impact of COVID-19. With nearly 120,000 residents, the Sub-Prefecture of Bocaranga has one of the few hospitals in the Prefecture and lacks almost everything, with no running water or electricity.

Among the patients of the day was Christel, a five-year-old boy accompanied by his mother Victorine, who never let him out of her sight. « Christel was very sick. I brought him here for a consultation three days ago. The doctor diagnosed malaria and since then we have been here for treatment », she explains.

A complex issue

Despite its wealth in natural resources, CAR is one of the poorest and most fragile countries in the world due to decades of conflict and structural challenges, with 70 per cent of the population living below the poverty line. In this context, access to basic services such as health and drinking water remains a major challenge for the population, particularly in rural areas. « I don't have a formal employment and I sometimes get by in selling some basic necessities. That's why I started treating my son's illness with traditional plants that I found, because I don't have any money, until my neighbor told me about free healthcare care in this hospital », explains Victorine.

In addition to malaria, Christel suffers from sickle cell anemia, a genetic disease that requires special treatment and medical follow-up. Thanks to the support of humanitarian organizations, Christel was able to receive free medical treatment and his mother was given advice on how to prevent malaria, including the correct use of impregnated mosquito nets and the disinsectisation of her home. « Since yesterday, he is starting to get better. The doctor says that his condition continues to improve and we will be able to get discharged from the hospital in a few days if all goes well », concludes Victorine.

Saving lives

Faced with the many challenges, humanitarian partners are mobilizing to take action, including with the support of the Humanitarian Fund in CAR. The NGO Doctors with Africa (CUAMM), which is one of the funding mechanism recipients, launched a project to respond to health emergencies in the Ouham-Pendé Prefecture in January 2022. As of 31 December 2022, more than 1,000 children had received health care, reducing the malaria mortality rate among children in Bocaranga from 14 to 3 per cent. 1,030 cases of gyneco-obstetrical and surgical emergencies have been treated and 72 survivors of gender-based violence (GBV) have received free health care. The project also trained more than 100 providers in the management of obstetrical emergencies and the prevention and control of infections. Material support was also provided, including donations of medicines and payment of the hospital's operating costs.

With the support of WHO, CAR has begun the process of introducing malaria vaccine into its national immunization program. As part of this process, the UN agency and other partners have supported the country in developing and submitting its application to the Global Alliance for Vaccines and Immunization (GAVI) to introduce the new vaccine. In Ghana, Kenya, and Malawi, for example, the introduction of the vaccine has proven effective in eliminating malaria as a public health problem.

More resources needed

In 2022, thanks to donors’ generosity, the humanitarian community provided quality health care to nearly 660,000 vulnerable people, or 60 per cent of the target. This includes curative consultations performed, assisted deliveries by qualified personnel in areas affected by a humanitarian shock, and rape survivors treated within 72 hours, as well as the vaccination of children aged 0 to 11 months.

For the current year, health partners aims to reach nearly one million people. To that end, US$ 38.5 million is required but to date, only 30 per cent of the funds has been received. 2.8 million people are in need of humanitarian assistance in health, the sector with the largest number of affected people, along with food security, drinking water and protection. Among them are families affected by displacement, children under five and GBV survivals.

Even if this Friday afternoon, marked by children playing in the street, street vendors and the horns of motorbike taxis looking for passengers seems quite ordinary for many Bangassou residents, it is not the case for Hawa Abakar. At 36 with a slim figure and a pensive face, she’s undoubtely wondering when will her journey end in this town where she found refuge.

Hawa and her family were forced to leave their home in Zemio, 250 km from Bangassou in the south-east of the Central African Republic, following an attack on the town by armed groups a year ago, and found refuge in Bangassou in the Mbomou Prefecture.

"To increase our chances of survival, my husband and I separated, each going in the opposite way with two of our children as we have four. My husband headed to the Democratic Republic of Congo border area and I went to Bangassou. It was the most painful time of my life because I didn't know if my husband and our two children who left with him had survived" she says.

