Central African Republic

Situation Report

Highlights

  • In 2021, 2.8 million Central Africans – more than half of the population – will need humanitarian assistance and protection.
  • The COVID-19 pandemic is severely affecting the 2020-2021 school year, in an already fragile sector
  • Fighting for the lives of children and their mothers
  • Floods continue to threaten the Central African Republic. A long-term solution remains essential; meanwhile, emergency needs are looming.
  • The instability in the west has serious consequences for the population trapped in the conflict.
Young mothers and their babies benefit from the mobile clinic in the village of Daté, made possible by a humanitarian organization. OCHA/Virginie Bero, Daté, Mambéré-Kadéï Prefecture, CAR, 2020.
Young mothers and their babies benefit from the mobile clinic in the village of Daté, made possible by a humanitarian organization. OCHA/Virginie Bero, Daté, Mambéré-Kadéï Prefecture, CAR, 2020.

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Central African Republic

Situation Report

Key Figures

4.9M
Population
2.8M
People in need of humanitarian assistance
1.6M
People targeted for assistance in 2020
1.9M
Food-insecure people
2.3M
Proj. food-insecure people (May-Aug. 2021)
640.7K
Internally displaced people
622K
Central African refugees
4911
COVID-19 cases
63
COVID-19-related deaths

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Central African Republic

Situation Report

Funding

$553.6M
Required
$354.5M
Received
64%
Progress
FTS

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Contacts

Maria Rosaria BRUNO

Acting Head of Office

Maxime NAMA CIRHIBUKA

Head of Public Information

Anita CADONAU

Reporting Officer

Central African Republic

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

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

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

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

The humanitarian situation continues to worsen

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

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

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

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

The Central African Republic is also one of the most dangerous countries for humanitarians in the world. On average, more than one incident per day affecting humanitarian workers was recorded between January and the end of September 2020, with two aid workers killed and 21 injured.

The next steps

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

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

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Central African Republic

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

Joining forces in the fight against COVID-19

Since the first case of COVID-19 was recorded in March 2020, the Central African Republic (CAR) has recorded 4,911 confirmed cases; including 63 deaths (as of November 19, 2020). Faced with this emergency, the NGO Concern Worldwide immediately adapted two of its current projects and launched two new projects, in collaboration with other NGOs, along the roads connecting the capital of the Central African Republic, Bangui, to the Cameroon city of Douala – a region which was most affected by the pandemic. 400,000 people across western CAR will benefit from this robust NGO mobilization.

Strengthening health centers

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

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

Joint efforts

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

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

Involving the community

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

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Central African Republic

Situation Report
Analysis
Back to school ceremony in Bouar
Students participate in the back-to-school ceremony, ©UNICEF/Valérie Sonlo, Bouar, Nana-Mambéré Prefecture, CAR, 2020

Finally, back to school

After almost seven months, pupils across the Central African Republic started to return to the classrooms on 19 October 2020 for the beginning of the school year 2020-2021. Schools were closed countrywide at the end of March as a measure to contain the spread of Covid-19. Some classes resumed in July and continued through to September, but only the three levels in an examination year, allowing pupils to proceed to the next class. Meanwhile, the children in the other nine levels without a year-end exam remained at home.

A spark of normality

For most children, 19 October was the day they had been waiting for. The school routine brought back a little bit of normality into the children’s lives that had been shaken by yet another crisis with the arrival of the Covid-19 pandemic.

While the Ministry of Education’s verdict for the capital Bangui was positive, the start of the school year was slower in other parts of the country, such as in the far north prefecture of Vakaga, in Haut-Mbomou in the southeast and in parts of Ouham and Ouham Pendé in the west. Insecurity that rules in these regions has displaced many teachers, destroyed school infrastructures and out of fear, children do not dare leaving the house.

School as a safe space

According to the Education Cluster, which supports the government and coordinates the humanitarian response in this sector, nearly 1.4 million children from pre- to secondary school were affected by the Covid-19 related school closure in the Central African Republic. Fears prevail that many of them will never return to school, in a country where only 49% of children complete primary school. Children were deprived of access to education in a context where the education system offers few, if any, opportunities for quality distance learning. Only 4% of the population has access to Internet. But schools also constitute a safe space for children, particularly in a country that is ravaged by conflicts and violence. The school closure has increasingly exposed children and youth to various forms of abuses, including economic exploitation in households, and the recruitment and use in armed groups. And girls, for their part, have been increasingly victims of sexual violence, according to the reports from various humanitarian partners.

