Armed conflicts and other humanitarian crises are notorious for claiming lives. But any disaster scenario can quickly go from bad to worse when health facilities are abandoned or ransacked. That’s precisely the situation brewing in the Central African Republic, where ongoing political fighting that erupted late in 2012 and intensified last December has plunged the country into chaos and devastated the health system. Many health workers have fled for safety, and looting has damaged health facilities and led to shortages of medicines and other essential supplies.
On 10 April, the United Nations Security Council voted to send peacekeeping forces to the Central African Republic. Meanwhile, the World Health Organization has been collaborating with the country’s Ministry of Health and non-governmental organizations (NGOs) to provide much-needed basic health services in the region. Michel Yao, a physician by training and the senior health security adviser for humanitarian crises at the WHO in Geneva, Switzerland, recently returned from a two-month trip to the Central African Republic. Yao spoke with Nature Medicine about the ongoing medical relief efforts in the beleaguered country.
Can you describe the current situation in the Central African Republic?
There are a huge number of people that are dying—we don’t have an exact number but we’re talking over a thousand people that have lost their lives and several thousand that have been wounded since December. Most of the health facilities have been looted, and health workers also left the health facilities, fleeing to save their own lives. So in this case, the system that is supposed to provide health services to people that are in need cannot work. As an alternative, health care is provided by the humanitarian health workers, but there are few public servants who can still work. The health facilities for the people in the capital city Bangui are more or less covered, but the main challenge remains outside of Bangui.
What are the country’s most pressing health concerns?
Most of the people in the Central African Republic are seeking health services for malaria, diarrheal disease, respiratory infections and vaccine preventable diseases such as measles.
What is the WHO doing to strengthen the health system?
The WHO is trying to focus on a few main areas. The first one is disease surveillance and response to any outbreak. With this early warning system we managed to detect some cases of measles in displacement camps, and we conducted an immunization campaign with our NGO partners to stop the outbreak. The second area is provision of health services, including trauma care, because we have a lot of people who have been wounded in the conflict, which is still ongoing. We are providing medical supplies to some of our NGO partners to make sure that people who are wounded have access to proper treatment, and to treat those diseases that I just mentioned. We are also supporting ambulance services and the blood transfusion center, which are quite critical in terms of trauma treatment.
A polio outbreak occurred last year in Syria, which is also experiencing a humanitarian crisis. Is polio a concern in the Central African Republic?
A few cases of polio were recently confirmed in Cameroon, a neighboring country, so we are concerned about the disease spreading into the Central African Republic due to the low immunization coverage. We are planning to begin a country-wide polio immunization campaign in the Central African Republic towards the end of the month.
How big is your team?
Before the crisis we had about 30 people in our central office in Bangui that has been there almost since the country’s independence. Right now, we have about 50 staff and we have established three sub-offices: one in an area called Bouar, another in Kaga-Bandoro and the last one in Bambari. We have experts in mental health, public health, disease surveillance and data management, all of whom help in terms of planning and designing the response strategy.
How much money is the WHO putting toward this humanitarian response effort?
We are requesting $16 million for our operation, including the deployment of our experts involved in surveillance and planning, and to support coordination with NGOs as well as medical supply equipment. Of this $16 million, right now we have mobilized roughly $4.5 million, or only about 28%. The overall health sector is asking for $56 million, and so far only 21% has been covered. So there is a need to provide more support to the Central African Republic response, assuming that the peacekeeping forces will improve access and will help us to recover the health services.