While there was a slight decrease in armed clashes between government forces and opposition armed groups in 2023, violence continued unabated in some regions of the country, leading to extreme poverty and massive displacement, and exacerbating the decades-long healthcare crisis. CAR has one of the lowest access rates to healthcare in the world: less than half of the country's health facilities were considered functional in 2023, and there is a severe lack of medical professionals.

In this fragile context, MSF's teams in the rural areas of Bambari, Bangassou, Batangafo, Bossangoa, Bria and Carnot delivered basic and specialist care for hundreds of thousands of patients. Throughout the year, we maintained support to referral hospitals, with services including emergency surgery, intensive care, paediatrics, neonatology, intensive nutrition, and sexual and reproductive healthcare.

In addition, we provided smaller health facilities and community health workers with training and medical supplies to treat malaria, respiratory infections and water-borne diseases, which are leading causes of death among children. We also facilitated access to care for HIV, sexual violence, and non-communicable diseases such as diabetes and sickle cell. Meanwhile, we handed over to the Ministry of Health our healthcare initiatives and HIV-related activities in Zemio, in Haut-Mbomou prefecture, and Boguila, in Ouham prefecture, where we had successfully introduced a community-based, patient-centred model of care.

Unfortunately, once again, this year, humanitarian workers and patients were not spared from violence. The UN recorded 169 violent incidents, involving threats and attacks. This included assaults against medical care, and in September, we were left with no choice but to suspend outreach support in the periphery of Batangafo for several months following a series of grave security incidents.

MSF also assisted people affected by violence in neighbouring countries who had sought refuge in CAR. In Vakaga and Mbomou prefectures, we provided emergency support to refugees from the conflict in Sudan, and in Ouham-Pendé prefecture, to people fleeing violence between herders and farmers in Chad. Other emergency activities included vaccination campaigns to curb measles outbreaks in Mbomou and Haute-Kotto prefectures.

In the capital, Bangui, our teams continued to run trauma surgery and post-surgical services at SICA Hospital, the primary facility for surgical emergencies in the city. At CHUC hospital, our support ensured the only free access to lifesaving care for women with obstetric complications and newborns, as well as for people living with advanced HIV. Our teams also strengthened the provision of sexual and reproductive care, and HIV testing and treatment in smaller health facilities.

Tongolo clinic, located next to CHUC, remained a lifeline for victims and survivors of sexual violence, offering essential medical and mental health support, alongside guidance for legal recourse and protection.

In October, the release of a five-year report, which compiles figures from five years of MSF’s care and commitment to addressing sexual violence in CAR, shed light on this invisible emergency, and on the urgent need for comprehensive care and support for victims and survivors.