Central African Republic

Situation Report
  A young displaced man is being vaccinated against COVID-19 at a site for internally displaced people in Ippy. ©OCHA/Anita Cadonau, Ippy, Ouaka Prefecture, CAR, 2022.
A young displaced man is being vaccinated against COVID-19 at a site for internally displaced people in Ippy. ©OCHA/Anita Cadonau, Ippy, Ouaka Prefecture, CAR, 2022.

Two years after the Central African Republic confirmed the first COVID-19 case

Two years have passed since the government of the Central African Republic (CAR) confirmed on 14 March 2020 the first COVID-19 case in the country. Since then, various humanitarian and development partners have been supporting the government in responding to the pandemic, in addition to responding to a humanitarian crisis that has been lasting for more than a decade.

As of 14 September 2022, 1,934,751 people, have received the COVID-19 vaccine from the COVAX facility and bilateral donations from China and Russia.

The Ministry of Health has revised its national vaccine rollout plan to scale up COVID-19 vaccination with the aim to cover 52 per cent of the total population by December 2022. The plan will include new targets, including people aged 15 and older. The plan will benefit from financial support from the World Bank, UNICEF, GAVI and WHO.

The CAR government launched on 20 May 2021 the COVID-19 vaccination campaign with the support of partners, notably WHO, UNICEF and GAVI. The campaign began with the symbolic vaccination of members of the government and health workers. Frontline health personnel, vulnerable people aged 50 and above, religious leaders, traders, community liaison volunteers, transporters and journalists were targeted first by the campaign. The COVID-19 vaccination campaign covers all 16 prefectures of the country, but is experiencing access difficulties due to insecurity and poor road conditions.

Response to the second and third wave

On the vigil of the campaign launch, President Touadéra on 19 May announced that a public health emergency will be declared and a number of measures taken to intensify efforts to contain the second COVID-19 wave, that hit the country in March and April 2021. Stricter barrier measures at gathering places such as restaurants, bars, places of worship, weddings and funerals, and public transport were announced, as well as their more rigorous reinforcement.

In January 2022, CAR was in the middle of the third COVID-19 wave. In the first week of January, 745 new cases were recorded, more than during the entire month of December 2021 (674 cases). As of 14 September 2022, the Ministry of Health has recorded 14,312* COVID-19 cases, including 113 deaths, since the beginning of the pandemic.

Conducive environment

A survey conducted by the NGO Ground Truth Solutions indicated that Central Africans are ready to be vaccinated against COVID-19 and believe that the vaccine will help to eradicate the virus, despite some scepticism and misinformation that persist. Humanitarian and development partners have been supporting the Ministry of Health in elaborating a communication campaign to inform and encourage people to get vaccinated and to counter the spread of false information about the vaccine.

Challenges on all fronts

CAR 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. COVID-19 hit a country already ravaged by decades of armed conflict and underdevelopment. According to the WHO, CAR was among the least prepared to face the pandemic. A series of aggravating factors render the country both vulnerable and the response to the pandemic difficult:

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 2.7 million people, half of the population, need health assistance. One in four Central Africans walks for over an hour to reach the nearest clinic and for many, the bills for consultations and medications are unaffordable. Only one in three Central Africans has access to clean water and for many, soap is a luxury good. Access to water and sanitation is particularly problematic at the many sites where 156,000 internally displaced people (IDPs) live, often in crowded makeshift shelters where physical distancing is not practicable.

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. 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.

Unprecedented humanitarian response

Faced with these challenges, humanitarian and development organizations have scaled up support to the Ministry of Health since March 2020 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. As a result, humanitarian partners improved access to health care for 938,000 people in 2020 and made access to water and sanitation possible for 770,000 people, including many IDPs. To mitigate the effects of COVID-19 on food security, humanitarian organizations in 2020 assisted 900,000 vulnerable people with food and over 170,000 farmers were able to produce their own food and increase income thanks to agricultural support.

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 an epidemic. With 48 per cent more beneficiaries reached in 2020 compared to the previous year, cash-based assistance experienced a surge. This steady increase continued in 2021, with 1.6 million people who received cash-based assistance, twice as many as in 2020. 577,000 people received US$ 12.1 million for COVID-related multisector assistance in cash or vouchers, first and foremost, to improve hygiene standards and access to water.

* 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, 104,622 people have been tested for COVID-19 as of 14 September 2022.