Thursday, March 20, 2008

Attack on town in Central African Republic

Curious as to what happened in Silambi, one of the towns I visited on my trip to the Central African Republic?

Read on for the Human Rights Watch report:

Central African Republic: Chadian Army Attacks, Burns Border Villages, Civilians in Peril in Northwestern CAR
(New York, March 19, 2008)
—The Chadian army has launched numerous cross-border raids on villages in northwestern Central African Republic (CAR) in recent weeks, killing civilians, burning villages, and stealing cattle, Human Rights Watch said today.

Since January 2008, Human Rights Watch researchers documented at least five separate cross-border attacks on Central African border villages, mostly between Markounda and Maitoukoulou in the northwestern part of the country. Chadian army troops appear to be acting in support of CAR and Chadian cattle herders known as Peuhls, at odds with local CAR farmers trying to protect their crops. The worst violence occurred on February 29, in a rampage that destroyed six villages in the area of Maitoukoulou.

More than 1000 people have been internally displaced or have been forced to flee across the border into southern Chad. The internally displaced live in dire conditions in Maitoukoulou camps, and in fear of further attacks, Human Rights Watch has found.

“The people in the northern part of CAR are getting it form all directions. They’ve been attacked by rebel groups, bandits, their own army and now the Chadian army,,” said Georgette Gagnon, Africa Director at Human Rights Watch. “These deadly incursions by the Chadian army further destabilize an already precarious region.”

CAR local farmers and nomadic Peuhl herders driving their cattle south from Chad during the dry season regularly clash over crop destruction by cattle and access to grazing and water sources. Because of the widespread insecurity in the region, the CAR authorities no longer play a prominent role in resolving these conflicts, and armed groups are increasingly involved in the clashes.

Local farmers told Human Rights Watch that in late 2007, they joined with CAR anti-government rebels in the region, the Popular Army for the Restoration of Democracy (APRD), to keep Peuhl herders off their lands. Clashes erupted in Katogo, Batangafo and Bakassa between the Peuhls and the farmer-supported APRD. In response, the Peuhl apparently convinced the Chadian authorities to intervene on their behalf. The first incursions by the Chadian army took place in mid-January in the village of Sabo, followed by increasingly intense attacks on Dokabi, Bele and Daga on the Markounda-Maitoukoulou road, as well as Bedaya Two and Bebingui, north of Paoua, in mid-February.

The clashes intensified on February 29, when marked Chadian military vehicles unloaded soldiers inside CAR, who then crossed the Ouham River on foot and on horseback into the village of Silambi. Together with Peuhl herders, the Chadian soldiers entered the town around 5 a.m., shooting indiscriminately. Witnesses said most of the attackers were men armed with assault weapons, wearing military uniforms with the Chadian flag on the sleeve and the distinct khaki-green turbans of the Chadian armed forces, and were speaking Chadian Arabic. One civilian was killed and another wounded by gunshots. The attackers pillaged and looted the village before setting fire to some 200 thatch-roofed houses, as well as the school and church. All but five buildings with tin roofs were burned down. The population of several hundred people fled, leaving behind their belongings and food.

Eyewitnesses and village officials told Human Rights Watch that the same day the attackers destroyed the next villages they crossed: Maikoyo, Ngartubam, Maissoulo Two, Dawala, and Tira. In each village, they repeated their scorched earth tactics. By mid-morning, they had destroyed all these villages except part of Tira, where they rested until mid-afternoon. They detained five residents to do chores such as fetching water, and slaughtering and cooking goats. The three detained men and two women were whipped and beaten by the soldiers. One 40-year-old woman who was among the detainees described to Human Rights Watch researchers how the soldiers forced her to burn her own house, as well as those of her husband and her son. She refused, but they whipped her until she agreed to participate.

In all, four people were killed during the February 29 attacks and at least four others wounded. Of the wounded, one died later that day. Another wounded was taken to Chad by the attackers and eventually released for a ransom of 15,000 CFA (about $35). A third man was taken by the villagers to a medical clinic in Gon, Chad, and was later abducted by the Chadian army. His family went to the nearest Chadian military base, in Moïssala, to find him, but he remains missing and there are grave concerns about his well-being.