Each year, violence against civilians forces thousands of Central Africans fearing for their lives to displacement to survive the conflict that continues to devastate the country, particularly in rural areas. One in five Central Africans is currently either an internally displaced person (IDP) or a refugee in neighboring countries.

In 2022, almost three-quarters of the IDPs were living with host families. This was the case for Hawa, who on her arrival in Bangassou was welcomed by Kadidia, a former IDP she met in the town's mosque. "Kadidia became our family. She welcomed me and my children and shares what she has with us. We are fed and housed," explains Hawa.

Crucial solidarity

As soon as they arrive in the host city, IDPs face many needs, including shelter, food, water, hygiene and sanitation. Very often, host communities provide initial life-saving assistance before a need assessment is carried out and an appropriate response provided by humanitarian actors. It sometimes multiplies vulnerabilities as the host family's resources are stretched by the now large number of people in the household.

Thanks to their determination after spending three months together, the two women managed to contact Hawa's husband and their two other children who found refuge in the Democratic Republic of Congo. "I was internally displaced from 2017 to 2020 after our town was attacked by armed groups. I know what it is like to lose loved ones, your home and to live in fear. Thanks God, I had benefited from humanitarian assistance. It is now my duty to help other people in a similar situation," says Kadidia.

Hawa did not only benefit from housing or food that Kadidia generously shared with her and her two children. "Kadidia taught me how to bake biscuits and once things calm down at home in Zemio, this will allow me to get ahead financially and take care of my children," explains Hawa.

Kadidia learned to make the biscuits as part of a programme to support the return of IDPs developed by the United Nations High Commissioner for Refugees (UNHCR) and the International Organization for Migration (IOM) in 2021. These organizations had also built houses for former refugees and IDPs wishing to resettle in Bangassou after calm had returned to the town.

A coordinated and inclusive humanitarian response

In order to meet IDPs needs and to support host families whose resources are diminished by the presence of additional people in their homes, the humanitarian response also takes into account host communities’ needs.

To date, humanitarian community in partnership with development actors have supported the return of more than 14,000 people to the Mbomou Prefecture, particularly in Rafai and Bakouma. This included activities such as the construction of houses, water boreholes, trainings in income-generating activities and livelihood support.

It is Tuesday morning and a cluster of women and small children is forming under a blue canopy at a site for internally displaced persons (IDP) in Kaga-Bandoro. All children have something in common: they suffer from severe acute malnutrition and their mothers have brought them for weekly treatment.

One of the mothers is the 20-year-old Jonvienne. She sits with her 1 ½-year-old daughter Richardine on a straw mat on the floor. A rash covers the girl's body. Flies circle her. She crawls around while her mother tells how they came to the malnutrition treatment site a fortnight ago for the first time, after community health volunteers identified Richardine as malnourished and referred her for treatment. “The child had been sick for a while, but I didn’t know what she had and worried a lot”, says the young woman. At 1 ½ years old, Richardine is tiny. She does not walk and has never tried to stand up. Her muscles are too weak. Since birth, she has only drunk breast milk. “And now, milk has become scarce,” says Jonvienne, who has been living at the IDP site for 10 years. “I don’t think I eat enough to produce milk.”

Major problems

Food shortage and malnutrition are alarming in the Central African Republic (CAR). Access to food and the availability of a wide range of foods that provide necessary nutrients are severely limited by decades of conflict, the lack of basic social services, such as health care, water, sanitation and hygiene, and exacerbated by poverty. Almost three quarters of Central Africans live below the poverty line.

Food insecurity

The latest results of the Integrated Food Security Phase Classification (IPC) show that 2.7 million people, almost half of the population of CAR (44 per cent), are acutely food insecure. Of them, 642,000 people are in the emergency phase (IPC phase 4), just one step away from famine. These 2.7 million people need immediate food assistance, as well as basic livelihood support. All of the country’s 72 sub-prefectures are classified as acutely food insecure, without exception. Food security is the sector with the largest number of people in need of humanitarian assistance in 2023, along with the sector water, sanitation and hygiene (WASH), according to the newly released Humanitarian Needs Overview for CAR.

