Africa's forgotten crisis in the Central African Republic threatens the country's most vulnerable.
Last week, five thousand civilians fled from former Seleka rebel fighters pillaging Bangui, the Central African Republic (CAR) capital, taking sanctuary in the main international airport. At least ten people have been killed since clashes began in Bangui on August 20 in the most recent instance of violence in over six months of instability.
Since fighting broke out at the end of 2012, CAR has been plunged into chaos, resulting in severe food and medical shortages. The country has remained in a critical state since Seleka rebels seized power from former President François Bozizé in March earlier this year. The deepening humanitarian crisis has been particularly threatening to the most vulnerable, including the nation's 2.3 million children.
Since the coup began in March over 200,000 people have fled their homes - they are now hiding in the bush, without adequate access to services or aid. 1.6 million out of CAR's 5.1 million inhabitants are now categorised as "vulnerable". Many of those most at risk are children. Last month, aid agency Save the Children warned that more than 100,000 children faced sexual abuse and recruitment into armed groups in the country.
No longer play fighting
Before the current crisis even began in CAR, UNICEF estimated that there were over 2,000 children linked with armed groups and militias in the country. Conflict has only made this worse, as thousands of children, some as young as twelve, have been reported to be carrying weapons and operating checkpoints.
Roland Marchal, Senior Research Fellow at the National Centre for Scientific Research (CNRS), argues that children aren't always forced to become soldiers; due to the precarious security situation, children may actively seek entry into militias.
Speaking to Think Africa Press, Marchal explained: "Kids try to get recruited because it is the best way to save his own life and have access to resources (including looting and blackmailing). We should look at this not as a political project but as a social response to survival stresses."
With survival the overriding goal for many CAR citizens, the education of children has taken a back seat. In April, it was estimated that the crisis had left one million children without a school and hundreds of thousands of children have missed almost the whole of the school year. Many schools throughout the country still remain closed due to the security situation or because of a lack of supplies, teachers and funding.
The medical situation in CAR is also currently dire. There have been reports that many medical centres have been abandoned or looted. Malini Morzaria, Regional Information Officer for the European Community Humanitarian Office (ECHO), reports that even before the current crisis health provision in the country was over-stretched and under-resourced.
Speaking to Think Africa Press, she says that "CAR's population face a declining life expectancy, currently 48 years old. The entire country has only seven surgeons and one doctor per 55,000 people." In the wake of the latest chaos the United Nations Assistant Secretary-General for Human Rights, Ivan Simonovic, estimated that less than 20% of the country's already strained health services are currently operational.
This lack of capacity is having a direct effect on children's health. Due to the absence of even the most basic healthcare, diarrhoea and malaria are having a dreadful impact on children, especially the 800,000 children under five in the country.
Ellen van der Velden, Medicine San Frontier's (MSF) Head of Mission in CAR, speaking to Think Africa Press, reports that "In the first quarter of 2013, health facilities supported by MSF treated almost 75,000 patients for malaria, representing a 33% increase over the same period in 2012. For children under five years of age, there has been an increase of 46% since last year, from 23,910 in 2012 to 44,469 in 2013."
A further worry for MSF is that the current lack of vaccination in the country is creating future health crises. Van der Velden explains that "Half of all children were not receiving routine vaccination before the coup, so it can be assumed that most newborns since December 2012 have had hardly any access to the routine vaccination package, which has increased the risk of outbreaks of diseases like measles, meningitis and whooping cough in the coming two years and created a cohort of children who are particularly susceptible to those diseases.
Measles is reported in different parts of the country and several mass-vaccinations have been conducted. Nevertheless, much of the country remains uncovered."
UNICEF has warned that the country faces a potential food crisis: the recent Emergency Food Security Assessment (EFSA) revealed that 484,000 people are at risk of food insecurity in the country.
Morzaria explains that the insecurity of the conflict has helped to create widespread hunger, as it has aggravated pre-existing food security problems: a poor harvest, poor food supplies and volatile prices.
She says that "Villages were looted of harvests and livestock, which are a source of nourishment for the children. Local people have told ECHO teams that they have had to resort to wild tubers to fill the stomachs of their children. The number of malnourished children registered in a nutritional centre in Bangui was double this year than for the same period last year."
So far over 10,000 severely malnourished children have been admitted for treatment and, with the lean season coming up, there are real fears that CAR could experience widespread food shortages. Van der Velden explains that food shortages have significant health implications as malnutrition weakens the immune system and makes children even more vulnerable to diseases like malaria.
What is being done?
Despite the UN Security Council having warned that there has been "a total breakdown of law and order in the country", there has not yet been strong international action in response to the crisis.
The UN Security Council have been considering sending forces to CAR but nothing as yet has been decided and whilst 3,600 African Union troops have been committed to the country, they are yet to be deployed. Amidst the latest turmoil this week, French President Francois Hollande has called upon the world to take action in the Central African Republic, warning that the country is "on the verge of Somalisation."
The unstable security situation has been consistently undermining relief efforts. Van der Velden reports that "Along with a number of UN agencies and non-governmental organisations, MSF has been the victim of robberies and looting."
Yet, despite the challenges, humanitarian organisations have managed to provide limited aid to some in the country. A UNICEF-chartered cargo aircraft, laden with 52 metric tons of humanitarian supplies, managed to make it to Bangui on 26 July.
However, vulnerable groups, including women, the elderly and children, remain at risk and Van der Valden believes that more help is urgently needed.
She says that "The international community needs to keep CAR at the top of their agendas and to support this fragile country. The humanitarian community must also maintain its commitment to CAR, in spite of the current political and security situation, and allocate adequate resources to respond to the medical and humanitarian crisis gripping the country."
Jamie Pickering is a freelance journalist. He is interested in political, economic and security issues in sub-Saharan Africa. He has a particular interest in Francophone Africa and the current conflict in Mali. You can follow him on twitter at: @JamiePickering2.