Delphine CHEDORGE from MSF speaks about Central African Republic

'A patient was killed and hospital staff were beaten trying to protect him'

Delphine Chedorge, MSF’s head of mission, talks about the challenges of delivering medical aid in Central African Republic

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Medecins Sans Frontieres, Doctors without Borders, give medical assistance in some of the most challenging situations in the world. Photograph: Jerome Delay/AP

Since the ousting of President Bozize in March 2013, Central African Republic has been more unstable than ever. A Séléka Muslim rebel coalition seized power, leading to killings and lootings met by revenge attacks from the anti-balaka (anti-machete) Christian militia. The country is experiencing widespread sectarian violence and the UN warned that “seeds of genocide” were being sown against Muslims. An African-led and French-backed peacekeeping force known as MISCA was taken over by the UN in September.

What is it like working in a country experiencing conflict?

There is no work, there is no money. It’s the poorest country in the world and the violence is something you experience every day. This year there has not been a single day without a national colleague saying things like: “My house has been robbed again. My brother has been killed. My sister was sick and died because she couldn’t go to hospital.” They are afraid every night and every day. I saw my Muslim colleagues, who I’ve known since 2007, leaving the country in January. It’s very difficult for everybody here.

Does this affect your work?

We do what we can with our national colleagues but I can see in their eyes that they are tired. They try to understand why their country is not functioning, why they cannot live in peace, and what the international community is doing. They ask me: “What can we do?” This is the reality we face when there are barricades and they cannot come to work. But they try their best; they stay and sleep in the hospital or they sleep at home with us.

Psychologically it’s probably something we should investigate more, especially for the medical staff; how they cope with violence when they take care of other people. They are victims as well. It’s becoming so common.

Have any of your colleagues been attacked at work?

It has happened several times, especially in December and January, that armed men have tried to come into the hospital. In Carnot, one of our patients was killed in front of us in the hospital and the medical staff were beaten trying to protect him.

Why was the patient killed?

Because he was Muslim. The same day, we had another Muslim guy in our hospital who had a small wound after being lynched. We were taking this man back to the church where Muslims are living as refugees, but the anti-balaka had been fighting MISCA peacekeepers nearby and when one anti-balaka was killed, people chose to get revenge on the patient – they jumped on the car and pulled him out. The medical staff and the driver tried to protect him, but they were pushed back. The guys killed the patient because he was a Muslim passing by. He was just the enemy of the day. The country is not functioning so people become crazy and they try to find one enemy. That day it was this one.

Has your car ever been attacked?

No, but I remember in January we were trying to rescue some wounded from the Muslim enclave in Bangi – there were anti-balaka throwing grenades. People were calling us saying: “We have two children wounded, please come to take them.” When we arrived at the enclave there was a barricade set up by anti-balaka. When they see your car passing it’s very tense. They said: “You white people, you are bringing problems here. You are helping Muslims so you are enemies.” At this moment you think: “Okay, we should just do a u-turn now and say that we cannot take the children.”

Do you ever want to give up and go home?

Yes. At some point we just get tired. To continue the job and be helpful for your colleagues and your patients, you need to be full of energy and have a clear mind. To be far from home for a long time, to be exposed to the violence for a long time, at some point you need a break.

What is it like being back home?

We feel empty. It’s very difficult to share the experience, to share what you have done with family, because you want to protect them and not to tell them everything. You realise that each time you start to tell the story to your family or friends they listen for five minutes then they speak about something else. You feel alone sometimes.

Do you ever see real change from the work you have done?

We know from the beginning that we are not changing the world. The benefit has to be to the patient. If we help the person, voila. That’s what we want. Of course we can say: “We treated 5000 people; these were the wounded we took care of,” but we are just coping with this war, and helping as many individuals as we can.

When do you think you will stop being an aid worker?

In December I told my boss: “I want to go to Central African Republic because I love this country, I know this country and I am so sad for this country. But I think this will be my last mission.” I am tired and I need a break, but I’m very unsure about what I will be able to do in France now. I will study first and then I will see what I need or want to do. My nephews are now eight and 10 years old. I like to see them growing up. That’s becoming more important now.

