In early 2022, the area of Ippy, in the centre of the Central African Republic (CAR), experienced renewed clashes between rebel groups and government troops supported by allied forces.

Fleeing violence, thousands of people from rural villages rushed to Ippy town and the sites for internally displaced people (IDP) that popped up there in recent months and years.

“When violence broke out, we fled to the neighbouring village, but it was attacked too, and my three sons were killed,” says Jeremy, who moved with his wife and children to Ippy’s Yetomane site, some 40 kilometres from his home. “We buried them in a mass grave and set off again. Since then, I have not been able to sleep.”

Olga and Jean-Claude travelled almost 140 kilometres with their test children to reach the Bogouyo IDP site.

“We walked for a week, with old people, children and sick people,” Olga and Jean-Claude explain. “Some died along the way, and we were forced to abandon their bodies in the bush without being able to bury them. They were only covered with grass. The children saw it all. How will they forget such images?”

MSF’s immediate response

In February, Médecins Sans Frontières (MSF) sent an emergency team to Ippy to provide medical support to people like Jeremy, Olga and Jean-Claude.

“As essential needs were not met in the displaced people sites, our first priority was to limit the risk of hygiene and water-related diseases,” explains René Colgo, MSF's head of mission in CAR. “In the first phase of our response, we built 269 latrines, installed water points and organised distributions of soap and jerry cans.”

The installation of water points increased access to drinking water from just 1.6 litres per person per day to 15 litres. When other organisations arrived and were able to take over the management of these facilities, our teams focused their support on two local health facilities.

“Basic healthcare was available for displaced people, but the most complex medical cases needed better care, especially for children and pregnant women, who are particularly at risk,” says Colgo. “We therefore provided staff and equipment to strengthen paediatric and neonatal services, treating pregnancy complications, and refer patients to these care facilities.”

In just two months, 381 children were hospitalised with MSF support, most of them with severe malaria. Our teams also provided medical care to 31 women with pregnancy complications, performed 20 caesarean-sections and referred a dozen patients to Bambari for more critical care.

Early in May, we also launched a vaccination campaign to provide basic protection for diseases like measles, polio, yellow fever, meningitis and tuberculosis to nearly 20,000 children under the age of 10, as well as to 9,000 pregnant women. Launched in Ippy town, the vaccination campaign also included immunisation against COVID-19 and will continue until July.

Needs in Ippy remain massive

Today, the situation is slightly calmer in Ippy and residents have started to return to their villages or settle in town. But in an area marked by years of chronic insecurity and displacement, people’s situation remains dire and uncertain.

“While people are leaving sites, the needs remain massive in the area,” says Colgo. “Way before the latest waves of displacement, access to healthcare services and water were already limited in Ippy.”

“The recent events have further exacerbated this situation. Many are destitute, with no means to pay for healthcare or food,” continues Colgo. “Some are traumatised by the physical and sexual violence suffered during their journeys or by the living conditions in the sites. Sustained support is clearly needed.”

“We are herders, but we have lost all our animals when we fled the village,” says André, who lives with his family on the Foulbé site. “And here, we can't farm because wherever we go, someone comes to tell us that we are on their land and chases us away. We can’t even pick up wood or leaves. What will become of us?”

This expression of despair is also shared by Jean-Claude and Olga.

“The future? How can I talk about the future when I don't even know if we are going to eat today?” says Jean-Claude. “Our future is very vague, but we hope to return to our village one day, to start life again.”

Olga is less hopeful about returning.

“There is nothing left there, and we live in fear of being attacked or getting sick. The nearest health centre is more than 25 kilometres away from the village,” says Olga. “My children have never been vaccinated. I don't even know if any of the children in the village have ever been. I can't see myself going back.”

The situation in Ippy unfortunately mirrors the reality of many other areas in CAR, where decades of intermittent conflict have fuelled one of the world’s most critical situations in terms of life expectancy, maternal mortality, malnutrition and lack of access to healthcare. According to the latest UN figures, almost 30 per cent of the population are now either refugees or internally displaced, and more than 60 per cent need humanitarian assistance.