Healthcare remains difficult to access in parts of the Central African Republic (CAR) that are under the control of the Séléka rebel alliance, despite relative calm following an 11 January peace agreement, say humanitarian agencies. A scarcity of health workers and a lack of medical supplies are among the problems.
"At the moment, there is a relative lack in response capacity among NGOs in healthcare. There are many places taken over by rebels, and in many of these places healthcare is partially disrupted, and access to paid healthcare is decreased in many places," Ellen Van Der Velden, Médecins Sans Frontières (MSF) head of mission in CAR, told IRIN.
"Where healthcare is available, it is [provided] with a fee for the user. Due to the fact that commercial traffic is not possible into the rebel-controlled area, it has to be assumed that fewer people than before are able to cover those fees."
Many health actors in Séléka-controlled regions have yet to return to work. This is "affecting the delivery of vital health services," according to an update by the UN Office for the Coordination of Humanitarian Affairs (OCHA), which added that "health centres outside the biggest towns are out of medicines".
MSF's Van Der Velden concurs: "Timidly, people are returning to their village/town of origin, and where supplies are available - from before the crisis, or delivered by passing by NGO[s] on assessment - healthcare facilities have reopened. Some, however, must have run out of supplies due to higher demand than supply, while some are feared to have been looted."
MSF remains active in the rebel-controlled areas in Ndélé, Kabo and Batangafo, with additional activities having been recently started in the Damara and Sibut areas.
CAR is characterized by chronic humanitarian need. Healthcare needs were already great, and are now even greater.
"Healthcare delivery, which was already poor in quantity and quality, has decreased, while the fact that care is to be paid for is more a burden to populations than before given the fact that they have fewer opportunities for trade or other money-generating activities due to rebel presence," said Van Der Velden.
According to the Internal Displacement Monitoring Centre (IDMC), tensions remain high in the rebel-affected regions despite the end of the month-long conflict there following the signing of the peace agreement in Libreville, Gabon.
The formation of a government of national unity weeks later was also met with resistance by some rebels, noted IDMC, adding that "reports of armed attacks in the country [had] led to accusations that some members of the rebel coalition breached the ceasefire".
In an 8 February statement, the International Committee of the Red Cross (ICRC) stated that thousands of people in CAR are living in uncertainty. "There is a risk of fighting breaking out, and many remain displaced, unsure whether to return home," it noted.
ICRC's Gabriel Mukalai added, "The effect of the Libreville agreement is not felt on the ground. There's no phone network. People don't know what's going on or what's been discussed. It's as if there is no peace accord."
At the height of the recent conflict in December and January, at least 80,000 people were displaced. "While some who had fled their homes in Ndélé have since returned, most are afraid to go back to their areas of origin due to the security situation," noted IDMC.
The displaced joined at least 52,000 others who were earlier displaced by ethnic tensions, criminal groups, activities of the Ugandan rebel group the Lord's Resistance Army (LRA), as well as pre-2008 conflict in the country, according to IDMC.
Ndélé, in the northeast, was the first town to be attacked by Union des forces démocratiques pour le rassemblement (UFDR) rebels, on 10 December 2012, before the UFDR formed the Séléka coalition with the Convention Patriotique pour le Salut Wa Kodro (CSPK) and Convention des patriotes pour la justice et la paix (CPJP) rebels. Other areas that were affected included Sam Ouandja, Bamingui, Kabo, Batangafo, Kaga Bandoro, Ippy, Bambari, Bria and Sibut.
[This report does not necessarily reflect the views of the United Nations.]