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Back to France, and gone again

Wow.  More than 2 months since I updated this site.  Sorry.  I finally abandoned my refusal to get onto a Facebook account, and I forgot this blog for a while.

After the escape of our lady hostage, my workload picked up quite a bit, spending time with her as well as with the families of the 3 men still missing.

I left Congo on 9 November, going to Paris for debriefings.  I stayed in Paris for 2 weeks for an internal training course, Field Oriented Operational Training.  This should allow me to be the coordinator of an entire project in the near future.   After 9 years of finance and human resources, I am ready for a change.

I then had a little over 3 weeks of vacation.  Most of that time was at home in Lyon, but I also made a 

4 day trip to Bucharest, Romania - the flight is cheap.  The city center is beautiful, although the rest of the city consists of soviet-style apartment blocks.  I walked a lot, visited a couple of museaums, It was a good trip.

My vacation was good.  Other than my trip to Bucharest, I stayed pretty quiet.  And I totally disconnected from my job with the crises cell for the kidnapped Congolese staff members.  The weather was exceptionally warm for November, so I did a lot of walking in the city, sometimes up to 5 hours at a time.  Good food, good wine, good companionship.  But at the end, I was getting bored.  

Now I am on the return trip to Congo.  I had briefings in Paris today.  A lot has been happening during my 6 weeks away, in the North Kivu in general, and also in MSF there.  And things will continue to move when I arrive.  Never a dull moment.

I will be in Congo for Christmas.  I love Christmas in the field.  I have loaded up on gifts for the families I look after (3 women and 11 children!) and for the other expatriates living in the house with me (up to 12), plus some Christmas food.  They are inexpensive gifts – I couldn’t do otherwise – but I love playing Father Christmas.  Ho ho ho.

I should be staying there until the beginning of February.  Seeing how I hate cold weather, I might have to find a way to extend my trip until spring………..

Press Release from MSF

September 1 press release

DRC - North Kivu

After the escape of one of our abducted colleagues, MSF asks for help to find the three other members of our team who were taken more than a year ago.

On Friday, April 29, Chantal, one of the four members of the MSF team abducted in North Kivu, was found unharmed. However, MSF remains with no news about our colleagues Philippe, Richard, and Romy more than 13 months after they disappeared. We continue our search and issue a new call to anyone who may be in a position to help with their release.

MSF members were deeply moved and delighted to learn of the escape of Chantal Kaghoma Vulinzole, who was kidnaped with three of her colleagues on July 11, 2013 during an attack on Kamango, blamed on the ADF-NALU. Chantal, a nurse originally from Goma, was a member of the emergency team that disappeared during a mission to evaluate the health facilities in Beni Territory. 

After more than 13 months of captivity under difficult conditions, Chantal was able to flee and reach troops, taking advantage of military operations in the bush against the ADF-NALU. Our colleague was found, weak and thin, on Friday and was returned safely to Beni by Congolese armed forces.

“It is an immense relief for her family, her friends and all of her colleagues to know that she is alive and with us again,” said Mégo Terzian, President of MSF. “We also want to believe that our three other colleagues - about whom we have no information - will also return. We are thinking of their families and of all the hostages. We will not forget you." 

We have been unable to establish contact with the three other members of our Congolese team, despite our efforts, resources mobilized, and the trails we have followed in the DRC and neighboring countries. “Chantal was separated from her three colleagues and was no longer in contact with them when she escaped,” explained Benoît Leduc, crisis cell coordinator in Paris. “Our search continues, with the ADF group now dispersed and, probably, disorganized.” 

Over time, a series of doors has opened and closed but we have been unable to obtain proof of life or direct access to those holding our colleagues. “People are willing to help us, but each time we seem to be close, our contacts report a last-minute obstacle or the people who might have the power to free the hostages do an about-face,” said Leduc.