Looking ahead, the situation is expected to deteriorate during the lean season in 2023 (April and August) in the absence of immediate and sustained food assistance. Households will run out of food stocks before the next harvest and 3 million people (49 per cent of the population) will likely experience high levels of acute food insecurity, including 807,000 people in the emergency phase (IPC phase 4).

A long list of key drivers

Although the intensity of armed conflict has decreased in 2022, insecurity and armed violence continue to be key drivers of food insecurity in CAR, limiting access to food and livelihoods, contributing to the massive forced displacement of people and their impoverishment. 516,000 people were displaced within the country as of 31 December 2022. This dangerous environment also limits the access of humanitarian organizations to people in need of assistance. In addition to insecurity, the deterioration of road networks further limits the supply of markets.

Prices of domestic and imported food and commodities have been driven up as an indirect effect of the war in Ukraine and a severe fuel shortage in CAR since early 2022. Import volumes have also declined due to restrictions and supply chain disruptions related to the war in Ukraine, especially for wheat and vegetable oil. Corn (+46 per cent), rice, groundnuts (+29 per cent) and palm oil (+15 per cent) prices have increased significantly compared to the previous year. A look at the past five years is even more alarming: the prices of rice and groundnuts have risen by almost half, those of corn, cassava and beans by about a quarter. The rise in food prices also led to an increase in the budgets needed for humanitarian assistance. The financial needs of the Food Security Cluster increased by 19 per cent in 2022 and actors involved in addressing acute malnutrition faced a 39 per cent cost increase, with disruptions in their supply chain resulting in delays in the delivery of aid.

Another important reason for food insecurity is persistently low local agricultural production due to poor farming practices, lack of seeds, farming tools and plant protection products (both the availability on local markets and financial means), limited technical capacity to respond to environmental shocks, such as floods and to a lesser extent droughts, and the lack of sustainable methods that aim to produce more without degrading soil fertility.

Malnutrition

Overall dietary diversity remains very low and people are increasingly adopting emergency strategies to meet food needs. These strategies include selling livestock, undertaking hazardous activities or selling family assets such as houses or land. Some 6.6 per cent of Central Africans suffer from acute malnutrition – 400,000 people, according to the latest SMART analysis from 2022. Most at risk are children below the age of 5, pregnant and breastfeeding women and people with HIV/AIDS. Every tenth pregnant or breastfeeding woman in CAR suffers from acute malnutrition; in some region, this is even higher. The number of people who need nutritional assistance in 2023, curative or preventive, has increased by 30 per cent compared to the previous year, reaching 1.5 million people. Of them, 1 million are boys and girls and half a million pregnant and breastfeeding woman, in a country with the fifth highest infant and maternal mortality rates in the world.

Life-saving emergency interventions

Under the blue canopy in Kaga-Bandoro, the NGO Médecins d’Afrique, with funding from the Central Emergency Response Fund (CERF), is providing an emergency intervention to address severe acute malnutrition among the most vulnerable – children aged 6-59 months – at the three IDP sites and 10 health facilities in Kaga-Bandoro. 1,369 children admitted for severe acute malnutrition benefit from the project that runs for a period of six months. They receive a treatment in the form of a ready-to-use therapeutic food called Plumpy'Nut®, combined with antibiotics, anti-malarial tablets, deworming and Vitamin A. Médecins d'Afrique teams monitor the acutely malnourished children once a week. As inadequate access to water, sanitation and hygiene is responsible for about 50 per cent of global malnutrition, they also receive buckets and containers to store water, soap, water purifiers, as well as reusable sanitary pads and underwear for the children’s mothers. In weekly education sessions, topics related to the promotion of healthy diets for babies and young children are discussed and mothers learn about best breastfeeding practices, the different categories of nutrients, age-appropriate foods for young children, meal composition according to food groups, the importance of hygiene in food preparation and many other topics to prevent malnutrition in the future.

