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.