Door-to-door brutality in the Central African Republic's civil war

A doctor with Médecins Sans Frontières describes the desperate plight of people driven from their homes by violence and fear

The conflict between Muslim rebels and Christian militias in the Central African Republic has claimed hundreds of lives and forced more than a million to flee their homes. Natalie Roberts, an emergency doctor with Médecins Sans Frontières (Doctors Without Borders), experienced the mass evacuations and door-to-door killings near Bozoum, in the west of the country.

As soon as I got off the plane I was told that there had been a mass casualty event and they needed me at the hospital. Every house on the way had been burnt during a wave of violence that had swept through the north-west in December, January and February. There had been so many rumours and so much fear that everyone had fled.

We drove quickly into town, not sure what we would find. At the hospital, I was taken to the sickest patient, a man who had been shot. At the time, there were five or six patients. The team told me that they needed to bring the Muslim patients to the hospital: they had not come in because they were too afraid they would be attacked. About an hour later, 18 patients arrived at once.

There were lots of shrapnel injuries from a grenade that had been thrown into the Muslim quarter and gunshot wounds from the shooting that followed.

We had to make a difficult decision about one patient. He had a bullet wound to the groin that had gone through his femoral artery. He wouldn't have survived an operation or a transfer. We hoped that he would live for a couple of days and would clot, so we gave him six units of blood, which was difficult without a blood bank, but he died overnight.

In the Central African Republic, people commemorate the dead overnight with drums. The funeral ground in Bozoum is close to the hospital, so, when you have a death there, the drums don't let you forget that someone has died.

It became clear that people were preparing to leave the Muslim quarter; belongings were piled on the streets.

News had come that a convoy would take people to Chad. Most had lived their whole lives in Bozoum; they had businesses, houses, families and a community there.

About 3,000 people boarded 14 trucks. It was hot, and a seven-hour journey to the border. Although they had an armed escort, it wouldn't stop them coming under attack. There was nothing our team could do. An entire community had been devastated. We knew the same thing was happening across the region.

I left Bozoum soon after. We had to get into the countryside – people were too scared to come to us. Everyone had fled their homes, many of which had been burnt, so they were living in the fields or bush, sleeping on the ground or under trees. Without village wells, they often had to drink from puddles or river water.

Every health post was in a bad state; medicines had been burnt or looted. We heard that people were dying in the bush. In those first few weeks, we felt scared at times, there was still so much violence happening. We would hear rumours and, the next day, go to a village only to find houses still alight.

The attacks were door-to-door. People don't have sophisticated weapons, it is personal violence. It got better as time went on but, at one point, everybody on the street carried some form of weapon. Even small children of six or seven walked around with machetes.

People in the Central African Republic have guns and machetes because many live in the bush and even in the towns they work in fields. It doesn't take much for these to be adapted to the war environment.

Tensions rise and everybody is afraid.

We saw machete or bullet wounds, which get dirty and infected. We saw a lot of patients who had been beaten: you can kill someone with a stick.

Often, people would not tell you how their injuries had happened. I've seen the results of bombs and other, more mechanised violence, but the brutality of face-to-face violence is difficult to handle.

Everybody would tell you who they had lost. In one village, 23 had died in an attack and, a month on, those left were still reliving it.

It is almost impossible to see how and when this desperate situation will end. Violence has affected the whole country. The work of small clinics makes small differences but, together, it adds up to so much more.

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