A long and stony road ahead

At the national level, 9 per cent of children enrolled at the beginning of the 2019-2020 school year have dropped out during the course of the year. Reasons are manifold and include, for example, the loss of family income due to displacement. As a result, parents become unable to pay school fees and supplies. Other factors leading to the school drop-out rate include the lack of qualified teachers and poor school infrastructure, insecurity in large parts of the country, but also the lack of latrines at school – particularly important for adolescent girls. The 9 per-cent drop-out estimate is based on the situation before Covid-19. The pandemic has seen children and youth increasingly take on income generating activities, for example as street vendors or in processing facilities, or they have become an integral help in the household and with childcare. The risk is high that many of these children will not return to school, particularly those from families where even the smallest income contribution is necessary to survive. The coming months will show how many children will have abandoned school in the wake of the Covid-19 pandemic.

Girls will likely be disproportionally affected by Covid-19 related school drop-outs. This has been the case even before the pandemic. While 75 per cent of boys proceed from primary to middle school, this only applies to 65 per cent of girls. Several factors are responsible for this gender disparity, including traditional roles that see girls in the household rather than at school, ignorance of laws promoting equal access to education, the lack of female teachers that function as role models, violence at school or on the way to school and early marriages and pregnancies.

Supporting the reopening

The Education Cluster in partnership with UNICEF and other partners are taking various steps to support the government in facilitating the beginning of the school year and to motivate students to return to class. The Education Cluster plans to introduce an Education Cash Transfer in the coming months for the most vulnerable children with the highest school drop-out risk. A financial support incentivizes families to keep their children in school and covers parts of the expenses.

In the framework of projects financed by the Humanitarian Fund for the Central African Republic, the Education Cluster will prioritize the reopening of non-functional schools, for example with the construction of temporary learning and child protection spaces, the recruitment and training of substitute teachers in the absence of qualified professionals, and the distribution of school supplies and pedagogical material to pupils and teachers.

In Vakaga prefecture, the NGO Intersos supported 250 children to finish the final primary school year, take the year-end exam and to proceed to middle school, thanks to support from the Humanitarian Fund. So many teachers had left in the wake of growing insecurity in the prefecture that such classes could not be hold for everyone, as it was the case in other parts of the country.

Trying to uphold hygiene standards

The humanitarian community has also been supporting the Ministry of Education to prepare a safe return to school in the wake of Covid-19. Funds from the Global Partnership for Education, managed by UNICEF in the Central African Republic, allowed the purchase of hand washing facilities, soaps and similar items that are distributed to schools across the country. Humanitarian actors have also purchased facial masks for teachers and pupils. The Education Cluster has been supporting the Ministry of Education in elaborating a protocol, defining the hygiene standards at school in the context of the pandemic.

However, despite great efforts, schools in the Central African Republic are likely not in a position to respond effectively to the requirements of the pandemic. In the current context, where many schools are dilapidated and where one teacher looks on average after 113 children, respecting physical distance during classes is naturally difficult, to say the least. Respecting Covid-19 barrier measures would imply the construction of hundreds of new classrooms and the recruitment and training of thousands of teachers.

The least lucky ones

Those pupils with the least of luck are those whose school has closed for reasons other than Covid-19. Data from the Ministry of Education reveals that nearly 300 of the 3,500 schools in the country are currently closed because of population displacement, lack of teachers, armed groups’ attacks or occupation of schools or check points that hinder access to schools. These students are not likely to return to school anytime soon.

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Central African Republic

Situation Report
Background
Didi Séley and her twins
Didi Séley and her twins Hassan and Mariam in June 2019, then in October 2020 ©OCHA/Virginie Bero, Zémio, Haut-Mbomou Prefecture, CAR, 2020

A fight for life

Hassan and his twin sister Mariam are over a year old now. Hassan has already taken his first steps and Mariam is just about to. Didi Séley's twins suffered from Severe Acute Malnutrition (SAM) in 2019 when they were four months old. After receiving nutritional care, they recovered and are now in good health. In the Central African Republic (CAR), 1 in 10 children do not survive to their fifth birthday due to a combination of factors, including malnutrition, for which more than 1 million children will need preventive and curative assistance in 2021.

Didi Séley, Hassan and Mariam's mother, fled the town of Bambari in central CAR in 2018 because of armed conflict. Abandoned by her husband, she found herself alone a year later with her newborns at an informal site for displaced people in Zémio in the south-east of the country. "Arriving at the site, I didn't know how to feed my children,” she says. Séley was not getting enough food, and as a result, she could not adequately breastfeed her two children.

A spark of hope

In June 2019, during an assessment of the needs of displaced people in Zémio, the Humanitarian Coordinator and OCHA met Didi Séley who was begging in despair at the IDP site with her twins who presented signs of advanced malnutrition, such as emaciated bodies and bloated bellies. Alerted by the children's nutritional situation, the humanitarian team initiated emergency treatment for the twins who were already in SAM. Humanitarian workers continued to monitor children's development and provided nutritional and medical care. “I had lost all hope for the survival of my children. If they are alive today, it’s thanks to the support of humanitarians,” said the visibly relieved young mother.

