In another report on the impact of the worldwide pandemic, Taylor Edgar looks at the battle for survival in the Central African Republic

The COVID-19 pandemic has the potential to heap one humanitarian crisis on top of another in the Central African Republic, one of the world’s poorest countries, it is feared.

World Health Organization coordinator, Marie-Roseline Daryncka Belizaire is worried that what limited resources CAR has will be quickly overwhelmed by a widespread Covid-19 outbreak.

Speaking from the capital, Bangui where she is working closely with the country’s top government officials, Marie-Roseline told welovestornoway: “CAR is a country with an underfinanced and protracted humanitarian crisis. I am worried that now we might forget about those crises only to concentrate energies and resources on COVID-19. We could have more people dying from malaria, HIV, malnutrition, gender-based violence, and maternal deaths than people dying with COVID-19 if the focus is not on those threats any more. I am not sure the country can keep the focus on them all at the same time. On the other hand, if the ongoing humanitarian crisis was not totally financed, what could make us believe that the COVID-19 would be?”

In a country with only three ventilators for a population of around 4.6 million, a COVID-19 outbreak can wipe out untold numbers of people. Given its infrastructure, weak healthcare system and recent history of conflict, it is unsurprising that the Central African Republic is anxious to keep a lid on COVID-19.

Explains Marie-Roseline: “The country is in a post-conflict slow recovery process. CAR is a very vulnerable country with a weak health system. The biggest challenge is human and material resources. There is a lack of health infrastructures and health workers in quantity and quality. COVID-19 is a new disease; it will take time to train health workers to respond adequately and to have all the material to cover the population needs.”

As of April 27, there are 50 COVID-19 infections, 37 coming from outside the country and 13 being local transmission cases. Ten patients have recovered, and there have been no deaths. 40 patients remain in hospital, while some 1812 tests have been carried out.

Comments Marie-Roseline: “Most of the cases have been treated in the established COVID-19 treatment centre. The surveillance system is in place and being improved every day. The community is involved at all levels. All sectors are involved in the response under the Ministry of Health’s leadership.”

The response to COVID-19 in CAR is very much a juggling act, with many local factors further complicating an already complex challenge. Among these are poverty, an economic downturn, the country’s informal economy and day-to-day livelihood earning. In addition to the weak health system and low levels of education, CAR is also struggling with an internally displaced population, refugees, and a 15-49 demographic where 1 in 25 are HIV-positive.

As if that is not enough to contend with, malaria and diarrhoeal diseases are significant causes of childhood illness, the maternal mortality rate is the second-highest in the world, a considerable number of children are homeless, and generally, there is a lack of sanitation and access to water.

]“The humanitarian response plan was less than half-funded, with a budget gap of around US$268 million. The COVID-19 is a humanitarian crisis in a protracted humanitarian crisis,” warns Marie-Roseline.

Despite the scale of the problems and infrastructure challenges, Marie-Roseline remains positive. At political and strategic levels there has been a well-organised response to COVID-19, she reports.

A ‘crisis cell’ is convened by the Republic’s President while a strategic committee, run by the Prime Minister with input from all partners and embassies, meets twice a week.

The Minister of Health is on point and meets every day with government ministries and partners such as WHO, the Work Bank, and others to set the course. The centralised response is backed by local initiatives at regional and district levels to implement measures being put in place to combat COVID-19.

“We can see some very interesting initiatives, for example, young people helping to maintain social distance at the ‘points of water’ or in the street markets. Local industry has provided hydro-alcoholic solution, and local banks are supporting the response financially,” says Marie-Roseline.

Asked if she ever feels overwhelmed by events in this vulnerable African nation, Marie-Roseline replies: “I feel very comfortable working in CAR so far. There are a lot of similarities with my home country (Haiti) and also with the North Kivu province in the Democratic Republic of Congo. It has been a big switch from Ebola after 20 months. It’s an opportunity to apply some lessons learned from Ebola but without copy-paste.”

She goes on: “I am working for the most wonderful organisation in the world whose mission is to save lives, and I have embraced this since the first day. So my mission is to serve the most vulnerable, regardless of their religion, social class, race, by leaving no one behind. While there are people in need of my help, I will keep going wherever this mission might drive me in the world.”

Looking ahead, the Haiti-born WHO coordinator feels the world will change post-COVID-19. There will be changes in how people treat one another. And a realisation that we have the same human rights no matter our race, religion, nationality or living conditions.

Marie-Roseline hopes, too, that there will be a renewed priority given to long term investment in public health.  “COVID-19 has revealed the incapacity of countries to deal with pandemic and the need to reinforce the health system as a whole. The International Health Regulations should be implemented with a systematic periodical review. Sciences and evidence-based strategies should lead decision-making processes,” she comments. Wise words, but hopefully not too late for the Central African Republic.

About the Central African Republic and Marie-Roseline

The landlocked country in Central Africa has a landmass of 620,000 square kilometres and an estimated population of around 4.7 million. By comparison, Scotland extends to 80,240 and is home to 5.5 million.  The Central African Republic, a French colony until 1960, has been waging a civil war on and off for the past 16 years. It is one of the world’s poorest countries, and in 2019 ranked 188th out of 189 countries in the Human Development Index.

The Central African Republic also has the dubious titles of being the unhealthiest country in the world as well as the worst country for young people.

Marie-Roseline was born in Jereme, Haiti and trained in medicine in Cuba. She holds a clinical specialisation in family medicine, and four Masters degrees in Science, public health and epidemiology. She is currently studying for an MBA and a PhD in Epidemiology and Public Health. The latter is currently on hold firstly due to Ebola and now COVID-19.

She is an internationally recognised expert in public health with 14 years experience and joined the World Health Organization in 2015.

In CAR, her day begins early at 7 am with an orientation meeting with her team before the daily strategic meeting with government ministers and partners. By 9.30 am her and her team begin field visit supervision at treatment centres. They supervise investigations, contact tracing, points of entry, and training of staff to ensure everything is running smoothly and resolving obstacles.

At 4 pm, she has meetings with teams coming back from the field, putting the data together and carrying out analysis.

At 5 pm, there is the daily coordination meeting, followed at 6 pm by a debriefing with the Health Minister and WHO representative to review the day and planning for the next one. Marie-Roseline gets home at 8 pm and spends an hour catching up with family before drafting the daily report and being updated by data managers and the laboratory on test results.

At 10 pm, she then spends time reading up on the latest COVID-19 information from around the world. Finally, she makes it to bed between midnight and 1 am.