Against the backdrop of one of the highest proportions of people suffering from acute food insecurity in the world, US$15 million were allocated for life-saving measures against food insecurity in CAR from the CERF Rapid Response Window in 2022, brokered by the United Nations Office for the Coordination of Humanitarian Affairs (OCHA). These CERF funds help humanitarian actors to scale up comprehensive emergency assistance for 200,000 people in 10 sub-prefectures, where food insecurity is most severe. A multisectoral approach combining food assistance, nutrition, health care, WASH and protection maximizes the impact of food security interventions and reduces people’s use of negative coping mechanisms associated with food scarcity in the context of extreme deprivation. Six United Nations organizations and partner NGOs expanded food distributions and cash transfers and improved livelihoods through the distribution of agricultural tools and seeds with CERF funds. Complementing these interventions, nutritional support was scaled up to treat and prevent child malnutrition and provide families with severely malnourished children with access to safe drinking water, basic sanitation facilities and good hygiene practices essential for survival, such as Médecins d’Afrique does in Kaga-Bandoro.

During the first nine months of 2022, humanitarian organizations in CAR provided food assistance in the form of food rations, agricultural tools, seeds and livestock to 1.24 million people and nutritional assistance, including therapeutic and complementary feeding and sensitization of parents to feeding infants and children, to 361,000 people. Thanks to donors’ generosity, food security assistance was fully funded in 2022; however, curative and preventive nutrition assistance lacked more than half the 30 million USD required for 2022.

Preventing and curing

Under the blue canopy at the IDP site in Kaga-Bandoro, an education session on nutrition is in full swing before the therapeutic treatment of the children begins. Two dozen women participate enthusiastically, sharing experiences and difficulties and asking questions to the NGO worker who leads the session in the local language Sango and regularly points to a large book with colourful illustrations to clarify his explanations. Jonvienne, the young mother, learns that breast milk is not enough for the development of her little girl Richardine and that children from six months need additional food. The women clap their hands, encouraging each other, and there is laughter, despite the seriousness of the subject and the situation of many children, including Richardine.

Gender-based violence (GBV) has reached alarming proportions in the Central African Republic (CAR), particularly in the wake of the crisis that has been afflicting the country for several years. This situation is exacerbated by socio-cultural norms that are unfavourable to women and girls, despite the existence of policies and legislation. Violence against civilians and insecurity in localities outside urban centres continue to increase the vulnerability of several million people, including women, whose livelihoods are being eroded and whose access to food and basic services, including health care and water, is severely limited. In 2023, 3.4 million people need humanitarian assistance and protection, or 56 per cent of the population. Of these, 2 million people have needs that are so complex and severe that their physical and mental well-being is threatened.

An alarming rise

Although internally displaced persons (IDPs) and refugees are often the most visible face of the crisis in CAR, GBV, especially sexual violence, has recently reached particularly worrying levels. Every hour in CAR, two people are victims of GBV, mostly women and girls. According to the statistics of the Gender-based Violence Information Management System (GBVIMS), collected from dedicated services 5,928 cases reported during the first four months of 2023. 23,644 cases of GBV were recorded in 2022, a 104 per cent increase compared to the number of cases recorded in 2021. The ever-increasing stress within households due to the food insecurity that severely affects the country, as well as the adoption of negative coping mechanisms (early marriage of girls, sex in return of food) continue to lead to an increase in GBV that affects thousands of women and girls. Among the 10 sub-prefectures that have recorded an increase in GBV cases, five are classified in the emergency phase 4 of food insecurity, one step away from a catastrophic situation.

Surviving or facing risks

This is the challenging choice that many women from time to time need to make in CAR, in a context where access to livelihoods such as fields, as well as to basic services such as water and health care, is severely restricted by insecurity resulting from the conflict. The annual multi-sectoral humanitarian needs assessments conducted in September also indicated that just over three quarters of households interviewed consider GBV, including sexual violence and early marriage, as the main security risk for women and girls. That is the reason why women and girls avoid certain places. But in a country where more than two out of five people do not have enough to eat, not going to the fields is a matter of life and death.

A challenge for available resources

In 2023, GBV partners provided psychosocial assistance to 17,831 survivors, 80 per cent of whom received the medical care they needed. However, only 41 per cent of survivors received multisectoral assistance, including shelter in a protective environment, livelihood support and legal assistance. Of the 602 service centres needed to provide psychosocial support and GBV case management to meet the needs of survivors in the country, only 18 per cent are available and only 26 per cent of reported rape survivors received the required medical care within the crucial first 72 hours. Yet, between 2020 and 2023, the number of people who need assistance and protection from GBV increased by 27 per cent.