Didi Séley benefited from multisectoral support provided by humanitarian actors in Zémio. Her children were followed every week and received nutritional inputs. She also received food from the World Food Program, as well as becoming a member of the women's group "Aimons-nous", supported by the NGO Association of Women for Promotion and Entrepreneurship (AFPE), with funding from the Humanitarian Fund for CAR. An Income Generating Activity Kit (IGA) assistance enabled her to start a small business and raise chickens, which allows her to earn money to support her twins. "Once I have saved enough money, I plan to exit the site, rent a house and move in with my children," said Didi Seley. In this group, the beneficiaries have set up a tontine system which allows them to grant themselves revolving credits in order to strengthen their business assets. "We come to the aid of tried women, those who are sick, victims of domestic violence, or destitute", said Jacqueline Mbolini, who is president of the group.

Didi and her twins among thousands

In 2019, Zémio was in phase 5, the most acute for humanitarian needs. With a population of more than 35,000 inhabitants, the city has welcomed, since 2017, more than 15,000 displaced people from the Ouaka prefecture and the various Zémio roads. Following large-scale humanitarian interventions, the level of severity of needs has dropped from 5 to 4 in one year. 75 percent of people in need receive the necessary assistance: food consumption has increased from 34 to 58 percent, access to hygienic toilets from 43 to 71 percent, school attendance from 43 to 87 percent.

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Central African Republic

Situation Report
Visual

COVID-19 Supply Dashboard

COVID-19 Supply Dashboard

Since the first COVID-19 case was detected in the Central African Republic on 14 March, the Ministry of Health and Population has confirmed 4,855 cases, including 62 deaths. As of 8 October, 32,741 people have been tested. 88 per cent of the confirmed cases are attributed to local transmission. In addition to the government’s effort, the humanitarian community continues to scale up emergency response at national and local level. However, severe shortage of basic COVID-19 supplies are experienced and current pipelines are insufficient to cover the pressing needs. Urgent support is required to ensure access to healthcare and protection for health personnel on the frontline.

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Central African Republic

Situation Report
Feature
Floods in Ngarba in the Bamingui-Bangoran Prefecture on the border with Chad. © REACH INITIATIVE / Ugo Semat. Ngarba, Bamingui-Bangoran Prefecture, RCA, 2020.
Floods in Ngarba in the Bamingui-Bangoran Prefecture on the border with Chad. © REACH INITIATIVE/Ugo Semat. Ngarba, Bamingui-Bangoran Prefecture, RCA, 2020.

Floods still threaten the Central African Republic

The rainy season, which runs from April to October, is an additional source of concern in the Central African Republic, a country already ravaged by more than a decade of conflict. During this period, numerous rivers overflow their banks after torrential rains, causing significant damage in areas with inadequate sanitation, poor waste management and a lack of urban planning. In 2019, nearly 100,000 people saw their homes flooded and destroyed and their source of water polluted, prompting most to move to temporary sites or to stay with host families. This damage happens in a country where basic social services are already severely degraded. If floods occur this year in the same proportions as in 2019, the vulnerabilities of the population will be further exacerbated in a context where the available resources face ever increasing needs due to COVID-19. As of October 5, only 63 per cent of the funds required for the humanitarian response to critical needs in 2020 have been mobilized.

Knowing more about the problem in order to solve it

In early September, the NGO REACH undertook a flood susceptibility study in populated areas in order to improve disaster preparedness. To develop a flood risk score, the results of this study, funded by the Humanitarian Fund for the Central African Republic (CAR), were subsequently cross-checked with those of the multisectoral needs assessments conducted in 2019. The data from this study, also shared with governmental authorities, revealed that the Prefectures of Ouham and Kémo have the highest risk of flooding (with more than 203,000 people at high risk), while those of Nana-Mambéré and Ouham Pendé are at low risk. This study also showed that most urban centers in CAR are located next to rivers and their watersheds, around which the livelihoods of many are developed. The banks of these rivers tend to overflow in the face of the increasing amount of precipitation collected in their watersheds. Thus, if no adaptation of infrastructure and contingency planning are considered, downstream interventions will not be sufficient for populations already battered by more than a decade of conflict and several other shocks.

In order to ensure optimal preparation in the face of the risk of flooding, a Technical Committee has been set up under the aegis of the Ministry of Humanitarian Action and National Reconciliation with the participation of the United Nations Office for the Coordination of Humanitarian Affairs (OCHA), the Central African Directorate General of Civil Protection, the Central African Red Cross, the United Nations Multidimensional Integrated Stabilization Mission in the Central African Republic (MINUSCA) and the city council of Bangui. This new structure made it possible to coordinate field visits in September in Bangui to identify risk areas and priority preparedness measures. Additionally, in coordination with MINUSCA, a mission to assess the level of the Oubangui River upstream was undertaken in mid-October.

