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Kaga Bandoro, Central African Republic - On the day rebel forces looking to overthrow the president drove into Kaga Bandoro, it was Christmas. They started looting government buildings first. The district officer’s house was pillaged, then the home of the region’s head doctor. The town’s population finished the buildings off after the Séléka forces had moved on.
The next day, the rebels came for the hospital cars.
Hospital director Dr Etienne Donabe was at work when they arrived. The cars were in working condition, but didn’t have tyres and were propped up on bricks. So the fighters took what they could: the engines, including that of the only ambulance in Kaga Bandoro.
“It was used for transporting patients to Bangui for special operations,” said Donabe. “They also took a vehicle used for transporting drugs around the district.”
They took crucial parts of the generator.
They removed most of the hospital mattresses.
They stole 12 motorcycles and five bicycles.
They made off with surgical gloves, masks, slippers and gowns.
They dismantled the solar panels that powered the radio used to communicate with the feeder villages.
They looted the medicine stores, emptying what Donabe estimates to be about 85 percent of the hospital’s stocks.
The district hospital of Kaga Bandoro - the main reference hospital for about 150 000 people - had no transport, few beds, no electricity, and little medicine.
The head doctor of the district was providing malaria treatment training to doctors in the capital when he heard the hospital and his home in Kaga Bandoro had been looted.
It was too dangerous to return. Séléka was targeting government representatives, and as district head of health, it was safer for Dr Serge Doctor to remain in Bangui.
Only, Bangui wasn’t safe.
Three months later, Séléka took the city, overthrowing President François Bozizé.
The country’s biggest hospital, Community Hospital, was also looted of mattresses, its capacity dropping from 278 beds to 170. Many of the staff members were too frightened to come back to work. The city had no electricity for a month.
The hospital was overwhelmed with patients suffering from bullet wounds, civilians and government soldiers and Séléka fighters - even South African soldiers injured unsuccessfully fending off Séléka’s advance. Doctors operated by torch and candlelight for a week before a generator was provided.
Doctor himself was a victim of the rampant looting. His mother’s home where he was staying was emptied, his car was stolen.
Weeks later, returning from another training mission further south in the country, he was attacked again.
“Doctors represented the government, so we were targeted.”
Meanwhile, back in Kaga Bandoro, Donabe was receiving daily threats from Séléka. They wanted money and the keys to the remaining hospital vehicles. Donabe had neither.
Then one day, he heard a rumour. Séléka was coming for him.
“That was at 5pm, as I was going home,” said Donabe. “At 6pm, I saw them coming.”
He fled, hiding in the bush behind his house for three hours. At midnight, he moved to the parish.
“I stayed there for two weeks before they started threatening the parish, as well,” said Donabe.
He left Kaga Bandoro for Bangui.
On a hot Thursday morning, a crowd of about 200 people waited outside a small building in Nana-Outa. The sun was high and beating down and the people crammed into small patches of shade waiting to be called inside.
The building used to be the local government clinic servicing both Nana-Outa and the surrounding villages. But the staff - like the rest of the population - fled into the bush when the violence reached their town. The health system collapsed.
“Government services have broken down, with the state unable to carry out its tasks, especially as regards health care,” said Georgios Georgantas, delegation head of the International Committee of the Red Cross, which started a weekly mobile clinic in Nana-Outa to meet the shortfall. “In situations of armed violence, access to health care is a top priority. It’s often a matter of life and death.”
People walk hours every Thursday to get help here.
Naomi Ndemayo had lived in the bush for seven months. She ran when she heard gunshots.
“Those who didn’t, were raped,” she said. Now, her one-year-old daughter was vomiting and coughing - malaria symptoms. There were no mosquito nets in the bush.
Marlise Indu’s family fled their village four months ago when they heard gunshots. Indu gave birth to two-month-old Alfa on a bed of banana leaves. Now, the baby was ill. So was she.
Celine Lisipana was pregnant. It was a 90-minute walk from the burnt-out ruins of her village about 19km away for her prenatal check-up. She has malaria. In three months, she will give birth.
“I’ll just have to manage it in the bush,” she said.
It’s a health crisis, but it’s also just a continuing problem for a country starting from a low baseline. Even before the crisis, the CAR had the second-lowest life expectancy in the world at just 48 years, with high mortality rates for easily treatable and preventable diseases.
The Community Hospital in Bangui has no X-ray machine and only one ventilator which is rotated between the patients in need.
A report published earlier this year by Doctors Without Borders described it as “a crisis on top of a crisis”.
“CAR has been in a state of silent, chronic medical crisis for many years,” it read. “A health system with far too few facilities, skilled medical workers, diagnostic or treatment tools, medicines and supplies, and surveillance capabilities. It is, for all intents and purposes, a ‘phantom’ system that does not really function.”
Earlier this month, Doctor returned to Kaga Bandoro.
His house behind the hospital had been stripped - doors, windows, the lot - and a group of Séléka soldiers sat in the shade on the porch and wandered through the hospital grounds with their guns. Nearly a year after they entered Kaga Bandoro, they are now considered the legitimate government forces. Still, the Red Cross was building a fence. A hospital is no place for weapons.
Donabe returned in August. Somebody broke into his office a week later and stole some equipment. He’s still receiving threats, this time from hospital staff, some of the many civil servants who haven’t been paid in months.
“They think because I’m the director, I have the money,” he said.
Doctor, meanwhile, was staying at a hotel. His return is temporary - he has been sent by the government to investigate measles cases in the area. Whether he would return permanently needed to be determined. He still didn’t have a home.
“I want you to understand,” said Doctor. “I don’t have to be here. My wife is French, she lives there. I can leave. It is only the love of my country that keeps me here.”