In a house in the town of Bangassou that looks quite ordinary from the outside, some twenty girls and women have gathered in the courtyard of the 'Ma mbi si' center, which means 'Listen to me' in the local language. The same tragedy has brought them together. Among them are minors, the youngest barely 15 years old. To the rhythm of a song that is meant to encourage them, they draw patterns, knit blankets, tablecloths and garments.

The activities carried out by the NGO COOPI are for the sole purpose of providing psychosocial support after the atrocities suffered, as each of these women and girls is a survivor of gender-based violence (GBV), including physical assault and rape.

In the Central African Republic (CAR), GBV, which include physical and psychological violence, rape, early marriage and female genital mutilation, are reinforced by socio-cultural norms that disadvantage women and girls, despite existing policies and laws on the subject. The situation has been exacerbated by the conflict that has been ongoing for more than a decade.

"I had never thought this would happen to me. I was just a child. For a long time, I hardly slept. Every time I closed my eyes I relived that moment," says Pelvia, an 18-year-old girl who was sexually assaulted when she was 16.

A phenomenon exacerbated by the crisis

Every hour, two people become victims of GBV in CAR, including sexual violence 5,928 cases were reported during the first four months of 2023. 23,644 GBV cases were recorded in 2022, an increase of 104 per cent compared to the number of cases recorded in 2021, according to the GBV Information Management System (GBVIMS), an initiative that allows humanitarian actors to securely collect, store, analyze and share cases reported by GBV survivors. And these statistics only include cases where survivors have consented to sharing information.

"One day, about two years ago, armed men came into our village, which is just a few kilometers from here. When we tried to escape into the bush, a man grabbed me by the arm and then sexually assaulted me," Pelvia says.

The annual multi-sectoral humanitarian needs assessments conducted in September indicate that more than three quarters of households interviewed consider GBV, including sexual violence and early marriage, the main security risk for women and girls. In addition, the ever-increasing stress within households due to the food insecurity that severely affects the country, as well as the adoption of negative coping mechanisms such as early marriage of girls and sex in return for food, continue to lead to an increase in GBV that affects thousands of women and girls. Among the 10 sub-prefectures that recorded an increase in GBV cases, five are sub-prefectures classified in phase 4 out of 5 on an international scale of food insecurity, just one step away from the catastrophic situation of famine.

"In the region, the number of GBV cases has almost doubled since the beginning of the year. Survivors are misunderstood and sometimes even rejected by the community, which further increases their vulnerability. Others hide the brutality they have suffered to avoid becoming social outcasts. It's really unfortunate, they suffer multiple times," Evangeline says, one of the psychosocial workers at the center.

Overcoming suffering

GBV, especially physical attacks and sexual violence, leave survivors with lasting damage. To help them rebuild their lives, the "Ma mbi si" center in Bangassou provides a holistic response that addresses the physical, psychological, legal and economic needs of survivors. In addition to the services provided in the listening center, the green line 4006, a free telephone hotline, provides psychosocial support and accompanies survivors from a distance.

"Here I feel better because psychologists listen to me. And spending time with women who have experienced similar atrocities helps me to move forward. We support each other when morale is low. I have also learned to knit. With this income I can buy some food and medications, when I need it, and save for the next school year.”

Thanks to financial support from the Central Emergency Response Fund (CERF) to the United Nations High Commissioner for Refugees (UNHCR), of which the NGO COOPI is the implementing partner, the center provides GBV survivors with personal hygiene products, psychosocial agents and lawyers to accompany them in the judicial process. Since the beginning of the year, COOPI has supported nearly 300 women in Bangassou and its surroundings. Other 'Ma mbi si' listening centers have also been established in Alindao, Zémio and Obo.

"I will never be the same girl again, but I will face it and move on. I have enrolled in high school and will graduate next year," Pelvia says.