MINUSCA is providing technical support, in close coordination with the city council of Bangui and OCHA, to the heavy work of cleaning of canals and markets as well as the securing of drainage canals.

Disaster victims in need of assistance

The floods reported so far have affected about 22,000 people accross the country. A first humanitarian response was necessary to come to the aid of the displaced following the floods observed at the end of September on the border between Chad and CAR. Heavy rains have also damaged two IDPs’ sites in October in Birao in the northeast, particularly shelters and water, hygiene and sanitation (WASH) facilities. Some needs from the 2019 floods persist, while other, new ones, are emerging.

While most of the people displaced by last year’s floods have returned home, more than 6,000 people are still settled in sites spread across Bangui. Following the permanent threats of flooding in the home areas of some flood victims, the government is considering their relocation.

Most of the 1,100 families living along the Bahr Aouk River in Ngarba-Bord and Am Ndjamena in the Bamingui-Bangoran Prefecture, in northern CAR on the border with Chad, fled in August and September to neighboring villages, following flooding. The river overflowed its banks following the torrential rains that fell in the region, destroying homes, basic infrastructure and crops. Several other residents in the border region fled along the Ngarba-Akoursoubak axis under difficult conditions. Their most pressing needs are food, drinking water, medical care, shelter and basic household items. Security has been very precarious in this area for a long time without the presence of the State. Among these victims are Chadian refugees, displaced persons, and Central African returnees.

Following a first reconnaissance flight made by OCHA, the United Nations World Food Programme and the NGO REACH on September 23, aid workers identified the most effective means to assist those affected and to deliver emergency aid to this region, which is difficult to access, especially considering security and logistical constraints. A first distribution of essential household items was carried out at the end of September by the NGOs Solidarités International and Première Urgence Internationale. At the end of November, SI, as part of the Rapid Reaction Mechanism, was distributing basic household items to 1,500 families of 7,500 people on the Ndélé-Miamani axis. In the same region north of Ndélé, on the Ndélé-Tiri axis, 6,750 people are in urgent need of water, hygiene and sanitation, and humanitarian actors are currently planning an intervention to respond to these needs.

Shelter and sanitation facilities of hundreds of people were damaged at the Yata and Aerodrome IDP sites in Birao following heavy rains in mid-October. With the support of the NGO ACTED, 235 IDPs have received emergency kits consisting of tarpaulins, mats, blankets, buckets, soap, jerry cans and cooking items. At the same IDP sites, the NGO TGH and MINUSCA have organized waste collection and will build four waste pits, latrines and showers to avoid the outbreak of diseases.

In Kabo, in Ouham Prefecture, where 4,500 people are affected by floods, assistance in the form of cash transfers and the distribution of essential household items is planned. However, there remains a significant gap in the food security sector in Kabo. Also in Bangui, disaster victims require assistance in the form of adequate shelter and the security of IDP sites remains a problem.

Signs of further flooding

Assessments initiated in August and September by various actors including the Ministry of Humanitarian Action and National Reconciliation, the General Directorate of Civil Protection and humanitarian organizations noted a significant rise in the water levels of the M'Poko and Oubangui rivers in Bangui and Bimbo, a town near the capital. These flood waters overflowed into the surrounding houses at a height of 50 cm, forcing residents to move in with nearby families. The drainage canals which normally evacuate water to the river are blocked and have are not been maintained. In 2019, 3 per cent of all people displaced in CAR were due to natural disasters.

The results of the Seasonal Climate Forecasting Forum in Central Africa (PRESAC, September 28-29, 2020) are alarming regarding rainfall forecasts in southern Chad and throughout the Central African Republic.

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Central African Republic

Situation Report
Background
Thanks to seeds received, Moussa Tanko is able to feed his family. ©OCHA/Virginie Bero. Baboua, Nana Mambéré Prefecture, CAR, 2020.
Thanks to seeds received, Moussa Tanko is able to feed his family. ©OCHA/Virginie Bero. Baboua, Nana Mambéré Prefecture, CAR, 2020.

Assisting farmers caught between armed groups and hunger to rebuild in Nana-Mambéré

Agriculture, the main source of income for the people of Baboua and Gallo in western Central African Republic (CAR) has been disrupted due to clashes between armed groups. The latest analysis of the Integrated Food Security Phase Classification reveals a deteriorating situation, particularly in the Nana-Mambéré Prefecture, where the population live in dire food insecurity. This already alarming situation has further worsened due to COVID-19. The 6,000 inhabitants of the towns of Baboua and Gallo, bordering Cameroon has become accustomed to getting most supplies from Cameroon due to its proximity and its more affordable prices. The movement restrictions enforced to contain the spread of COVID-19 further exacerbated the people’s vulnerability, as there were, suddenly, restrictions put in place to cross the border.