More than one year after our colleagues disappeared, MSF is thrilled that Chantal has returned. We continue our efforts to find Philippe, Richard, and Romy. Given the difficulties we have encountered, MSF calls for help from anyone with information on our team members or who can help us establish contact with them. To save the lives of all the hostages and ease their families’ pain, MSF is issuing a call for assistance and asks those holding the hostages to release them immediately.

Chantal, hostage MSF, is free

Hurray!  Here is the translation of an article  from yesterday:

*********************

RFI Radio 30 August 2014 :

Democratic Republic of Congo: Chantal, an employee of MSF and hostage for over a year, is finally free.

Chantal, one of four members of Doctors Without Borders held hostage since July 2013 in the Democratic Republic of Congo, has regained her freedom after fourteen months in the hands of the Ugandan rebel group ADF-Nalu, an ultra-violent group that has terrorized civilians in North Kivu for several years.

The young nurse, originally from Goma, is currently in the military camp of Beni under the protection of the Congolese army.  However, MSF has still no news of her three colleagues abducted the same day  in Kamango where they were on a mission.

It was around 23 pm Friday night that Chantal's husband heard the news during a brief phone conversation with his wife.  According to the few who have seen her since, Chantal is certainly safe and sound, but thin and still very shocked by her fourteen months in detention.

Benoit Leduc leads the Crisis MSF for the Democratic Republic of Congo. He has been fighting since July 2013 for the release of these four employees.   « The release of Chantal is very, very good news. » he says.  «  In saying this, I do not forget our three other colleagues for whom we have very little news. It is believed that they are being held in separate groups.  So Chantal was not in direct contact with our colleagues when she was released.  Our search continues, and we think of them and their families, but also all the other civilians who have been kidnapped in the region of Beni. »

A military collision facilitated the escape

According to Kinshasa, it was a skirmish between the army and a small group of ADF-Nalu wandering in the forest that allowed this young woman of thirty years old to escape.

Very little information has filtered through concerning the conditions of her detention. « As a nurse, she cared for the rebels.  It was through this that she stayed alive. » says the spokesman of the Congolese government.

Between 600 and 800 civilians, according to sources, are still held by the ADF-Nalu who continue to rage through eastern DRC. Since the launch of the operation Sokola ("Cleansing" in Lingala) in January against the Ugandan rebels, more than 160 people have been released.

***********************************

So now, I am scrambling to get everything set up for her return here to Goma, hopefully in a stressless environment.  This is good work!  I will also be spending a lot of time with the families of the 3 men who are still missing, assuring these families that we are continuing our search for them as intensively as before.

Happy, happy, happy!

Uganda, Philippines, Congo

I enjoyed my time in Uganda.  I was there for 2 months to bridge a gap between the departure of one coordinator of finance and human resources and the arrival of the new one.  We are in the process of closing an HIV/Aids project (handing it over to another organization after 13 years of running that program) in Arua in the north.  We also have a new program running health centers in refugee camps on the northern border for South Sudanese refugees fleeing the fighting in that country.  This second program continues to grow at an incredible rate.   Currently, there are around 60,000 refugees in the camps. The South Sudanese situation, unfortunately, is not likely to improve in the near future.  Although it is a full day ride to each site, I had the opportunity to get to the projects several times in my 2 months. 

Uganda is a relatively peaceful country in that region of Africa, and it is beautiful. (Photo is the Nile)

The Nile river flows from Lake Victoria to begin its journey through the continent.  There are many national parks, and on my trips to the projects, I saw several species of monkey and baboon, as well as antelopes and elephants.  The capital of Kampala, where I was based, is a safe city and has all the services one could ask for.  Uganda, however, is a very homophobic country (typical in this region) with a new anti-gay law voted into power in February 2014 stipulating life imprisonment for homosexual acts.  Many international donors have cut funding to the country because of this new law.

