Central African Republic
Information last updated: 24 April, 2020
Temporary closure of schools, bars, airport and bans on gathering of more than 15 people (with no set end date). Despite low infections reported in the country, and no casualties reported yet, the Central African Republic remains as one of the world’s most fragile countries to deal with Covid-19.
- Percentage of cases treated in hospitals : 27% (on April 11).
Response set up and capacity
The government, and particularly the Ministry of Health and Population, is officially in charge of responding and coordinating the response. However, three-quarters of CAR’s total territory are rebel-controlled areas where the government’s power to impose coronavirus containment measures is practically non-existent.
The capacity of the public health system is extremely weak – with lack of qualified personnel, testing and medical equipment – and is very dependent on external aid.
Entities / Organizations
• The president of CAR and the government, in particular the Ministry of Health and Population, are officially in charge of responding and coordinating the response
• Institut Pasteur de Bangui: WHO reference laboratory
• Hôpital de l’Amitié : Unique treatment center in Bangui
• Armed groups that control large swathes of territory
• National Emergency Public Health Response Center (COUSP) including members of the Health cluster (including WHO, UNICEF, UNOCHA, and large-scale NGOs such as International Federation of the Red Cross, Médecins sans Frontières (MSF), etc.)
• Other active UN agencies: MINUSCA, WFP, UNDP
• Civil society groups and NGOs at regional, national and local levels
• International donors such as the World Bank or IMF
Mitigating factors - What is being done?
- March 19: Following the discovery of the first case, restrictive measures were prescribed by the Government including the self-quarantine of all travelers from areas with local transmission.
- March 26: The Government strengthened prevention measures, that are to date, still enforced. These include the closure of schools, universities, bars and places of worship, the closure of the airport (with several exceptions such as for humanitarian or cargo flights) and restriction of internal travels, a ban on any gathering of more than 15 people and the extension of the self-quarantine period from 14 to 21 days. Alongside these measures, foreign travellers with previous travel to countries with local transmission are banned from entry.
Recently published photos show people crowded in markets and congregating inside bars that, from the outside, purport to be closed.
Other national measures that have been put in place include the establishment of a WHO-supported National Emergency Cell, with six commissions related to COVID-19. In addition, communication efforts from the government and nonprofit organizations are being scaled up, including through a radio and television network, leaflets and brochures, messages on social networks and a call center in charge of disseminating barrier gestures by SMS. Nevertheless, WHO have announced an insufficient production of awareness-raising materials. A programme to counter misinformation and rumors is also being rolled out.
With regards to international humanitarian response, it estimated that 401 million would be required for the humanitarian response plan in 2020. In March, 68.4 million had already been mobilized, representing 17% of the funds. Furthermore, the UN launched on March 25 a global appeal to urgently raise $2 billion to fund humanitarian assistance in the most at-risk countries, including the Central African Republic.
Risks, vulnerabilities, obstacles
- According to OCHA, CAR is one of the least prepared countries to face a COVID-19 outbreak, i.e. it ranks 8 out of 54 African countries in terms of vulnerability. It is at high risk for severe outbreaks and exhibits multiple layers of vulnerability including:
- Weak Health System: CAR scores 5 on a 1 to 5 scale, with 1 representing less risk and 5 most risk, There are only three ventilation kits, one oxygen concentrator and one dedicated COVID-19 treatment center with just 14 beds available for a population of almost five million. Furthermore, only 100 tests have been made available in late March, rendering visible the lack of testing equipment. The lack of qualified personnel, proper waste disposal and hygiene equipment systems are also notable. Last, 70% of health services are provided by aid organisations, which are threatened by ruptures and stock-outs and a backlash against foreigners.
- Conflict: Three-quarters of CAR’s total territory are rebel-controlled areas where the government’s power to impose coronavirus containment measures is practically non-existent. UN peacekeeping force has now suspended most internal travel and stopped rotating in new contingents which could undermine security in the country.
- Existing measles epidemic: CAR declared a measles epidemic in January 2020. More than 15,000 new cases of measles, including 66 deaths, were reported between 1 January and 5 April 2020.
- Economic vulnerability: The supply of food and non-food items is highly dependent on external provision. The suspension of most international flights and the closure of Cameroon’s border could have a devastating impact on the overall availability of supplies on the market and generate price speculation.
- Population health vulnerabilities: About 700 000 internally displaced persons with half living in densely populated camps, have poor access to water, sanitation or hygiene. 2.6 million people are in need of humanitarian aid (including 1.7 million in acute need and 2.2 million in need of health assistance), and more than 1.6 M people are affected by food insecurity. 7/10 people in CAR do not have access to safe drinking water
- Infected and vulnerable neighbouring countries: CAR is part of the 24 out of 30 most vulnerable African countries that form a disease hot spot belt (see Figure below), i.e. where COVID-19 could easily spread across borders. As of April 23, 1,163 infections were registered in neighbouring Cameroon to the west and 359 in the Democratic Republic of the Congo to the south.
Potential actions and demands
WHO recommendations include:
- Reinforce the equipment of the treatment center: “Hôpital de l’Amitié”
- Build and equip another COVID-19 case treatment center in Bangui
- Rehabilitate, create new and equip isolation centers.
- Appoint a person responsible for epidemiological surveillance at points of entry within the Ministry of Health
- Train additional rapid response and contact follow-up teams
- Train and equip laboratory technicians in district hospitals and similar institutions to collect, store and transmit samples from suspected COVID-19 cases
- Revise collection tools; etc.
WASH and prevention
- Filling gaps in personal protection equipment
- Improving access to water and soap, especially in areas affected by the humanitarian crisis
- Placing hand-washing facilities in health facilities, IDP sites and entry points; etc.
- Strengthen the capacities of the Emergency Line
- Carry out perception surveys on COVID-19
- Strengthen the capacities of community media within the country
- Decentralize activities in districts outside Bangui.
In addition, in CAR, many communities live outside of government supervision and face entirely different social and environmental circumstances to each other. Therefore, some observers suggest that local communities should be consulted to find locally-suitable versions of transmission control.
Contributor(s): Inès Biette.