A multi-sectoral approach

CERF's support aims to scale up emergency assistance for 200,000 people in 10 sub-prefectures where food insecurity is worst, with a multi-sectoral approach combining food assistance and other sectors, including protection. This is the case of the Alindao, Zémio and Obo Sub-prefectures, which are covered by COOPI's activities with its psychosocial care centers for GBV survivors.

Three, six or nine months are the duration of some of the emergency aid projects in Alindao, a town in the south of the Central African Republic (CAR), one of the regions with the greatest humanitarian needs in the country, especially in terms of food security. Security in the region is also very fragile; clashes between different parties to the conflict have forced thousands of people to flee. Against this backdrop, Paulin* and Rodrigue*, then 15 and 16 years old respectively, joined an armed group in 2018 without much thought and in the hope of a better future. Bertrand* answered the call of the same armed group to avenge his father, who was killed during the conflict. "Every time I saw his grave, my whole body cried out for revenge, and I couldn't resist," Bertrand says looking back four years later. He was only 16 years old at the time.

What has become of them

In 2019, the national NGO Espérance, with support from the Humanitarian Fund for CAR (CAR HF), took 95 children and adolescents, including Bertrand, Paulin and Rodrigue, out of armed groups and reintegrated them into the community as part of its nine-month project to protect children and young people affected by the conflict. The project covered Alindao, Mobaye and Zangba in the Basse-Kotto Prefecture in the south of the country. The beneficiaries returned to school in 2020 and received school supplies. They were also supported in income-generating activities to strengthen their self-determination and independence. Children who had been separated from their parents as a result of the conflict were placed in foster families and returned to school. Communities were also sensitised to coexistence and social cohesion. In total, almost 23,000 people have benefited from the project.

Paulin was in Grade 5 when he returned to school. Since then, he has moved up two grades and is looking forward to taking his high school diploma Brevet de Collège (BC) in July 2023. "With my BC, I will go on to vocational training to become a nurse and help my community," Paulin, now 20, says proudly. Access to basic services in CAR, including health care and education, is very limited. On average, there is less than one doctor for 10,000 people, while only 55 per cent of children complete primary school. "With the new sewing machine, which I bought with the savings from my shop, I am learning a new trade, and with the money I earn, I can pay school fees, buy school supplies and support my family," Paulin says happily as he operates the sewing machine.

Rodrigue currently attends Grade 4. The 20-year-old has also successfully completed two grades since he left the armed group. He continues to sell basic necessities in his shop, an income-generating activity initiated with the support of the CAR HF through the national NGO Espérance. "When I am at school, my little brother takes over the shop so that I don't miss any customers. Our classes are at different times and this suits us," he explains, counting some CFA franc bills, the currency used in CAR. Thanks to his business, Rodrigue can stay in school and was able to buy a bicycle, which is an excellent means of transport in this region. From an initial 121,500 CFA francs ($190) in 2020, his capital has now grown to 260,850 CFA francs ($410). Rodrigue plans to enrol in university and become a high school teacher after graduation in four years.

Bertrand has also completed two grades and is now 20 years old. Like Rodrigue, Bertrand has opened a shop whose capital has since grown from 150,000 ($235) to 210,000 CFA francs ($390). With his savings, he acquired a cassava mill, which allows him to multiply his sources of income while he continues to attend school. "With the money I earn, I buy my school supplies and I have also enrolled my niece in school, while supporting my mother," says Bertrand. His father had been killed during clashes in 2018.

Healing the pain

Bertrand points to his father's grave next to the house that has now become his home and explains that he has been healed of his resentment. "Every time I saw this grave, I wanted justice to be done. That's why I joined the armed group.” Through the psychosocial support Bertrant received, he has learned to control his resentments, speak out and make the right choices. This was the aim of the listening clubs for children and the child-friendly spaces that the NGO Espérance had set up for children and adolescents who had left armed groups.

"I thought that I had lost my son when he joined the armed group. I was moved, when one morning, it was Friday 11 September 2020 at 10 a.m., I saw him come back home, promising not to leave again", says Rodrigue's father with tears in his eyes.