With the financial support from the Humanitarian Fund for CAR, the NGO DanChurchAid provided seeds and farming tools to families in need. The most destitute people also receive food vouchers in the form of electronic coupons.

Moussa Tanko is one of the beneficiaries. He hopes to have enough food for his family, consisting of his wife and seven children, after the harvest. Originally a cattle breeder, Moussa became a farmer after losing his cattle during an escape from armed clashes in 2019. "I couldn't manage to feed my family properly. The support we receive is a blessing. The cassava we received and planted has grown and we are now eating the vegetables. Soon I will be able to harvest red beans. My family won't starve anymore.” On one hectare, Moussa planted the seeds received, including red beans, cassava, maize and groundnuts.

Like Moussa, 625 families composed of 3,125 people in Baboua received seeds and hoes. In addition, 375 of the most vulnerable families of 1,875 people, including widows, people with disabilities, orphans and the elderly, received emergency food through electronic vouchers distributed in the villages of Baboua, Gallo, Donbayeke, and Beloko. This assistance means that families will not be forced to consume the seeds that are meant to be planted to make up for food shortage.

Although this assistance has enabled Moussa and the other beneficiaries in Baboua and Gallo to restart agricultural activities and get some food on the table, other needs, such as access to drinking water, hygiene and sanitation, have yet to be met.

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Central African Republic

Situation Report
Background
Children respecting barrier measures to prevent COVID-19 contamination during the measles vaccination campaign. ©WHO, 2020.
Children respecting barrier measures to prevent COVID-19 contamination during the measles vaccination campaign. ©WHO, 2020.

Responding to the resurging measles epidemic

Since the beginning of 2020, the Central African Republic (CAR) has been facing a resurging measles epidemic. From 1 January to 22 September, 28,633 cases were reported, including 137 deaths, compared to 3,388 cases registered in 2019 and 241 in 2018. The epidemic has affected more than half of the country's 35 health districts with a high prevalence in the capital Bangui, the west and the centre-east.

This resurgence is the result of a poor immunization coverage of children that has accumulated over the years. Routine vaccination coverage rates are generally low in CAR, often reaching less than 75% of the population. This situation has resulted in a large number of children at risk of contracting the measles virus.

On 24 January 2020, the Ministry of Health and Population declared a national measles epidemic. Subsequently, a response plan and a resource mobilization strategy were developed with the support of the World Health Organization (WHO), the United Nations Children's Fund (UNICEF) and non-governmental organizations. The main action adopted in the response plan consisted of a national vaccination campaign targeting 2.65 million children aged between 6 months and 10 years, with an emphasis on the children aged 6 months up to 5 years, given their particular vulnerability. Due to the limited availability of vaccines and medical equipment, a difficulty which was further amplified by COVID-19, the vaccination campaign was planned in two phases: a first phase in February and March covered the 13 most affected health districts and a second phase followed in August in the remaining 22 health districts.

A positive outcome despite difficult circumstances

The vaccination campaign was made possible with the support of GAVI, the World Bank, WHO, UNICEF, Médecins Sans Frontières, the Centers for Disease Control and Prevention and other national and international NGOs. Final evaluations reveal that almost 100% of the targeted children or even more, due to the lack of up-to-date census data, were reached by the campaign, with the exception of two health districts. In Vakaga Prefecture in the far north, only 65% of all children were vaccinated and in Haut-Mbomou Prefecture in the east, less than half of all children could be reached.

After an initial phase between January and March, where measles cases continued to increase, a decrease was observed in the 13 health districts that had already implemented the immunization campaign. In September, a considerable drop in suspected cases was noted with less than 50 new infections per week in the last two weeks of the month. However, it is important to remain vigilant and to continue strengthening epidemiological surveillance, to organize mini-campaigns in those locations not fully covered and to accelerate routine vaccination in general to avoid outbreaks.

Although the vaccination campaign proceeded well overall, it faced challenges related to insecurity in several parts of the country, poor road conditions, especially during the current rainy season, and the absences of some parents and children, explained by their pursuing of activities related to survival such as finding food. In August, a vaccination team of six was kidnapped by an armed group in Mboki in the Haut-Mbomou Prefecture. The vaccination team was released after several days following negotiations between the UN Office for the Coordination of Humanitarian Affairs (OCHA), UN peacekeepers and the local authorities, but medical equipment and money were taken away. Children in the remote Vakaga Prefecture were not all vaccinated because the heavy rains that fall this time of the year rendered some roads impassable. In a next step, healthcare stakeholders are planning a census of the areas poorly covered by the measles campaign and will mobilize additional resources to complete the immunization.

