COVID-19: One year on
A year has passed since the Minister of Health of the Central African Republic announced the first case of COVID-19 on 14 March 2020. Measures to contain the spread and to protect the population were taken immediately, with the support of the humanitarian community. By the end of March, schools were closed countrywide, group gatherings were banned, international flights were halted and movements between Bangui and the regions restricted, with the exception of those related to humanitarian assistance. Two months after the first positive case was detected, the first death related to COVID-19 was recorded.
One year on, 5,170* people have tested positive and 68 passed away due to the virus, according to the Ministry of Health, and the country looks back at a year during which humanitarian needs soared. Never in the past five years have there been so many people in acute need as today. The pandemic hit a country already ravaged by decades of armed conflict and underdevelopment.
Challenges on all fronts
According to the World Health Organization (WHO), the Central African Republic was among the least prepared countries to face the pandemic. A series of aggravating factors render the country both vulnerable and the response to the pandemic difficult.
Fragile health system and poor access to water
First, the health system is barely functioning, due to a chronic shortage of skilled health workers, medical equipment and basic medicines. Seventy per cent of health services are provided by humanitarian organizations and over 2.5 million people, half of the population, need health assistance. One in four Central Africans needs to walk for over an hour to reach the nearest clinic and for many, the bills for consultations and medications are unaffordable.
When it comes to one of the most basic measures to avoid contracting COVID-19 – regular hand-washing with soap and water – the situation does not look brighter. Only one in three Central Africans has access to clean water, a toilet and shower. And for many, soap is a luxury good. Access to water and sanitation is particularly problematic at the many sites where 235,000 internally displaced people (IDP) live, according to the Commission on Population Movement (28 February 2021) often in crowded makeshift shelters where physical distancing is not practicable.
Supplies and logistics
The provision of protective equipment and medical devices to diagnose and treat COVID-19 patients posed a serious challenge, particularly at the onset of the pandemic. Six months into the pandemic, the country possessed only two ventilators and 25 in the pipeline, representing three per cent of the identified needs. Poor road infrastructure and the six-month rainy season disrupt supply chains to large parts of the country. Insecurity further hinders access to services and the possibility of humanitarians to reach people in need of assistance. A severe lack in cold chain infrastructure further impedes the safe supply of medicines across the country.
And the human factor
On top of these tangible challenges came widespread disbelief about the existence of the virus and misinformation about contagion and prevention. Verbal aggression, intimidation and stigmatization against foreigners, including humanitarian workers, occurred during the first months of the pandemic, as they were thought to have imported the virus.
Unprecedented humanitarian response
Faced with these challenges on all fronts, humanitarian organizations and development actors scaled up support to the Ministry of Health to provide a comprehensive and decentralized response and to strengthen the public health system and access to water and sanitation. Nearly a third of the US$ 553.6 million budget for humanitarian assistance in 2020 was dedicated to the COVID-19 response.
Buckets and soap
Boreholes were drilled and water points set up. Hand washing stations were installed. Buckets, soap, face masks and chlorine were distributed to health centres, schools and IDP sites. Tents and mobile housing units were turned into medical isolation and consultation sites for suspected cases. Humanitarian organizations reorganized IDP sites, creating zones to isolate suspected cases and grouping families with patients into designated zones to provide assistance. The capacity and availability of health personnel was increased. Communication plans were elaborated, community workers trained to sensitize the population on prevention measures and radio messages were aired. Remote learning programmes for children were developed to make up for the school closure.
As a result, in 2020, humanitarian partners improved access to health care for more than 938,000 people and access to water and sanitation for 770,000 people, including many IDPs. Awareness-raising and risk mitigation campaigns reached over two million people.
Airbridges for people and goods
An immediate priority of the response was the procurement and expedition of urgent humanitarian cargo and the prepositioning of stocks. The European Union set up an airbridge in May 2020 and shipped 40 tonnes of personal protective equipment and resuscitation equipment to Bangui. The United Nations Humanitarian Air Service (UNHAS) transported humanitarian personnel and relief items to Bangui when commercial flights were halted from March to July 2020 and enabled the medical evacuation of aid workers and the deployment of teams to remote locations.
Investing in communications
Humanitarian partners established a tracking initiative to monitor misinformation and fear associated with COVID-19 among the communities. Over 1,300 community feedbacks were gathered and analyzed to adapt the response and communication efforts. Health and protection actors developed and disseminated key messages on stigmatization, misinformation and manipulation related to COVID-19, for example in the Weekly Bulletin on COVID-19 Rumors and Information. Over 10,000 radios were distributed between April and July 2020 alone and 90 per cent of Central Africans were reached with lifesaving information on COVID-19.
Adapting the modality of assistance
Cash-based interventions became a preferred modality of assistance that avoids large crowds and provides a safer space for humanitarian assistance in times of a pandemic. With 48 per cent more beneficiaries reached in 2020 compared to the previous year, cash-based assistance experienced a surge. Over 375,000 people received US$ 11.6 million for COVID-related multisector assistance in cash or vouchers, first and foremost, to improve hygiene standards and access to water.
Everyday implications for everyone
Despite unprecedented efforts on the part of the humanitarian community and the worst-case scenario prevented, the year has not passed without leaving its traces.
Exacerbating the learning and protection crisis
The Central African children paid a particularly heavy price during the pandemic. Most were out of school for half of the year. The Education Cluster estimates that 1,4 million pupils were affected by the school closure. Fear persists that some children will never return to school, adding a further layer to the already poor level of education. Analysis also showed a rise in sexual violence against girls in many areas of the country and in particular in Bangui during the school closure.
Soaring costs of living and food insecurity
The pandemic has also had direct and indirect impacts on food security and nutrition. Disruption of imports due to border closure and increased border controls has affected the supply of and demand for certain products and hence, their prices, in a country that relies heavily on imports. Families lost their income at a time when they faced higher living costs related to the pandemic. Containment measures limited physical access to areas where people normally earn their living and increased transport costs. Today, 2.3 million people – nearly half of the population – do not have enough to eat. This figure has increased by 910,000 people in just three months. To mitigate the effects of the pandemic on food security, humanitarian organizations in 2020 assisted 900,000 vulnerable people with food distributions and agricultural support helped 170,000 farmers to produce their own food and increase their income.
On 23 February 2021, the Minister of Health Dr Pierre Somse launched the process of developing the National Plan for the Deployment and Use of COVID-19 Vaccines with the aim of starting vaccination in April. The country will benefit from the global rollout of vaccines through the WHO-led COVAX Facility with 372,000 doses, in additional to bilateral donations, that have already been announced.
A recent survey conducted by the NGO Ground Truth Solutions indicates that Central Africans are ready to be vaccinated against COVID-19 and believe that the vaccine will help to eradicate the virus. However, the survey also showed negative opinions and misinformation about the vaccine among some religious and community leaders. As they are perceived as a reliable source of information on COVID-19, it is crucial to integrate them into future awareness campaigns to avoid the spread of false information about the vaccine.
While the pandemic halted life in large parts of the world, at least momentarily, in the Central African Republic, COVID-19 has added just another layer to an already protracted humanitarian crisis that traps large parts of the people.
* Given limited testing capacities, the government’s diagnostic strategy since July 2020 limits tests to suspected cases and people at risk. Thus, the number of confirmed COVID-19 cases should be interpreted with caution. For illustration, only 38,422 people have been tested for COVID-19 as of 15 March 2021.