Central African Republic

How to realize Africa’s potential for the future of all its peoples and build international support for the continent’s development were key questions explored in the first session of the Africa Rising Forum held this week in New York.

Taking place at the Africa Center and organized by the Mo Ibrahim Foundation, the 22 September event brought together a number of African heads of state, United Nations partners, and leaders from African civil society and the business community.

They examined how to move beyond simply talking about the need for broad-based economic transformation and sustainable development to taking concrete steps to make them a reality, especially with regard to the post-2015 development agenda. 

A session on ensuring shared prosperity looked at ways to improve investment and resource mobilization, champion entrepreneurship and ensure social protection. Another stressed that development cannot be achieved without the existence of good governance, peace, security and respect for human rights.

It was agreed that ensuring health for all was a critical facet of Africa’s rise, and that ending the AIDS epidemic as a public health threat by 2030 now a realistic goal. There was also a consensus that the continent’s rise should not only be measured in terms of overall wealth generated but by the inclusiveness of socioeconomic progress that leaves no one behind.

Under-Secretary-General of the United Nations Michel Sidibé and high-level delegation visit IDP sites

GENEVA/BANGUI, 20 February 2014—The Executive Director of UNAIDS Michel Sidibé has witnessed the desperate conditions for internally displaced people (IDP) in the Central African Republic. He flew to Bossangoa in the northwest part of the country on 20 February with Under-Secretary-General of the United Nations and Emergency Relief Coordinator Valerie Amos and other senior high-level officials.

Bossangoa has suffered a wave of sectarian violence and the city which once had some 50 000 residents is now nearly empty as people have left their homes to escape the violence between Muslims and Christians. Now most of the city’s former residents live in two separate sites—one for Muslims and the other for Christians.

The delegation visited both IDP sites and Mr Sidibé spoke with Christians and Muslims and met with religious leaders from both faiths. Several attempts by religious leaders have so far failed to bring about reconciliation and people are refusing to return home out of fear of further violence.

“The human suffering and misery must end,” said Mr Sidibé. “We must ensure the existence of minimum security conditions so that people can return to their homes without fear of violence.”

“We are calling for security and protection. We don’t want to leave the Central African Republic and flee to Chad. This is where we have our families and our life,” said the Imam of the Boro district of Bossangoa, Ismaël Naffi.

Life at the IDP sites is hard. While numbers fluctuate, it is estimated about 36 000 Christians are on the grounds of the Catholic mission of Saint Antoine de Padoue––and about 1 200 Muslims are living in a school called “Liberté”. Conditions are very difficult with food, clean water, medical care and proper sanitation in short supply. The coming rainy season is likely to worsen conditions.

“We are speaking in the name of all the people who are still living in abandoned sites and don’t have any recourse,” said the Archbishop of Bangui, Monsignor Dieudonne Nzapalainga. We are asking that a solution is found on the international level so that security returns…so that cohesion returns and each one of us can rebuild this country that we all love.”

According to latest UN reports the unrelenting violence has forced around 700 000 people to flee their homes searching for safety within the country’s borders and many others have crossed the borders into neighbouring countries. There are growing food shortages and increasing numbers of displaced people with acute nutrition needs are arriving in the capital city of Bangui. Life-saving medical and health care services are needed in the most affected areas including essential medicines, laboratory supplies, safe blood and medicines to prevent outbreaks of infectious diseases.  

There is also growing concern over the safety of women and girls as there are an alarming number of reports of sexual attacks in IDP sites.

“It is intolerable that violence stalks women and girls as they try to rebuild their lives in temporary homes,” said Mr Sidibé. “It is already traumatic to be up-rooted by warring militias from familiar communities, and so IDP centres must provide true safe havens for women and girls.”

At the moment there are limited funds for gender-based violence emergency-response efforts and few IDP sites offer adequate medical and psychosocial response services to survivors of violence.

Prior to the start of the current crisis, the country was already struggling with its AIDS response and the ongoing violence is making the situation even more difficult. According to the country’s authorities 125 000 people were living with HIV in 2012, of whom 15 000 were receiving antiretroviral therapy. Since the violence began, two-thirds of people living with HIV on treatment have fled their homes and are no longer able to access the medicines and care they need. There is growing concern that the interruption in treatment will cause a resistance to the life-saving drugs, making future care difficult.

Under-Secretary-General of the United Nations and UNAIDS Executive Director Michel Sidibé on joint humanitarian mission warns of a growing health crisis

GENEVA/BANGUI, 19 February 2014—The political and military crisis in the Central African Republic is obstructing humanitarian efforts and endangering the already limited access citizens have to essential health services.

UNAIDS Executive Director Michel Sidibé is conducting a joint mission with Under-Secretary-General of the United Nations and Emergency Relief Coordinator Valerie Amos, the African Union Commissioner for Political Affairs Aicha Abdullahi and the Assistant Secretary-General of the UN Department of Safety and Security, Mbaranga Gasarabwe from 18-20 February to the Central African Republic.

