"Fighting took place in and around several locations where Médecins Sans Frontières (MSF) works, including Bongono, Batangafo, Bokayanga and Kabo," reported Stéphane Hauser, MSF coordinator in Batangafo. "Confrontations and violence due to armed groups have also flared up in the region. Civilians who have fled to the bush for safety have also been attacked. In one village, several hundred houses were burned down."

Thousands of people have been forced to move temporarily as a result of the outbreak of violence. So far, 15 people have been injured. MSF teams have treated seven people suffering from gunshot wounds at hospitals in Batangafo and Kabo. The majority of victims are civilians. A third MSF surgical team – comprising an anaesthetist and a surgeon - has joined two teams already working in the hospitals.

MSF also supports seven healthcare posts in the region, but it has had to scale down its work as a result of the violence.

"Our team was obliged to temporarily suspend almost all of its out of town visits, along with activities at healthcare posts in Bokayanga and Bongono, which normally see about 250 patients per week," explained Hauser. "Because of the lack of security, part of the population went to ground in the bush and we saw a marked drop in the number of consultations."

The violence has forced the population to seek refuge in the bush, out-of-reach of MSF medical teams and with no access to healthcare. In Batangafo region alone, MSF reports a 50 percent reduction in the average number of patients seen, despite increased healthcare needs.

"Little by little, we have seen an increasing number of patients whose state of health has been worsened by their flight into the bush. By this we mean children suffering from malaria, respiratory infections, diarrhoea and conjunctivitis; and adults suffering from non-specific types of pain," Hauser said.

"MSF is one of the few remaining factors of stability and normality for the region's inhabitants," said Gabriel Sánchez Ibarra, MSF head of mission.

Despite the implementation of a peace process designed to put an end to years of conflict in the CAR, armed groups still operate in the triangle made up by the villages of Kabo in the north, Batangafo to the west and Ouandago to the east. They include Central African armed forces, rebel groups, and armed bandits. Other confrontations between local groups such as nomadic herders and farmers continue to fan the flames of insecurity in this "triangle of violence".

"Bruised by years of conflict, the civilian population has now been taken hostage by violence committed by these armed players," said Ibarra. "In medical terms, the facilities managed and supported by MSF are often the only healthcare services available.

"And at a human level, we are no doubt one of the few remaining factors of stability and normality for the region's inhabitants, who today live in fear of a return to open conflict. Therefore, it is very important for MSF to remain here and to continue working with them."