Beyond measles and for a global vaccination coverage

On 9 September 2020, the Minister of Health and Population launched the preparatory work for the High Level Forum on Immunization with the aim of obtaining political commitment to make routine immunization – against polio, measles, yellow fever, tuberculosis, diphtheria, tetanus, pertussis, hepatitis B and Hemophilus influenzae – one of the country’s development priorities and to achieve a 95%-immunization coverage of all mothers and children.

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Central African Republic

Situation Report
Analysis
Food distribution for displaced people in Bocaranga. ©Bocaranga, Ouham Pendé Prefecture, CAR, 2020.
Food distribution for displaced people in Bocaranga. ©AFRBD. Bocaranga, Ouham Pendé Prefecture, CAR, 2020.

Instability in the west has serious consequences for the population trapped in the conflict

The security situation in the western Central African Republic, particularly the Nana-Mambéré and Ouham Pendé Prefectures that border Cameroon, continues to worsen since June. In September, humanitarian activities had to be temporarily suspended again, following a disturbing recurrence of attacks attributed to armed groups, including on the axis Bossemptélé-Yaloké, Bohong-Bocaranga, Bouar-Niem-Yéléwa, Mbartoua-Besson and Makounziwali-Koui.

Following clashes between an armed group and the Central African Armed Forces that left four people wounded and one vehicle burnt, 2,500 people fled the villages of Makounziwali and Santoine into the bush and the surrounding villages. An ambulance came under fire from elements of an armed group and an ambush by armed assailants against a convoy of commercial vehicles between Bossemptélé and Yaloké left one person dead, one injured and two vehicles burnt. This occurred over the course of three days in early September. An attack by an armed group on the town of Bohong, located between Bouar and Bocaranga, in mid-September, resulted in the displacement of the entire population, estimated at 5,000 people, to the neighbouring villages.

The suspension of humanitarian activities as a result of this insecurity had direct consequences for 25,000 vulnerable people who were receiving assistance in Nana-Mambéré and Ouham Pendé. Approximately 2,450 displaced persons are still located around the town of Bocaranga. Despite difficult conditions due to insecurity, humanitarian organizations are making great efforts to assist those trapped in the conflict. The United Nations World Food Programme (WFP), for example, distributed food to 1,050 displaced people (IDPs) in mid-September. More than 8,000 IDPs were also assisted with food and non-food items in and around Bocaranga by the NGOs Action Contre la Faim (ACF) and Association des femmes rurales de Batangafo pour le développement (AFRBD) between July and September.

The NGO International Rescue Committee (IRC), which supports the Koui hospital in providing free health care to approximately 3,000 vulnerable people, has, since the end of May, been unable to deliver medicines or monitor activities because of insecurity that has forced it to suspend its activities at the hospital. The situation is similar for the health facility in Sanglerime, located 20 km from Koui, whose beneficiaries are estimated at 1,400 vulnerable people. The inhabitants of the region are now forced to buy medicines, but for most of them, this remains unaffordable. In the absence of humanitarian assistance, the sick are not able to access health care.

Prior to the recent clashes, NGOs such as IRC, Mentor, Association des femmes pour la promotion de l’entreprenariat, Convention pour la promotion de droits de l’enfant, Cordaid and AFRBD provided medical services for the local population, supplied malnourished children with therapeutic supplements, distributed emergency food and household items for those in need, and improved access to clean water and hygienic conditions. These actors play a major role in a region where the presence of the State is minimal and basic services are non-existent apart from a few exceptions.

Since the second half of September, the security situation has been gradually normalizing thanks to the patrols of peacekeepers and a gradual return of the population has begun. More than 3,000 families representing 16,000 people have begun to return to the villages of Bohong, Mbotoga, Bode and Santoine. Despite this return, a multisectoral assessment conducted by the NGO ACF showed the extent of the humanitarian needs that remain. The main needs are the supply of medicines for the hospital in Koui and the three health facilities in the region, as well as food for the most vulnerable returnees.

However, security risks on half of the axes in this region remain high for the population and humanitarians, making it impossible for them to move around without restriction.

As if the situation were not difficult enough, the ability of humanitarian actors to reach people in need is further reduced by the current rainy season, which makes physical access to some areas almost impossible due to deteriorating condition of roads and bridges. One of the impassable axes, on which approximately 7,000 people live, leads from Koui to Yéléwa. Road conditions prevent humanitarian partners such as Mentor, which supports two health facilities in the area, and AFRBD, which is expected to distribute food to 1,500 people, from reaching the population in need.

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Central African Republic

Situation Report
Emergency Response
A mobile clinic in the village of Daté enables access to healthcare. ©OCHA/Virginie Bero. Daté, Mambéré-Kadéï Prefecture, CAR, 2020.
A mobile clinic in the village of Daté enables access to healthcare. ©OCHA/Virginie Bero. Daté, Mambéré-Kadéï Prefecture, CAR, 2020.