It remains unclear whether the attacks by the Chadian army have been approved and coordinated with the CAR authorities, who have in previous years allowed the Chadian army to operate within the border region. Since the raids were partially in retaliation against the rebel APRD group, evidence suggests that the CAR authorities may have authorized the attacks. One of the villages attacked, Bebingui, is the hometown of APRD spokesperson Laurent Djim Weil.

Between 2005 and 2007, the security forces of the Central African Republic, particularly the elite Presidential Guard, carried out massive abuses against the civilian population of northwestern CAR, executing hundreds of civilians and burning down an estimated 10,000 homes in an abusive counterinsurgency campaign against the APRD. In September 2007, Human Rights Watch published a detailed report, State of Anarchy, documenting these killings and village burnings. The CAR authorities withdrew the abusive Presidential Guards from northwestern CAR in late 2007, leading to a dramatic drop in executions and other abuses.

“The security situation for civilians in northwestern CAR remains very fragile,” said Gagnon. “The Chad government needs to immediately instruct its troops not to participate in these attacks. The victims also deserve accountability for these attacks and the abuse they sustained.”

Monday, March 17, 2008

A few photos from Central African Republic

Hanging out in a tree outside the compound in Boguila.

Igor and his friends in Markounda.

Two little girls enthralled with a Petanque game in Markounda.

Me with some of the midwives and a representative from a woman's group in Boguila.

Monday, March 10, 2008

Flight from Africa

In order to return to Bangui to make my flight to Europe (via Tripoli, Libya!), it was necessary to take a 10 hour drive. I rode in the org's white land cruiser filled up to the brim with some oil drums, luggage, and a patient in the back.

Because it's almost 100 degrees, the only way to stay cool is with the windows down - so I was covered in red dust within 10 minutes. I didn't bother to bathe before leaving because I knew after 10 hours, there was going to be no point. My white shirt was red by the time we got to Bangui.

We have a "white face in the front" policy - supposedly to protect us from bandits who are less likely to rob expats than fellow Africans but since I do not yet have the proficiency in the radio that that is needed, I squeezed into the front hour with my translator. "Situation Oscar Kilo. Transmission Terminee." Like that is so difficult to do. But you have to do it every 30 minutes. For ten hours. ugh.

Since I didn't have to do that, I instead practiced my patented "sleeping in uncomfortable places" routine. I was taking a snooze dangling from my seat belt when we went through a village. Normally, my job is to smile and wave to everyone. The kids like it and get to say Mbonjo (which sounds like bonjour but really means WHITE PERSON). While I was sleeping, my driver and translator cracked up because someone started shouting: Mbonjo lango! (White lady is sleeping!)

The translator and driver also taught me a joke. Whenever a pig ran out in front of the car (which was often) - we would shout Coupeur de Route! Which means, literaly, the cutter of the road. But it's also the name for the vicious highway bandits that they have. A little black humor, Central African Style. We did many variations of this joke "un petit coupeur du route", "beaucoup des coupeurs de route", and so on. My attempt to explain the joke "Why did the chicken cross the road?" went down in resounding failure. I guess its not a universal joke.

We left Boguila at 6am and by 1pm we finally got to the first substantial town, Bossasoa. We pulled over and squatted at the roadside grill to eat some grilled goat meat and Manioc served in the market with super hot peri peri powder and some hot tea to wash it down. No electricity in this town so no cold drinks yet. After an unsatisfactorily short break, we jumped back in the car and headed south again.

After stopping to buy pineapples, check outthe price of fish sold on the side of the road, change a flat tire, we finally reached a town which is famous for having cool drinks. Thank god. We stopped and got some fresh fish grilled over charcoal with salt, limes, and spicy onions and peppers on top. Since they don't really have knives and forks at these roadside stands, I again, ate with my fingers. And got pretty good at it! It's much easier to eat a full fish with your fingers than a knife and fork! We washed it down with the most refreshing coca cola I've ever had.

