"At a clinic in one village, 400 people attended. Suddenly a villager thought they heard a vehicle approaching from the distance. All 400 rose and fled into the bush within seconds, leaving the MSF workers standing alone and stunned."

"Even the sound of a car made people run into the bush; this pervasive fear amongst the population is what struck me the most," says Simon Collins, a medical doctor working for MSF in the Central African Republic (CAR). Since November 2005, Simon has been working in the north of the country, out of the village of Markounda, close to the border of neighbouring Chad.

"Violence has become part of their lives," according to Simon Collins. "When we are on the road with our mobile clinics, we regularly passed burnt houses; one village after the other completely destroyed and abandoned. It gave us an eerie feeling when we stopped to see what has happened. This total silence around you.

"Only after half an hour or so, people slowly emerged out of the bush. From talking to local people, it was clear that they now associate the arrival of motor vehicles with men coming to burn and kill - hence their ongoing fear, even when we arrive for a clinic."

The civilian population in the north of CAR is bearing the brunt of an ongoing conflict between rebel and government forces. This has flared in the north since June 2005 causing, among other things, the total collapse of the health care system in a country where the economy was already weak.

"This had a significant effect on the health care in the country," according to Simon Collins. "The ecomonic problems caused a significant lack of income, especially in the north, so that most people simply could not afford anymore to pay for their healthcare?"

As a result of the emerging violence, the collapsed health care and the displacement of the local population, MSF started operations in November 2005 with two mobile clinics operating out of Markounda. The clinics were mobile, bringing healthcare to the people, because either fear or distance prevented the population from coming to Markounda itself.

"My first impressions were quite bizarre," recalls Simon Collins, "I've worked in conflict areas before, like Darfur, but never I have seen such an intense fear amongst the people we were trying to help. For example, at a clinic in one village, 400 people attended. Suddenly a villager thought they heard a vehicle approaching from the distance. All 400 rose and fled into the bush within seconds, leaving the MSF workers standing alone and stunned."

The intensity of attacks on the population has been significant and repeated. In one particular village the attackers burnt 494 houses out of the 498.

"The attacks were so intense. I recall one particularly in December last year when 930 houses were burnt within a day. Clearly civilians were being targetted," says Simon Collins. "The week after we managed to not only treat them medically when needed but also distribute plastic sheeting; blankets and soap to them."

Within a few months time the MSF team expanded to five international and 30 national staff. Ten mobile clinics were set up along the border area with Chad, most of them visited every other week. More than 4,000 consultations are being conducted on a monthly basis. Since there were patients who required more intensive treatment than that available at the mobile clinics. MSF set up a 16-bed, 24-hour care hospital in Markounda.

Weekly MSF admits 10 to 15 people in the hospital and treats several hundreds of patients at the hospital's outpatient section.

"The numbers are maybe not as massive as in other conflict areas in Africa," says Simon Collins. "Overall we working to assist some 10,000 people. This will increase within the coming weeks to 30,000, as we will also being working in the regional referral hospital. Many of these people are hiding in fear in the bush. These people desperately need care, not only medical care but, as important, also the notion that they are not forgotten."

Project information

MSF works in Markounda, northeastern CAR running a hospital and mobile clinics to 10 locations with five expats and 30 national staff. MSF will also begin assisting the regional referral hospital at Boguila Kota, 70kms south of Markounda, in May 2006.

Thousands of people fled from the north of the CAR into southern Chad around the town of Goré. A MSF team of 6 expats and tens of national staff focus on basic health care doing on average 800 consultations a week as well as nutritional and water/sanitation activities.