An integrated response improves health, nutrition and access to water for those affected by conflict

Rébaï Jérémie, at 17 months old, weighed less than 8kg when he was brought to the dispensary of Daté, a village 50 km from Berbérati, where he received nutritional supplements and anti-malaria treatment for a month. By the time he was 10 months old, he should have already weighed between 8 and 11kg. "I can say with joy that my son's life was saved thanks to the assistance received", testified Jeanne Namféï, the mother of Jérémie, a beneficiary of a programme supported by the Humanitarian Fund for the Central African Republic (CAR).

Like Jérémie, nearly 100 malnourished children are cared for by the NGO African Relief Service (ARS) in Daté, a village of just over 1,000 people, in the Mambéré-Kadéï prefecture. These malnourished children are referred to the health facility by trained community relays, who travel through villages, screening children. In addition to taking care of malnourished children, ARS organizes mobile clinics. In Daté village alone, nearly fifty children, suffering from various illnesses, were treated, free of charge.

Other villages, on the outskirts of Amada Gaza in western CAR, also benefit from the support the NGO provides. At the Amada Gaza’s dispensary, between 30 and 40 patients are treated every day thanks to the medicine, medical equipment and financial support that ARS provides. "We could hardly take care of 20 patients a day," said a health worker. Of the 3,895 children aged between 6 months to 6 years, screened in July 2020, 119 children (3 per cent) suffered from severe acute malnutrition and were admitted to therapeutic nutritional units supported by ARS. This NGO also provides the dispensary with medicine, ensures the referral and transport of patients in serious condition to the Berbérati hospital and has built an operating theater.

Reducing maternal and infant morbidity and mortality associated with acute malnutrition

In Gamboula, a town also located in Mambéré-Kadéï, the NGO African Development Initiative (AID) takes care of malnourished children and provides the district hospital with essential medicine. This support is also extended to the neighboring villages of Ndongo, Dilapoko, Béina, Vodowa as well as the secondary health post of the Evangelical Baptist Church.

From June to early September 2020, 52 malnourished children were admitted to the hospital in Gamboula where they were taken care of, with five meals a day, and therapeutic nutritional supplements. The NGO AID also helps parents and other who are accompanying sick children to the hospital, for example by covering accommodation and transport costs, as well as by distributing soap and buckets – essential items during the current health crisis.

COVID-19 measures taken into account in the response

These two NGOs have also integrated COVID-19 prevention measures into their various activities. In the case of Amada Gaza, sixty-five hand washing devices were installed in health facilities and public places. Some 30 healthcare providers have been trained in nutritional care according to a simplified protocol to prevent the spread of COVID-19 and 100 community relays have been trained in understanding barrier measures. These, in turn, will raise awareness among the population about these issues. In Gamboula, the propagation prevention mechanism can be seen in the promotion of hygiene measures, the distribution of hygiene kits to the most vulnerable people, the installation of hand washing devices at border entry points, mining sites, markets and other gathering places.

In the sub-prefecture of Gamboula, access to villages remains difficult due to the presence of armed groups, while the resilience of the population has been severely eroded following recurrent insecurity. In the Amada Gaza sub-prefecture, the deterioration of the road is hindering access to people in need. Access to these areas is only possible by motorbike, which reduces the assistance that can be provided to the population, but also the possibility of exchanges between the different localities.

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Central African Republic

Situation Report
Visual

Overview of incidents affecting humanitarian workers, October 2020

Incidents

The civilian population is the primary victim of tensions and violence in several parts of the country. The CAR is also one of the most dangerous contexts in the world for humanitarian workers: more than one incident per day affecting humanitarian workers have been recorded in the first ten months of 2020. From January to October, 343 incidents have been recorded compared to 244 during the same period in 2019. In October, almost half of the 39 registered incidents (which were 37 in September) were related to interferences, diversion of aid, illegal taxation and restrictions of movements. Robberies and threats are also impeding the work of humanitarian workers and represent more than half of the incidents this month.

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Central African Republic

Situation Report
Visual

Overview of population movements in September 2020

Overview of population movements in September 2020

An estimated 640,715 people were internally displaced in the Central African Republic (CAR) as of 30 September, according to the latest figures published by the Population Movement Commission. This figure shows a decrease of less than 1% in displacement trends compared to August when the number of IDPs was estimated at 641,292 people (577 fewer people). Returns were thus weak during the month of September and mainly observed in the prefectures of Basse-Kotto, Haute-Kotto, Mbomou, Ouaka and Vakaga. The prefectures that have registered new displaced people are Bamingui-Bangoran, Ouham and Ombella M'Poko (Bangui) where victims of the recent floods have joined the sites sheltering the former victims of the 2019 floods. About two thirds of IDPs in CAR live with host families (67%) and one third at IDP sites (33%).