I handed over to my replacement and returned to France at the end of June.  This was my last assignment under my 2 year contract with MSF’s emergency department.  In those 2 years I worked in 7 different countries:  Mali, South Sudan, Congo, Uganda, Jordan, Turkey (for our Syria project), Central African Republic, with a second tour in Uganda at the end.  I really appreciate the opportunity I had to work with this amazing department.

After debriefings in Paris and a couple of days at home in Lyon, I left on a vacation in the Philippines for 2 weeks.  I had not travelled for pleasure in at least 4 years, and I had a friend I wanted to hook up with there.  It was great, a few misadventures concerning finding my friend along the way.  It was rainy season, so we decided that Philippines’ beautiful beaches were probably not a good idea.  We stayed in Manilla for the 1^st week, staying a few days in a rather luxurious bed and breakfast in an upscale part of the town for 3 days, and roughed it out in some seedier sections of the city before and after.  Then we went to Baguio, “the summer capital of the Philippines” in the mountains for the second week.  My flight took off just before the first big typhoon of the season passed through the area.  Oufff.  It was a great vacation, and just what I needed to get out of my humanitarian mindset.

I had just a few days back in Lyon before leaving for the Democratic Republic of Congo (formerly Zaire) to start my new job, which is part of a small group trying to resolve a crisis for our organization in that country.  On July 11, 2013, four of our Congolese staff members were abducted in the town of Kamango on the border of Uganda during a rebel attack.  MSF has been working ever since to find there whereabouts.  Although we have several indications and contacts, we still have nothing concrete.

My job in this group is primarily to be the focal point for the families of the victims, informing them where we are and providing moral support.  I also do administrative and logistics support to the rest of the group.  As we do not know how long the situation will continue, each of the positions in this group will be working in a tandem configuration.  For example, I will work 2 ½ months, then hand over to my partner for 1 ½ month, then I return, then I hand back over to the same person, and we keep rotating between ourselves until the crisis is over.  This allows us to provide continuity in the flow of information and the contacts, and to avoid starting over with new people every 2-3 months.

Much of what we are doing is confidential, so I will not be talking on here a great deal about the job.  Suffice to say that I am extremely happy to be part of this group, and very happy to be back in RD Congo in the city of Goma (east side of the country at the north point of Lake Kivu on the border with Rwanda), where I stayed 2 years 2008-2010.

Back in Uganda

During my 3 weeks in France, I did nothing but sleep, eat, sleep, drink, sleep.  Did I mention sleep?  I have worked harder in my life than in Central African Republic, but I am no longer 40 or 50 years old (in fact, I just celebrated my 60^th birthday!  I am happy to still be breathing!).  I was dead when I returned. 

After 3 weeks, I returned to Paris to work on the budget for the Central African Republic for 3 days, and then I left for Uganda.  I was here about a year ago for a very short-term project – 3 weeks of preparing a kit for setting up the administrative system in a new project.  It turned out to be necessary – we opened 2 emergency missions since then in the country. This time I am here for 3 months – to fill a gap between 2 longer-term people

Apart from their Neanderthal attitude towards gays  - they just signed a new bill in February making homosexual acts punishable by life in prison - Uganda is a rather developed central African republic – less so than Kenya or Rwanda, but more than Tanzania and much more than the Congos or Central African Republic.  Last year, many of the countries donating to Africa cut way back on their funding to several African countries, including this one.  The signing of the new gay bill has put even more funding into jeopardy.

We have one regular program here in the country, which has been running for 12 years.  As an emergency relief organization, this is pretty rare for us.  The program is an aids and tuberculosis program.  We are in the process of closing this project, handing it back to the Ugandan government, with the funding of Sustain, who gets their money from USAID.  The problem is that we have been planning this handover with them for over a year; the deadline for us to leave is end of April for the Aids program, and end of July for the TB program, including a rather strong cohort of anti-drug resistant cases.  Sustain’s money has still to be unblocked by USAID!  We are strongly worried about the follow-up of our patients.  But we realize that if we stay, the problem will be the same in 1, 2, 3 months.  We get out now and put pressure on USAID to unblock the funds, or this will continue forever.

