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In Pictures: How new CAR violence has made women more vulnerable

Female refugees and internally displaced women particularly at risk after a new wave of fighting engulfs the Central African Republic.

CAR has one of the highest maternal mortality rates in the world [Alexis Huguet/MSF]
Published On 9 Mar 2021

Since December 2020, a new wave of violence has swept over the Central African Republic (CAR), exacerbating an already dire humanitarian crisis.

Renewed fighting between armed groups and government forces backed by foreign troops broke out in many parts of the country, often taking a heavy toll on civilians and leaving more than half of the country’s nearly five million people in need of aid.

The country has struggled to find stability since it descended into a full-blown war in 2013 that led to the deaths of thousands and destroyed critical infrastructure and basic services.

Even before the war broke out, CAR’s healthcare system had been weakened by decades of mismanagement and turmoil. Years of fighting since then have ravaged what is left of it, resulting in limited access to many services and facilities – and the latest cycle of violence has made things even worse.

This situation disproportionately affects displaced people and refugees, whose numbers have skyrocketed since December. Currently, 1.3 million Central Africans – more than one in three people – are internally displaced or refugees abroad, often in very precarious living conditions.

On January 3, a coalition of armed groups waging a nationwide offensive captured the city of Bangassou, in the southeast of the country, forcing some 13,000 people to flee. The residents crossed the Mbomou River to find shelter in the small village of Ndu, in the neighbouring Democratic Republic of the Congo.

On the same day, nearly 800 people – most of them women and children – took refuge in the compound of Bangassou University Hospital. The number of people seeking shelter at the hospital kept on growing over the days.

In such circumstances, women’s health is, particularly at risk. Even outside of periods of acute violence, their socioeconomic status in CAR, their exposure to violence and the very poor access to family planning make them particularly vulnerable. As a result, the country has one of the highest maternal mortality rates in the world.

Christelle holds her baby girl Alvina in Ndu, in the school where she has lived since the January 3 attack on her hometown of Bangassou. She was preparing to celebrate the birth of her second child when the coalition of armed groups attacked and took control of the city. 'My pregnancy was very advanced when we fled the city. But I was followed at the health centre, and luckily everything went well during the delivery,' she recalls. On January 17, United Nations peacekeeping troops retook control of Bangassou. [Alexis Huguet/MSF]
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In a country already plagued by instability and fighting, the latest outbreak of violence has exacerbated an already alarming situation. Today, more than half of the population needs humanitarian aid. [Alexis Huguet/MSF]
Ester, in pink, and her older daughter, Princia, in yellow, are holding newborn twins Laure and Rhode. Ester was about to give birth in Bangassou when the January 3 attack took place. 'This is the second time that I have taken refuge here. The first time was in 2017,' she explains while waiting for the post-natal consultation for her twins at the Ndu health centre. 'I thought I was going to give birth here, but I had complications and the team transported me to Bangassou because I needed a c-section.' Patients suffering from complications or in need of more advanced care are transported and cared for by Doctors Without Borders (Medecins Sans Frontieres, or MSF) at Bangassou University Hospital. [Alexis Huguet/MSF]
Regine, 24, is a refugee from Bangassou. She fell ill and was hospitalised for a few days in the health centre of Ndu. [Alexis Huguet/MSF]
Twenty-five-year-old Amatou, lying down in the pirogue, is pregnant and about to give birth but the midwives in the MSF-supported Ndu health centre found some complications and are transferring her to the hospital in Bangassou, on the other side of the river, where she can undergo surgery, if needed. [Alexis Huguet/MSF]
'Amatou is in good hands now,' rejoices Odette, one of the midwives helping Amatou, after accompanying the mother-to-be to the delivery room, and heading back to the river to go back to the Ndu health centre. [Alexis Huguet/MSF]
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Amatou’s family, including her mother, aunts and sisters, is waiting outside in the maternity wards of the Bangassou hospital while she is being examined. [Alexis Huguet/MSF]
Beatrice is preparing 'koko', made of herbs collected in the bush and mixed with a sauce. Because of the growing insecurity, prices have increased and finding food has become difficult. Like hundreds of Bangassou residents, Beatrice and her family rushed to the city’s University Hospital when armed groups attacked the town on January 3. 'It was total panic. Thousands of people were trying to cross the river in canoes to go to Congo. Many were in danger of drowning. Instead of crossing, we preferred to come to the MSF hospital here,' she recalls. This is not the first time Beatrice and her family have taken refuge in the hospital grounds. [Alexis Huguet/MSF]
When the coalition of armed groups attacked and took control of Bangassou on January 3, more than 800 people - mostly women and children - took refuge in the grounds of the MSF-supported university hospital. Philomene, 50, was among them. 'When we heard the shots, we were terrified. With the family, we went straight to the hospital because we knew we would be safe there,' she says. Philomene has been living here for several weeks with her children and grandchildren. 'I am a widow, and I have already lost six of my eight children to disease and violence,' she explains. 'Most of my grandchildren here are orphans. And today we have to live here.' [Alexis Huguet/MSF]
The view of Philomene’s temporary housing located in the Bangassou hospital compound. She shares this empty building with her relatives and other families who fled violence. [Alexis Huguet/MSF]