Mr Sidibé, Ms Amos, Dr Abdullahi and Ms Gasarabwe met with the country’s President of the Transitional Government, Catherine Samba-Panza who expressed her appreciation to the United Nations for its efforts in bringing humanitarian aid to people in need. However the President said more humanitarian action is desperately needed as many people are hungry. She said reconciliation was essential and that so far the root causes of the crisis had not been tackled.

The President’s words of reconciliation were echoed by Christian and Muslim leaders who met with the delegation as well.

The United Nations has called for US$ 551 million to meet humanitarian needs—of which 13% has been raised. Global solidarity is crucial to ensure funding is made available for the two and a half million people reportedly in need of assistance.

“There is no longer a fine line between living and dying in the Central African Republic. People are dying—we are on the brink of a health catastrophe,” said Mr Sidibé. “If we do not act now, a generation will be gone forever—under our watch. This is not acceptable.”

"Some 2.6 million people need immediate humanitarian assistance, while reports of terrible atrocities and attacks against civilians and aid workers continue," said Ms Amos.

Dr Abdullahi said, “With my initial interactions here in Bangui, my impression is that there are key priorities; security of lives and properties, humanitarian assistance, guarantee of human rights, rule of law and justice, public service reforms including the building of a new constitution and return to constitutional order. The African Union Commission is committed to supporting the Central Africa Republic (CAR) transitional government in addressing these multifarious concerns as key to restoring constitutional order, political stability and democratic governance in the country.’’

The delegation is also scheduled to travel to Bossangoa in Northwest Central African Republic, a region that has suffered a wave of sectarian violence. The delegation will meet with Christian and Muslim communities and visit a site for internally displaced persons.

Dr Meskerem Grunitzky-Bekele UNAIDS Regional Director for West and Central Africa with President of the Central African Republic Mr François Bozizé, January 2010.
Credit: UNAIDS

The Central African Republic, one of the poorest countries in the world, has been heavily affected by the HIV epidemic. It is estimated that 160 000 people are living with HIV in the country, and only one in four of those in need have access to Anti-Retroviral Treatment (ART).

The situation for orphaned and vulnerable children in the country is dire, with assistance only provided to 2400 children, one child out every 30 who need support.

Pediatric care is almost exclusively implemented at one hospital in the capital. They currently have 630 children in their care, and national coverage only reaches one child out of 20 to 22 who requires HIV treatment.

To scale up access treatment, but also prevention, and care and support services, the Central African Republic has been awarded Global Fund grants (Rounds 4 and 7). However, the country has encountered a number of bottlenecks and structural problems with a severe effect on implementing the national response to AIDS.

Some of the most intricate obstacles include pharmaceutical stock shortages and distribution issues, minimal involvement of civil society, as well as effective financial management. This has led the Global Fund to suspend Round 7 grant disbursements and postpone the Malaria Round 8 grant signature, as precautionary measure.

To unblock bottlenecks, a joint mission was undertaken by UNAIDS, Global Fund and WHO Roll Back Malaria, ESTHER, USAID, ,French Cooperation and Grant Management Solutions to meet with government officials including the Head of State Mr François Bozizé and the Prime Minister Mr Faustin Archange Touadéra.

The delegation comprised of senior experts from key agencies working on AIDS and on Malaria in the region with an objective to ensure all requirements of the global fund round 8 are met in the country’s proposal.

In Central African Republic, the mission found conditions similar to countries in state of humanitarian emergency–running the risk of total ARV drug stock outs before the end of January 2010. This could have lead to devastating treatment interruption for people living with HIV currently accessing ART in the country.

An emergency order of 50,000 doses was submitted to the Centrale Humanitaire Médico-Pharmaceutique in Nairobi, paid directly by the Global Fund. The first shipment arrived to the country on 30 January, just one week after the joint mission, with a second shipment on scheduled for the 10 of February.

Simultaneously, the Government made a special commitment for an order for approximately 2.5 months of treatment which is expected to arrive in March 2010. In addition, the National AIDS Commission has ordered three months of treatment to be paid by the GFATM which is expected to arrive in June 2010 – this order will then be renewed on a quarterly basis.

The mission was organized within the framework of the Joint UN Regional Team on AIDS and jointly led by Dr Meskerem Grunitzky-Bekele UNAIDS Regional Director for West and Central Africa and Cyrille Dubois, Global Fund Regional Team Leader, West & Central Africa.

"This joint mission shows the importance of the UN working together with bilateral partners and civil society organizations as one to remove bottle-necks for Universal Access to HIV prevention, treatment, care and support services," Dr Grunitzky-Bekele said.

During the mission a roadmap was developed with clearly defined actions and responsibilities, which has gained widespread political support from all levels of Government and development partners.

The UN Country Team in the Central African Republic provided strong support to the mission and expressed commitment to ensure follow up of the roadmap. UNAIDS Regional Support Team for West and Central Africa continue to coordinate regional support for the implementation of the roadmap with the frame work of the Joint UN Regional Team on AIDS.