London — Three months after rebels seized power, Central African Republic (CAR) is in the grip of a humanitarian emergency and most of its people have no access to basic medical services because of insecurity and lack of funding, Medecins Sans Frontieres (MSF) said on Tuesday.
Since the Seleka rebel coalition began its offensive in December 2012, schools, health clinics and hospitals have been ransacked, doctors and nurses have fled their posts, and international aid agencies have come under attack.
Almost all aid agencies have withdrawn to the capital Bangui or to neighbouring Cameroon, leaving much of the country without aid.
"These attacks have deprived an already vulnerable population - 4.4 million people spread across a country bigger than France - of access to even basic medical treatment," MSF said in its report, Central African Republic: abandoned to its fate? "In a country which already had the second-lowest life expectancy in the world, at just 48 years, the people are now even more at risk."
A transitional government, installed after Seleka seized power in March, is struggling to establish control. It has very limited presence outside the capital where armed groups are active, and even in Bangui armed men loot and attack public buildings and private homes.
An estimated 1.2 million people, about half of them children, have been cut off from basic services since December, the U.N. children's agency UNICEF said in May. The agency estimates the entire population of CAR is affected by the crisis directly or indirectly.
"Fear of movement has further reduced access to healthcare, loss of income has made it even more difficult to pay medical fees, and unreliable drug supply systems have completely collapsed. Mortality rates are only likely to worsen in the coming months," MSF said in its report.
HUNGER "ABOVE EMERGENCY LEVELS"
Even before the crisis, people's access to food and healthcare was limited. Hunger levels in parts of the south and northwest of the country were above international emergency levels, according to surveys carried out by MSF in 2011. Since the fighting began in December 2012, food prices have soared, according to the World Food Programme.
According to the World Health Organization, only half of children received routine immunisations in 2011. Since the fighting began, the U.N. children's agency UNICEF has organised a measles vaccination campaign, but it was only able to reach children living in or near Bangui.
"It can be safely assumed that most newborns since December 2012 have not had access to (vaccines)," MSF said. This has increased the risk of outbreaks of measles, meningitis and whooping cough to which a large number of children are now susceptible.
Malaria is the country's leading cause of death, MSF said, and the agency's doctors are seeing an alarming number of malaria cases, 33 percent higher than this time last year. "We are facing one of the worst years in terms of the impact of the disease," Ellen van der Velden, MSF's head of mission in CAR, said in a statement.
Malaria drugs are in short supply, and government plans to distribute mosquito nets in 2013 had to be cancelled because of the fighting. Tens of thousands of people who have been forced to flee into the bush have been more exposed to the disease.
Aid agencies have been hampered by funding shortages as well as lack of security. The United Nations has received a third of its appeal for 2013, including just 13.2 percent of the $21.2 million requested for healthcare.
The U.N. humanitarian chief, Valerie Amos, and the European Union's head of aid, Kristalina Georgieva, are visiting CAR on July 11 and 12 to assess the crisis.