When we finally arrived in Bangui at 5pm ish, i was dropped off at the expat house where I found one of the Italian expats from the east of the country frying some eggplant and marinating some freshly killed warthog that he had brought from the East (where there are much more game animals). I took a shower. I wanted to throw out the clothes I was wearing but instead put on some clean clothes. I had four hours before the airport and my flight to Tripoli, Libya.

Goodbye Africa!

Fighting HIV in Africa

After my adventures up on the border with Chad and Central Africa, I thought that returning to the hospital in Boguila would be less adventuresome... somehow more staid than the derring do of the mobile clinics.

I spent the day interviewing the national staff (inadvertently getting in the middle of a contract negotiation crisis) and talking to the expats.

An Angolan nurse who runs the HIV/AIDS and TB program at the hospital told me that he really hopes we can do more about HIV and stigma in the area. He had treated a woman with HIV and TB who was about 26 years old. She had a small baby and her mother was taking care of her in the hospital where we were giving her medicine to allow her to live with her illness. Her mother had other children and grandchildren to look after so took her out of the hopsital and brought her home. In Africa, it is up to the family members to bring food and nurse the patients. It's not unusual to go into the Intensive Care Ward and see an old man with three ladies sitting on his bed, trying to feed him some manioc. I had been told in our Markounda office that one of the problems we had ws trying to convince people to go to our hospital in Boguila because it was so far away (almost a three day walk) and people didn't like the food. Which sounds flimsy until you realize that in order to take care of someone who might die anyway, you have to prioritize them over all the children and family members that you normally take care of. You have to sleep surrounded by strangers and scavenge for food in an area that is not your home. It's not that easy.

Anyway the Angolan nurse was worried about this woman because he knew she didn't have acess to her medicine. He asked the mobile health clinic to go into the village and look for her. They did and they found her lying on a mat, near to death. The family refused to return with her to the hospital. The staff demanded of everyone “Who will save this woman’s life?”. There were no takers.

Lifestyles of the Young and Foolish

Bara, Central African Republic

In the morning after the mobile clinic, we break camp and head to Bara for another clinic. After some negotiation with the local secourists, we decide the easiest way for me to go 5km (or 3 miles) into the bush to meet up with some displaced families is by bicycle. African bicycles, as it turns out, do not have brakes anymore. Nor do they have decent saddles or pedals anymore. And there are no paved roads. So all in all, it was a bit of a risky adventure.

To the amusement of the children who had never seen a white woman on a bicycle before, I took off with my translators into the bush. The first bit was a challenge – the path was wide enough for two people to walk side by side but there were termite mounds, roots, lots of loose shifting sand, and branches everywhere. After a few minutes, I got into the stride on this brakeless bicycle and away we went. The women we passed carrying their babies to the MSF clinics seemed amazed to see me and laughed and called out Lalee (hello). About 10 minutes into the ride, we hear a motorcycle approaching us. It’s the rebel commander of the APRD coming out to personally greet me! He is driving, wearing a lovely Hawaiian shirt, with his body guard (?) behind him with a very menacing looking Kalishnakov. But both have huge smiles on their faces and great me enthusiastically in French. I explain that my French isn’t that great and we have a nice little conversation where he welcomes me to his village. After much effusive shaking of hands and smiling, we part ways, he turns around from the way he came and we follow him but in a good distance back.

After 15 more minutes of biking through the bush past some scraggly looking cotton plants about to be harvested, we come to a small clearing that has a hut built in it and two older women living there with some goats and chickens. We sit down to interview them. They seem fairly well to do since they have clean clothes on and lots of goats and chickens. In the other villages where people weren’t even displaced, the population is almost in rags with very few animals and only small amounts of food on display. After a few minutes talking with them it becomes clear that this is Captain Felix’s mother! We finish up the interview and head off to the next encampment – which turns out to be the rebel camp where the rebel captain and his men and about three motorcycles are all parked. They call us over again and demand that I come to inspect a man that is lying under a lean-to. We try to explain that I’m not a doctor but I guess my logod t-shirt was not convincing them. I go over to see what I can do – it’s an elderly man who is the rebel captains uncle. It turns out he’s been seen in our hospital but has an inoperable tumor in his chest and was sent home to die. I call the base and they explain again to the captain on my satellite telephone that there is nothing else they can do for him but if they want to bring him to the clinic, they’ll look at him again. I’m left in the awkward position of trying to portray comfort and compassion to this man lying in the heat and dust in the bush dying with his helpless family around him. Still, I would rather die with my family around me in my home than in a tent after a four hour truck ride.