Our other program for the moment is for around 60,000 South Sudanese refugees in the north of the country.  Yes, the youngest country in the world is now (again) at war with itself.  We are running health centers in 5 camps.   And the conflict is foreseen to continue for several months.  There will probably be a new camp in the near future.  At the moment, there are around 300 new arrivals every day.  The camps are full of women and children – most of the men remain to take care of the livestock and crops, as well as to fight.

 

The Ugandan government has been relatively generous in setting up these camps – giving 30m x 30m to each family, so that they can grow some crops to feed themselves.  But for us, this means many different health centers, so that they are in the proximity of the populations. Our headquarters are concerned about the costs relative to the number of refugees – costs related to the construction of the centers, the staff needed to run them, and the vehicles necessary to transport staff and patients between different sites.

I have been fortunate to be able to visit both projects within my first 2 weeks here.  I have also been unfortunate enough to have to revise the budget for the emergency project in my 2^nd weekend here.  Headquarters were already giving us grief about the costs, and my budget is about 20% higher than the last.  Aieaieaie.  I will not be a popular man in headquarters.

And in the meantime, I am not too popular with the Ugandan tax authorities either.  Due to the reduction in western government donations, they are scrambling to collect taxes from everyone in the country.  We have been honest, but they are making new tax assessments on everyone, including us.  I received 5 new ones in my first week here.  We have a good lawyer, but he is more specialized in labor law (also a need for us here).  We now need a tax consultant and another administrator to work with him to document what we have paid against what we should pay (not so easy) and negotiate a final settlement to put this issue to bed.  I thought this was going to be an easy 3 months, but for the moment, it is not the case.

On the home front, the capital of Uganda – Kampala - is a nice place to be.  We are in an animated, safe area in the city, with plenty of services, restaurants, etc.  I have a wonderful room with wifi and a balcony on which I can work on the weekends.  That is where I am writing this post right now.  Only problem – my favorite bar has been shut down.  It is a Congolese bar just 300 meters from the office – lots of Congolese in this country also.  Apparently, they were shut down because of excessive noise, which does not surprise me.  So they are taking advantage of their administrative closure to tear down everything and rebuild.  Not good for their staff, who are without work during that period.  I celebrated my birthday by having dinner with one of my favorite waiters from the place in a small French restaurant just across from the former bar.  He is hurting, with no source of income.  It appears that the new place will open about the time that I leave.  Sniff L. 

I am very happy that there are a few international and national staff that I know from last year, and a few international staff that I know from previous missions.  I have dinner at the house tonight with one very special friend from last year.

 

One very bad news.  A good friend of mine who was the Project Coordinator of the project which is closing died about a week before I arrived. MSF did all they could to help him, but apparently it was too late – he had been sick for a long time.  He was only around 40 years old.  We all miss him greatly.  I wish his family the best in this time of need.

When I finish here, I will have finished 2 years of contract with the emergency department.  I have been told that it is probably good to stop there. Although I love working in this department, I agree.  It is rather stressful.  So after here, I hope to have 4-6 weeks of vacation – travel to a country without work – as I have not done in a long time.  I was thinking to go to Philippines to visit a friend there for part of that time.  I want to continue the big MSF adventure, but probably now in our regular programs as before, but outside of the administrative side and more as a project coordinator.  We will see.

Back from Central African Republic

I am back from 2 months in Central African Republic (République Centrafricain in French).  It is a country, as its name implies, in the center of the African continent, about the same size and France and Belgium combined.

There is an internal conflict going on there which pits Christians against Muslims, but the causes of this conflict are much deeper than religion, as is usually the case.

Central African Republic (CAR) suffers from a chronic lack of effective government.  The country gained its independence from France in 1960.  The last person who effectively ran the country was the vicious dictator Bokassa, who reigned from 1966 through 1979.  Since his reign of terror, the government has been nearly non-existent.  The plight of this country gains little attention from the outside world, because in has little or no economic interest – its mineral deposits (diamonds, gold, uranium, etc) are largely unexploited.  Agricultural is important, but those products are mainly consumed locally.