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Situation Report
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Overview of the CAR Humanitarian Funds (January - September 2020)

Overview of the CAR Humanitarian Funds (January - September 2020)

The humanitarian situation in CAR remains dire. 2.6 million people require humanitarian assistance and protection. The number of internally displaced people remains high, with nearly 660,000 IDPs reported as of July 2020. Civilians, particularly women and children, continue to bear the brunt of the conflict. The food security situation has also worsened, with now 2.36 million people in acute food insecurity. One child out of 18 is at a significantly elevated risk of death due to severe acute malnutrition. Only one out of 10 can access hygiene facilities, and only one-third of the population has access to safe drinking water. The COVID-19 pandemic has further exacerbated the vulnerabilities of the most marginalized groups. Since January, the CAR Humanitarian Fund has allocated US$21.8 million to support the humanitarian community's efforts to address the most critical and life-saving needs in line with priorities identified under the 2020 Humanitarian Response plan (HRP) and the 2020 Global Humanitarian Response Plan (GHRP). Overall, $7.3 million supported the multisectoral response to COVID-19. This includes activities implemented under health, water-hygiene-sanitation, camp coordination and management, shelter and non-food items, nutrition, food security, protection, and common services such as logistics and emergency telecommunications clusters. Thanks to the donors' continuous generosity, the CAR HF was able to strategically, efficiently, and quickly allocate the funding to support the implementation of 67 emergency projects, using the reserve allocation modality rather than the standard one. Frontline and best-positioned partners on the ground were prioritized. As a result, 95 per cent of the funding was allocated to international and national Non-governmental organizations. The funding allocated through the first reserve allocation was explicitly designed to support common services in remote and difficult to reach areas and enhance camp coordination and camp management in Birao. The second reserve allocation focused on responding to the most critical needs under the 2020 HRP ($ 6.7 million) and mitigating risks associated with the COVID-19 pandemic ($5.3 million). The third reserve allocation focused on duty of care / coordination support as well as sectoral and multisectoral response on critical gaps for vulnerable groups in line with the 2020 HRP. Finally, the fourth reserve allows to avoid the disruption of the internet services for humanitarian actors in 10 priority areas.

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Central African Republic

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

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

First case: 14 March 2020

Total cases: 4,911 (18 November 2020)

Total deaths: 63

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

Transmission: The Ministry of Health and Population indicates that the virus is predominantly spread through community transmission. Only one in five deaths occurred at hospitals, the others within the community. Given limited testing capacities, the government’s diagnostic strategy, since July 2020, limits tests to suspected cases and people at risk. Thus, the observed decrease in new confirmed cases should be interpreted with caution. For illustration, 33,914 people have been tested as of 18 November 2020, resulting in a 14.5 per cent rate of positive cases, which is relatively high compared by international comparison. Nearly three quarters of positive cases are men.

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

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

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

Situation

Since the first case was detected in the Central African Republic (CAR) in mid-March, the Ministry of Health and Population confirmed that 4,911 people have contracted COVID-19, including 63 who died as a subsequence (as of 18 November 2020). All seven health regions of the country have reported cases, with the capital Bangui being the hardest hit by the pandemic.

According to the World Health Organization (WHO), CAR is one of the least prepared countries to face the COVID-19 outbreak, with 2.3 million people already in need of health assistance and about 70 per cent of health services provided by humanitarian organizations. The country’s health system, marked by a chronic lack of medical equipment, critical medicines, qualified personnel and poor road infrastructure that disrupts supply chains, was under extreme stress prior to the pandemic and has been further stretched to prevent, contain and treat COVID-19.

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

Among the most at risk are the 641,000 internally displaced people (IDP). Risks of transmission are particularly high at overcrowded collective sites such as in Bria, Haute-Kotto Prefecture, where some 50,000 people live.

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

Response

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

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

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

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

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

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

In July 2020, the United Nations and its partners updated the Humanitarian Response Plan, a US$152.8 million appeal to address the most immediate and critical health and non-health related needs of millions of Central Africans affected by the consequences of COVID-19. Thus, for this year, a total of US$553.6 million are required for the Central African Republic, of which 63% or US$351.4 million have already been mobilized.

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Central African Republic

Situation Report
Visual

Humanitarian dashboard, January to August 2020

Humanitarian dashboard, January to August 2020

The humanitarian situation in the Central African Republic (CAR) remains dire. More than half of the population (2.6 million) is in need of humanitarian assistance and protection. One in four Central Africans has been forced to flee. In addition, CAR remains one of the most dangerous countries in the world for humanitarians. Despite this difficult operating environment, humanitarian actors were able to provide 1,332,726 people with lifesaving assistance in at least one sector of intervention.

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