We head on – after about another 30 minutes biking in the heat through increasingly difficult paths, we came to a little settlement of about 8 brand new huts. There about 10 women sitting in a shelter and they agree to talk to us. We discuss their problems – no soap, hard to keep clean, when the bandits come they have to run further into the bush and when they sleep without shelter, the babies get sick from malaria and get respiratory infections. I don’t feel comfortable asking them about any rebel abuses because I know the rebel chief knows I’m here and I don’t want to put them in any danger.

It seems hard to imagine the smiling man in the Hawaiian shirt fretting about his dying uncle as someone who would terrorize the population. Perhaps they don’t – but one thing about armed men in Africa that I’ve learned is that they can be ruthless and charming, you cant’ judge them by appearances. The women tell me that the bandits often kidnap women and take them far away. They can sometimes find their way back and they are often pregnant. Thankfully, there doesn’t appear to be a lot of stigma within the community. They also complained vociferously about the fact that our clinic ignores them when they want help with sexually transmitted infections. You only treat pregnant women and children! A spirited discussion with our translator ensues and he almost runs off a few times. It’s good to see girl power!

We pedal back to the mobile clnic to the general hilarity of all that witness me. Sadly, the photo that my translator took of me didn't turn out because it was too blurry.

My first day out in the bush

Maitekolou, Central African Republic

After a trip from Boguila to Markounda with a “Kiss” (where two cars meet up to exchange passengers and their bumpers kiss) at a town called Tale, I met the Markounda team. The first day I spent in their very small compound next to their inpatient department of about 25 beds with five expats. They have a small cat and a vegetable garden.

We spend the day in meetings and at 7am the next morning headed off with two cars packed to the gills with 31 people (including patients being transferred home) and all the supplies that they need to carry out two mobile clinics, supply several malaria testing field sites, and food for the expats. We took off down a long dirt road with mango trees on either side and miles and miles of brush and fields of straw as far as the eye could see. It was quite deserted. From time to time, we would see birds or once or twice a civet cat dart out in the road but there were very few people. We arrived in a small town to find the local staff waiting for us. The coupeurs de route or highway bandits that plague this area had struck.

Because of the low intensity war between the government of the Central African Republic (FACA) and the Armee de Populaire Resistance pour Democracie (APRD), there is absolutely no law and order in this area. Deep in rebel territory, former mercenaries from Chad and Sudan who were hired by the current president to aid him in seizing power along with renegade Chadian army and local thugs prowl the area stealing everything they can get their hands on. IN this case, they stole all the malaria test kits, paracetomol (Tylenol) and cotton swabs that we had left behind and terrorized the population. They’ve killed 8 people this week along this road, we learned. After restocking them and offering them solace, we took off again for a town called Silambi that is on the border with Southern Chad and at the junction of two rivers. The town is frequently the scene of fighting between local farmers defending their sorghum, manioc, and cotton crops from the Peuhl, the ethnic cattle herders. The Peuhl call in the Chadian military to help them and the villagers call in the rebels to help them. People die in the meantime. (Note: about four days after I wrote this, Silambi was attacked and burned down. Stay tuned for more info).

I interviewed two groups of people who told me about hiding in the bush from the frequent clashes as well as from the Couepeurs de Route. While in the bush, they are eaten alive by mosquitos and tsetse flies which cause huge amounts of malaria and sleeping sickness. In fact, 30 percent of all the illnesses we see in our clinics are malaria. There was a malaria bed net distribution in June of 2007 but by August, the bandits had stolen almost all of the mosquito nets and the population was vulnerable again. Pregnant women and children are particularly susceptible to malaria so MSF attempts to distribute bed nets to them but most probably, they end up with the man of the household or traded in the market for food. The other thing missing is soap. We see huge amounts of scabies, eye infections, and other signs of people living without the bare necessities of life. They try to bathe in the river but soap costs more than they can afford and takes a 2 day walk into Chad past hostile border guards to buy. So they live withtout.