Protection weakened by the conflict

Due to the insecurity and lack of schools around Mangagbé, Pavica and Ngouakongon, Paulin, Rodrigue and Bertrand's places of origin, their families are still living at a site for internally displaced persons (IDP) at the Sacré Coeur parish in Alindao. They settled there in May 2017, after fleeing clashes. Like them, more than 140,000 people still live at IDP sites across CAR. Insecurity and displacement have greatly affected access to education. In 2022, around 10 per cent of children enrolled in school dropped out during the school year. As a result of persistent insecurity, one in five Central Africans is either internally displaced or a refugee in a neighbouring country.

As soon as one enters Bakala, it becomes apparent where one has arrived. A man is walking down the street with a toddler by his hand, and one wonders how this child can already walk at its age. It is small and thin, as if it were only a few months old. Malnutrition and undernourishment are acute in the Bakala region, with disastrous consequences for the people. The child is certainly a lot older than its small body suggests. The food situation in the Bakala Sub-prefecture was classified as an emergency in the last analysis in April 2022, the category on an international scale just before the extreme case of hunger is declared. 638 000 Central Africans are in this situation, nearly one in six.

Not much on the table

People in the Sub-prefecture of Bakala in the heart of the Central African Republic are sleeping on an empty stomach. Cassava leaves, mashed and boiled, and okra vegetables, made into a sticky sauce, is what ends up on most people's plates, a single dish per day. Cassava leaves and okra vegetables, day in, day out, the nightmare of a balanced diet, and yet better than nothing. "What would we do if there were no leaves?" asks Desan, a 40-year-old farmer in the village of Mourouba, 20 km from Bakala, and immediately adds the answer himself: "We would probably starve."

Displacement and return

Many of the region's inhabitants fled armed conflicts in 2020 and 2021, to Grimari, 75 km away, and surrounding villages. "Thousands of armed rebels had captured the region. Everyone fled, even the dogs," says Desan. This year, many of them have returned, thanks to an improvement in the security situation in the region. But they have not found much: the fields have remained fallow, food and seed stocks have been looted or burnt. What remained were ghost towns. The returnees lack the most basic necessities for survival.

Armed groups continue to be active in the towns’ outskirts and at the mining sites, restricting access to fields, farmland and forests, and disrupting supply chains. This has led to the depletion of food supplies, rising prices and the adoption of negative coping mechanisms. In early 2022, people also fled the Ippy area towards Bakala, further increasing the pressure on scarce food resources.

An immediate response

Due to the dire food situation in much of the Central African Republic and the urgent need for immediate intervention, the Humanitarian Fund for the Central African Republic (CAR HF) awarded USD 4 million in February to address food insecurity for 80,000 people in areas where conflict has worsened access to food, including in the Sub-prefecture of Bakala. The funding enabled a rapid and flexible emergency response for vulnerable people that saves lives and complements other funding mechanisms.

A ray of hope

There had been no humanitarian aid in Bakala since 2012. Accordingly, the joy at the arrival of the NGO OXFAM was great, as were the expectations. 1,700 families – more than 10,000 people – in the Bakala Sub-prefecture receive food, agricultural tools and seeds from OXFAM as part of one of the projects funded by the Humanitarian Fund to alleviate the most urgent needs and improve food security. The distributions reach returnees, internally displaced persons, as well as the host population.

Grateful beneficiaries

Siri (22) and Shabere (23), two young women from Mourouba village, received rice, beans, oil and salt in three monthly rations to supplement their diet. Their round bellies begin to show under their coloured skirts as both are expecting. "The better nutrition helps my unborn child to develop and grow," says Siri.

Barthelemy (64), a father of five, was able to afford some bean and maize seeds out of his own pocket and is now waiting for his harvest. He too has benefited from OXFAM's food aid. "The food received is very welcome while I am waiting for my harvest. It ensures that a meal is put on the table in our home, so the children can concentrate in school," says Barthelemy joyfully.