Another problem for CAR derives from its central location.  It is surrounded by countries which also have internal conflicts (Democratic Republic of Congo, Uganda, South Sudan, Chad, etc).  Rebel forces in these countries often flee into CAR when things get hot, taking advantage of the weak government and ineffective national armed forces to use the place as a hiding ground.

The current conflict started with a coup by Michel DJOTODIA in March 2013.  He is the leader of a collation of old rebel groups under the name of Séléka.  This group, which includes many foreign mercenaries, became the defacto military force in the country and reeked havoc on the population.  CAR is 80% Christian, and the Séléka forces are primarily Muslims.  In September DJOTIDIA announced that the Séléka ad been dissolved, but most of the militias refused to disband.  Local Christian militias formed, known as anti-balaka (anti-machete or anti-sword), taking revenge on the Muslim population, whether or not they are associated with the Séléka.  This is the conflict with which we are dealing, and it is indeed a very bloody conflict.

MSF (Doctors Without Borders) has been present in CAR for many years to help alleviate the suffering of the population due to the aforementioned lack of government, which includes an inadequate health system.  And as a result of the current conflict, all 5 operational sections of the organization are there, as are many other non-governmental organizations.  The budget of all MSF operations combined in the CAR for this year is 40 million euros. That matches the total government budget for health care in the country.  Although the primary emphasis is on treating victims of the armed conflict, we are also distributing water, food and non-food items to internal refugees, and providing primary health care in community health centers.

I arrived in the capital of Bangui on 7 January, 1 month after the first big conflict in that city.  A surgical team was already in place to treat trauma patients from the fighting.  We set up an emergency coordination team, along side the regular program coordination, to manage the new projects associated with the conflict:

• The emergency room / trauma surgical center in the Bangui Community Hospital
• A health clinic in a Muslim area of Bangui which was quickly becoming enclaved
• A team to explore the needs in terms of health care and displaced population needs (food, shelter, water) in the north-western side of the county

My job in this emergency coordination, as usual, was to manage the finances and human resources for the set-up.  The teams evolved with the project. We have all worked very hard, and we are very proud of the work we have done to help the population suffering from a neglected conflict in this neglected country.  I know I have worked this hard in my life before, and maybe even harder, but I am no longer 40, or even 50 years old now.   I left Bangui on Tuesday evening 4 March, after 2 months in CAR.  It was an all-night flight, with debriefings the next day in Paris, and returning to my home in Lyon on Wednesday evening.  I promptly fell into bed and did not move from it for 36 hours.  Now I feel refreshed.

I will stay in Lyon for 3 weeks, until 25 March.  Then I will be off again, probably working this time with South Sudanese refugees in Ethiopia, or with Congolese refugees in Uganda.  In any case, this year has started out as one in which the whole world is crazy, with conflicts all over the globe.  I have a job for life.

The only constant is change

I had a good rest for 2 weeks in Lyon.  Christmas was spent with friends, and I had a quiet night at home for New Year’s (after 15 years of running a bar, that is one night I prefer not going out).  I walked a lot in Lyon – the weather was not so bad – and discovered a few new things.

I arrived back in Paris yesterday, the 2 January to prepare for my departure to South Sudan.  And this morning, the 3 January, everything changed.  Due to team profiles and numbers, I am now going to Central African Republic (CAR) – conflict situation still, just a change of countries.

This is great for me, because I have never been to CAR before, while last year at this time I was just leaving South Sudan.  It would have been good to see the South Sudan team again, but it is also good to see a new place also.  And I was going to work with some great expatriates in South Sudan with whom I have already worked, but we have a great expat team in CAR also, and I know most of them already.

So rather than leaving tonight, I will leave on Tuesday 7 January to allow time to get the different visa and have another set of briefings. So I have a weekend in Paris – ain’t life tough?  This may give me an opportunity to see some old customers from my bar who are

living in Paris.  That would be great.