Life | The Silent Crisis

The Central African Republic is one of the least developed countries in the world and certainly one of the poorest. Most of its citizens don’t live beyond 40, 13 per cent of its children die in infancy and only a third of the population has access to safe drinking water. Recent political turmoil has left the country’s infrastructure, including its health service, virtually destroyed. Life went to the Central African Republic to find out how this humanitarian crisis is holding back the country’s development and to see what, if anything, could be done about it.

Charlene is fighting for her life with meningitis or malaria. Her chances are slim. Infant mortality rates in the Central African Republic are among the highest in the world. Even if Charlene survives, she’ll struggle to reach five. If she makes it that far, she’ll probably live only until her 39th birthday.

poorest countriesOne of the poorest countries in Africa, the Central African Republic is struggling to avoid economic and social chaos. The country is one of the least developed countries in the world and certainly one of the poorest. Few people there live beyond 40, 13 per cent of children die in infancy and only a third of the population has access to safe drinking water. The recently political turmoil, the looting and the fighting have left the health service virtually destroyed. Pleas for help to the international community have been ignored.

Life interviewed the President, François Bozize, who confirms that health is the country’s top priority: ‘Health is a priority for the Central African Republic’s development and its future. And in order to do this we have made enormous efforts to ensure that the Ministry of Health’s budget accounts for between 15 and 20 per cent of the national budget.’

Minister of HealthAlthough the Minister of Health says the current figure is nearer 5 per cent, it is still higher than the percentage allocated by most poor countries – but the present situation is desperate: there is just one hospital bed for every one thousand people and one nurse to every 8,000 people. At the Community Hospital in the centre of Bangui, the capital, the newly appointed Minister of Health, Dr Lea Koyassoum Doumta, is touring the wards to get an idea of the grim task she has taken on. In the developed world, the lifetime risk of women dying in pregnancy or childbirth is one in two thousand eight hundred. In Sub-Saharan Africa, it’s one in 16. But at this hospital, unfortunately, the figure is much worse. Around 600 babies are born here every month, but 90 mothers – around one in seven – die giving birth.

The hospital is in a terrible state. The main waste incinerator hasn’t worked for years and the water treatment plant has completely fouled up. Apart from becoming a breeding ground for mosquitoes, which carry malaria and yellow-fever, the contaminated water in the system is leaking. Repairs will cost around $12,000 but the limited funds available have to pay for emergencies. Most patients have no money for medicines. Doctors are rarely paid and when they do it’s money they’ve been owed for years. It’s a vicious circle.

The Minister of Health continues her journey. She’s travelled a hundred kilometres outside Bangui, accompanied by members of the World Health Organization – one of the few agencies operating in the Central African Republic. They’re visiting a hospital at Damara an area close to the border with Congo. Here, just one doctor, Doctor Bagaza Barthelemy, is responsible for 29,000 people. Assisted by a handful of nurses and midwives, he delivers 25 babies a month and deals with dozens of cases of ectopic pregnancies and other serious gynaecological problems. Many are the victims and survivors of an almost institutionalised policy of rape by the marauding armies which tore the country apart during the last coup in 2003. One of them, Marie-Therese, describes what happened to her when the Banyumalenge militia came: “When the Banyamulenge came, my husband had gone to Bangui and they came – there were 12 of them who broke into the house and they all raped me and I fainted and lost consciousness.” Many of his women patients have been abandoned by their families and must eke out an existence selling cheap alcohol at the side of the road and many still have their children to care for.

Many of the CAR’s problems could be solved by money. But appeals for aid have fallen largely on deaf ears. Only a handful of aid agencies continue to work there and the amount of aid it gets is pitiful compared to other sub-Saharan countries. In 2003 it got just 12.9 US dollars per person. Other countries at the bottom of the UN’s poverty scale got much more. Chad got $28.8, Niger got $38.5.

President BozizeIt was hoped that things would change when President Bozize kept his promise and held democratic elections in May 2005. He was duly elected president with 64% of the vote in the second round. Bozize has pledged to restore the country’s national unity and security, but despite all this, foreign governments have been slow to respond to his repeated requests for assistance and support. He complains:

‘In effect help from the international community is not as forthcoming as we expected. We believed that after the return of a legal constitution, the support would be general, ongoing and substantial. But alas it is slow in coming.’

To make matters worse, recent heavy rains brought serious flooding to parts of the country and around 25,000 peoples lost their homes. In response the United Nations authorised emergency aid of US$ 18,000 dollars – less than a dollar for every victim. Now there’s a real risk of serious disease like typhoid and cholera – all of which add an even greater burden to the country’s buckling health system. As WHO spokesman Dr David Nabarro puts it: ‘We were talking about the problems in Niger for well after a year after the locust invasion which swept through the Sahel and decimated crops, but the money only came for operations in Niger when TV pictures of terrible suffering were being broadcast. And it’s such a frustration that we have often have to wait for the catastrophe to get the money we really need.’


For information on the Central African Republic (CAR), see the CIA World Factbook and the US State Dept. Other sources include the BBC Country Profile, and Lonely Planet.

Read the World Bank country profile, the International Monetary Fund, WHO’s pages, and Unicef’s At a Glance. The Safe Motherhood Initiative is here.

General news in English on CAR is available at, and in French at Sangonet, and

And here is President Bozize’s official website.


Films in this series

Life | Back in Business

Eleven years of civil war between 1991 and 2002 left Sierra Leone in ruins. ...
Life | Cash Flow Fever

Worldwide, an estimated 200 billion dollars goes to developing countries ev ...
Life | Collision Course

Every year one and a quarter million people die and more than fifty million ...
Life | For Richer, For Poorer

Life assesses the changes made by Brazil's worker president, Lula. ...
Life | Kill or Cure?

Investigates the issues surrounding access to cheap drugs in the developing ...
Life | Killing Poverty

Assesses the record of Kenya's Kibaki government in controlling corruption. ...
Life | Kosovo: A House Still Divided?

Continuing attempts to clarify land and property rights seized during the c ...
Life | Roma Rights

Roma communities in Europe have been subjected to centuries of persecution ...
Life | School’s Out

Why desperately poor people in Nigeria are choosing to pay for their childr ...
Life | Srebrenica: Looking for Justice

Examines the long and painful process of identifying the many thousands of ...
Life | The Donor Circus

Zambia, southern Africa, is one of the poorest countries in the world, wher ...
Life | The Great Health Service Swindle

Investigates why health care professionals leave developing countries to wo ...
Life | The Silent Crisis

Explores developing issues in the extremely poor Central African Republic. ...
Life | Trouble in Paradise

For tourists, the Maldives are a paradise on earth. But in December 2004 th ...