The Central African Republic faces health and humanitarian consequences of COVID-19
First case: 14 March 2020
Total cases: 4,936 (8 December 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, 34,679 people have been tested as of 8 December 2020, resulting in a 14.2 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.
Since the first case was detected in the Central African Republic (CAR) in mid-March, the Ministry of Health and Population confirmed that 4,936 people have contracted COVID-19, including 63 who died as a subsequence (as of 8 December 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 623,000 internally displaced persons (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.
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 65% or US$357.3 million have already been mobilized.