In the Central African Republic the words "Tongo Tongo" can bring a deathly silence to any conversation. They translate from the local Zande dialect as "those who come early", but to people living in Rafai, in the remote south-east of the country, it means only one thing: the Lord's Resistance Army.
For more than two decades, Joseph Kony and his Lord's Resistance Army (LRA) have wreaked havoc across central and eastern Africa. Driven out of Uganda they have all but lost their original purpose of protecting the interests of the marginalised Acholi tribe and instead have scattered themselves across a vast region of the Central African Republic, the Democratic Republic of Congo and South Sudan, recruiting fighters, kidnapping children and raping as they go.
A European Union security source confirmed last week that Kony and his fighters are believed to be hiding and regrouping in the forests of Vovodo, just north of Rafai. The International Criminal Court has a warrant against Kony, and this week US troops arrived to support Ugandan forces hunting him and his group.
Few organisations would choose to set themselves up in the backyard of one of the world's most notorious rebel leaders. But the medical relief charity Merlin, which The IoS has chosen for this year's appeal, has been working in the Central African Republic for the last four years, trying to resurrect government clinics that have been all but abandoned.
Christine Dabai, 15, was able to get urgent medical attention from Merlin after she escaped the LRA in August this year. She was captured 30 miles from Rafai in February, tied up and marched for weeks into the forest. When she arrived at an LRA camp she was forced to become a sex slave to one of the militia's elderly leaders. "He locked me inside and made me have sex with him four times a day," she recalls, unable to look up. "If I refused he would beat me."
For months she was locked away, only able to leave the hut to go to the toilet. One day she was sent to find yams as a punishment and managed to escape. When she emerged from the forest she was found by Ugandan troops posted in the country and brought to Rafai. Thanks to Merlin she was able to get emergency treatment for her wounds and sexually transmitted infections, including chlamydia and gonorrhoea.
The Central African Republic is one of the riskiest places on earth in which to provide healthcare. It is also among the most in need of it. Fewer than 30 per cent of the population have access to health services and four out of five people live more than 10km from the nearest health centre. Life expectancy fell from 52 to 48 between 1990 and 2007, and only 6.8 per cent of children under one receive all the vaccinations they need.
Merlin is the only major British charity operating in the Central African Republic. Maria Wangechi, the charity's director in the country, attributes this to a belief that the country is beyond help. "This is a forgotten crisis and there's a lot of donor fatigue. It's a little Somalia. Donors are tired of the Central African Republic – they see it as hopeless – but we believe we can make a real difference to healthcare here," she said.
Development aid has increased by an average of 181 per cent across sub-Saharan Africa since 1985, but in the Central African Republic it has gone up by only 37 per cent. "It's a desperate situation. What we're talking about is a collapsed health system."
In March this year the only government doctor serving the entire south-east region was killed by the LRA. Stopped by armed gunmen who seized his supply of money and drugs, they shot him and set him on fire in his car. No vaccinations have been delivered in Obo, the regional capital, since then – but Merlin is planning to establish a new clinic there.
In Rafai, Merlin already has a hospital and a health outpost. The charity was the first international organisation to arrive there, a year ago. "Just the name Rafai brought shudders to people," Ms Wangechi recalls. "But we found people there who were waiting for someone to help."
Rafai's population has more than doubled in the last year after the arrival of thousands of people whose villages had been destroyed by the LRA. Now some 10,000 people live in the remote town previously served only by a dirty hospital with no qualified staff. To get to Merlin's field hospital and accommodation you have to cross the Chinko River using a decrepit 1940s ferry that constantly breaks down and does not operate at night. If the LRA attacks, everyone – including Merlin's staff – is trapped by the river. Getting drugs and supplies through is also a struggle.
The national army offers scant protection. This sparsely populated, landlocked country is home to four million people, scattered in vulnerable remote towns and villages. The 6,000-strong force, including cooks and cleaners, reserves half its strength to protect President François Bozizé in the capital, Bangui. Mr Bozizé seized power in 2003 in a coup, and is paranoid that rebel groups will oust him. The remaining 3,000 troops are unable to exert any control on a country that is bigger than France.
The republic is bordered by some of Africa's most notorious trouble spots, including Darfur, South Sudan, the Democratic Republic of Congo and Chad, and its unpoliced forests have become a home for disaffected rebel groups from across the region. The UN estimates that at least 10 armed groups operate, including home-grown rebels. Their bellicosity has forced more than 100,000 from their homes into temporary camps. In the south-east, it is the LRA fighters that are most feared.
Rafai is littered with child survivors of LRA captivity, many too traumatised to return to normal life. Mongui Fabrice, 15, is one of 24 people, mostly children, whom the LRA took during a raid late last year. He was beaten with machetes and made to carry sacks of food for hundreds of miles.
Today he sits with two other LRA child survivors in an outdoor chapel in the centre of Rafai. He pulls and twists his fingers until he winces with pain as he brings back the bad memories. "I was taken with my younger brother and we were all tied together with rope ... after a week of walking they said my little brother wasn't walking fast enough so they killed him. Then they told me to go and sit on my brother's dead body."
A week later he arrived at their camp, where he stayed for four months before being able to escape when sent on an errand. Next to Mongui is his seven-year-old half-sister, Tibemboli Florida. She was found abandoned, paralysed by fear. Now she barely speaks, silently wringing her hands like her older brother. Not everyone was lucky enough to escape, though. Piki Eduard, 66, had two of his seven children taken in an attack in Agoumar, near Rafai, last July. His 14-year-old daughter, Djabinza Nadine, and his 11-year-old son, Bakoumbazanga Benjamin, are still missing. "I think my children are both still with the rebels in the forest. I'm very worried about them. There's nothing I can do."
But at least Merlin's presence in Rafai means families there may be able to avoid preventable deaths. The country's main cause of death for children under five is malaria, which accounts for 28 per cent of all deaths in that age group. Merlin hopes to bring this down by ensuring that the government clinics are staffed by trained nurses and doctors.
Jeanne Dagolia's baby, Fatrane Faustin, was nearly killed by the LRA. His 25-year-old mother was holding Fatrane when the fighters came. They snatched him and threw him into a stream. "I thought my son was dead," she recalls. Unknown to her, a villager heard him crying and rescued him half-drowned. The only sign of his ordeal today is a scar across his forehead where it hit a rock.
But now he faces death at the hands of another killer: malaria. Fatrane, who is now three, is lying in the family's thatched hut, sweating with fever.
Dr Pekezou Tchoffo Aurelien, medical co-ordinator for Merlin, takes Fatrane to the charity's health outpost at Agoumar. He checks his racing heartbeat and temperature, quickly diagnoses malaria and gives him some drugs. "Now he'll be fine. Even by tomorrow you'll see the difference," he reassures Jeanne.
Fatrane's first escape from death was miraculous; his second will be down to something far more prosaic: basic healthcare.
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