Crisis in the Central African Republic

Dec 8th, 2009 4:56 PM UTC
By Les Roberts

Les Roberts, Clinical Associate Professor at Columbia University’s Mailman School of Public Health has worked extensively in countries ranging from Zimbabwe to the Democratic Republic of Congo. He previously wrote for the ONE Blog about the situation in Central African Republic here:

The rate of mortality among children under five years of age, a key indicator in the Millennium Development Goals, has dropped globally by approximately two-thirds since 1960. This may be one of the greatest achievements in all of human history. While this decline has been less dramatic in Africa than in other regions, the under 5 year-old mortality rate declined 9% between 1990 and 2005 across the continent. Yet this overall achievement hides a startling disparity. Over the past 15 years, Egypt, Morocco, Tunisia and Libya have roughly halved their under 5 mortality rate, while a few countries have actually experienced increases in child mortality…with CAR being perhaps the most striking example.

This past summer, our team led a survey of 60 randomly picked locations across the country, in order to find out the extent of the crisis in CAR. Half of these locations were in areas serviced by the Central Government, while the other half were largely in areas where government presence in terms of services—and the rule of law—is hardly felt.. Using the experiences of these villagers and townspeople to represent those of all Central Africans, we estimate that roughly 7% of the population died in the past year. This is 3 or 4 times the normal rate in this region, and our interviewers recorded roughly twice as many deaths as births.

It is a freakish event for our species to shrink without widespread violence. It happened in parts of the Congo a decade ago, in Somalia in the early 1990s and in parts of Sudan and Ethiopia in the 1980s. Population declines from infectious diseases are an indication that society has ceased to provide even the most basic of protective functions. Of the 512 deaths people told us about, which occurred either in their households or the homes of their next door neighbors, many were from unknown causes. Of those cases where people thought they knew the cause of death, malaria or fever, diarrhea, HIV and TB accounted for most. These illnesses, along with respiratory infections, account for most deaths in this region of Africa. Despite the country’s tumultuous history, the various armed groups and bandits active on its soil, and its volatile neighbors (Sudan, Chad, and the Democratic Republic of Congo all border CAR, while Uganda’s rebel Lord Resistance Army have found a base there), only 10 (2%) of the deaths we recorded were from violence.

Few understand that this is the nature of war in Africa. Yet in the major civil wars in Africa—the Biafran conflict in Nigeria, which spawned humanitarian aid as we know it, and the wars in the DRC, Sudan, and Liberia—violence has never accounted for more than 15% of all known deaths. Instead, war deprives people of the most essential services: access to health care, the ability to stay where they have their own buckets and dishes, the ability to send items down the road to market. In the next installment, we will describe how even the lowest levels of unrest in CAR have resulted in the collapse of life-saving services, and what this meant for the lives of several Central Africans that we encountered along the way.

TAGS: Central Africa Republic Series, Central African Republic, ONE, Policy News