The Central African Republic - Still waiting for action

摘要

Certain contexts test the effectiveness of current global health funding mechanisms and personnel to the limit, and beyond. The Central African Republic (CAR), where last week the UN raised the risk of genocide, is one horrendous example. Since the ousting of the government in March, 2013, violence by armed forces has escalated into rapes and killings of civilians, burning of villages, and targeting of medical workers. There are around 400000 internally displaced people, and more than 200000 refugees in neighbouring countries, most with limited access to water, sanitation, and health care. The displacement has caused widespread food insecurity and risk of malnutrition. Most international organisations left CAR or immediately withdrew to the capital, Bangui. Yet the country is also suffering a chronic health crisis. It has the world's second lowest life expectancy—48 years. Malaria is the major killer, and HIV prevalence is the highest in central Africa (4-9%)- Rural health services have few qualified staff, frequent drug shortages, and patients must pay high out-of-pocket costs.