Desan, the 40-year-old farmer, like many others, recently returned to Mourouba village, after having fled in 2021. He has farmed before, but all his seeds were burnt during the last attack by armed groups. He received bean and maize seeds, as well as hoes from OXFAM and has already sown. Desan expects to harvest in November – a harvest that will help him to feed his family and at the same time set aside seeds for the next season and improve his nutrition in a sustainable way. He would also like to sow groundnuts, his favourite food, but seeds are too expensive. "Times are difficult. We eat cassava leaves every day. The help received is a real relief."

In the Central African Republic, 3.4 million people need humanitarian assistance and protection. Of these, 2.4 million people have needs that are so complex and severe, their physical and mental well-being is at risk. Evaluations and assessments conducted by humanitarian organizations help to determine the scale of people’s needs, understand those needs, and define response plans. To develop appropriate, community-based programmes, humanitarian actors also collect feedback from affected communities on the assistance they have received. This feedback is crucial, as it places affected people at the centre of humanitarian response. Assistance can then be adjusted and improved, wherever needed.

A cross-cutting issue

As part of the Intercluster Coordination Group (ICCG), the Working Group on Accountability to Affected People (AAP) ensures the establishment and monitoring of collective mechanisms for community engagement and accountability to affected communities. The Working Group produces regular analyses of feedback, complaints, and requests for information from affected people with the aim of identifying trends in satisfaction, priority needs, and preventing the spread of misinformation. The Working Group then advises humanitarian partners through national and regional coordination mechanisms on appropriate actions to take in response to feedback from communities. Where to find assistance? Where to complain if you have been harmed while receiving humanitarian assistance? Where to find the right information? How is humanitarian action perceived in affected communities? These are some of the questions the AAP Working Group helps to answer.

Humanitarian partners have established information and feedback centres at sites for internally displaced people (IDP) in Bria, Kaga-Bandoro and Bambari, all located in central CAR. In so-called ‘listening clubs’, through kiosks selling movies and music, and via interactive radio programmes in Bria, Bambari, Kaga-Bandoro, Bangassou, Obo and Zémio, specially trained staff collect information from communities and in return, provide these communities with information that can save lives. Various assessments carried out this year have shown that people in general, as well as beneficiaries of humanitarian assistance, feel that they are not sufficiently informed about humanitarian assistance, the criteria to receive assistance and access to humanitarian services (Multisectoral Needs Assessment 2021).

Improving feedback and complaint mechanisms

In September 2021, the Emergency Telecommunications Cluster (ETC) supported by the Central African Republic Humanitarian Fund automated the interagency common feedback and complaints mechanisms led by the United Nations Children's Fund (UNICEF) in partnership with the NGO Intersos at an IDP site in Bria, Haute-Kotto Prefecture. Located in eastern CAR, the IDP site – known as PK3 – is home to the country's largest displaced population of nearly 39,000 people (Population Movement Commission, September 2021). Utilizing customer relationship management software also used in the banking sector, trained agents confidentially record complaints and feedback from displaced people on tablets connected to the internet. The information is then automatically transmitted to the humanitarian organisations concerned by the feedback or complaint, significantly speeding up the process. In the past, such processes were carried out manually, for example with notes deposited in suggestion boxes, which limited the feedback mechanism to those who could write and restricted the timeliness of responses.

The ETC has also installed five telephone booths at the IDP site in Bria to allow people affected by the crisis to communicate with their families and to call humanitarian helplines free of charge. Mobile phones are the main means of contact for displaced families. On average, one in five displaced people own a mobile phone, according to an ETC assessment, while four in 10 displaced people pay to make calls. Charging stations for mobile phones have also been set up by the ETC at the PK3 site in Bria that can be used free of charge. By promoting free and safe access to mobile communications, these services provide critical access to information for affected people. In Bria, half of the population faces barriers to receiving information, particularly due to the lack of a radio or a telephone (Multisectoral Needs Assessment 2021).

Further efforts

While displaced people at the PK3 site in Bria now have access to information at their fingertips as well as opportunities to provide feedback on humanitarian assistance, this is not yet the case in other parts of CAR. Staff to support common feedback mechanisms are gradually being trained and infrastructure put in place by the humanitarian community, based on lessons learned and using available resources.