After our interviews, we had to return to Maitekolou, the site of our big mobile clinic. We had about 200 people lined up under a tree to see our four nurses. The expat doctor does triage, supervises, and pops in for difficult cases, such as an epileptic boy who fell into a fire during a seizure and burned almost all the skin of his buttocks. Because its too unsafe to travel after dark, the team spends the night every week in the health clinic. We brought out mattresses, mosquito nets (a necessity for delicate expat flesh!), and tables and chairs.

By 6pm, the sun was down and the national staff were gathered around to eat their communal meal of a big steamed boule of manioc and a stew of the three unfortunate chickens that I had met earlier in the day. The expats ate boxed rice and chili con carne. We all drank warm sterilized water toted from Markounda in old plastic liter seven up bottles that had baked in the sun all day. DELICIOUS!

By 7pm, most people were exhausted and had hit the hay. I sat up with a few of the national staff and the expat doctor practicing my French and quizzing each other on African geography. By 8pm, we crawled into our mosquito nets.

“Oh! We can’t shut the door to the room!” said one of the expat nurses I was bunking with… “since you are by the door, just be careful of snakes and scorpions when you wake up in the morning” she said, “I’m sure the guard will keep any wild dogs out.”

Nighty Night.

Market Day in Boguila, Central African Republic

Boguila, Central African Republic

Sunday was the day off here today. I felt a bit lazy because I wasn’t out running around and interviewing everyone but I didn’t want to bother the staff on their day off. (Another difference to Refugees International!) I went to the very tiny and uninspiring market in Boguila with one of the French Canadian nurses. She knows everyone’s names and stops to chat and make jokes. She knows many of the people in the market. I really enjoyed accompanying her. Finally - one of the staff practicing proximity! The town was small and it was hot - about 100 degrees. Some nice memories from today – taking photos again of little kids in the market place which makes them happy and they laugh. Looking at the stuff on sale in the market place. Walking around saying Bonjour to everyone. Walking home from the office with a little kerosene lamp under the pitch black sky, the smell of the white flowered tree which smells like gardenias, the big fat stars in the sky, another cool shower in the hot hot dusty evening before crawling into the mosquito netting. Beer kept cold in the vaccine refrigerator. Listening to Yamore by Selif Keita and eating Crepes with nutella and plum jam on them for breakfast.

Bad memories: the pit latrine. the polyester sheets.

The roads here are better than in most African countries and better than I would have expected for a country billed as Africa’s forgotten humanitarian crisis. It seems calm. It seems like a sleepy little African country. They have taxation points and check points and a paved and graded road. Even the “bad part” of the road was not as bad as roads I’ve ridden on in Haiti, DR Congo, Liberia, or South Sudan. There are mango trees planted all along the road and its not deforested or trashed. There are no teeming over crowded camps without a tree around them. The hospital that MSF runs is nice and this house for expats is rather nice. The latrine is truly the cleanest one I’ve ever used in Africa. It’s so much better than where we were staying in Darfur in 2004 or in Liberia with Fidele or even in Ituri.

We ate a boa constrictor casserole for dinner and listened to one of the doctors play guitar. In bed by nine pm.

Almost missing the plane to Africa

I don’t know why it always surprises me that after a year, it’s difficult to travel to Africa. I have become soft – used to traveling around Europe on cheap airlines with electronic kiosks and my elite status boarding pass. But I’m also cursed – moving to work to Europe to work at MSF took every veneer of sophistication, patience, or pride that I had and destroyed it. I used to be able to navigate security seamlessly at Dulles Airport. I had the science of packing for a trip down to an hour. I knew exactly what to do and when to do it. I had a tidy little life in Washington DC. Good friends I could call at any point, restaurants that would deliver to my apartment, a cute and homey apartment with free cable TV and wifi access.

Now – I haul two suitcases to the metro, to take the train to the airport at Schiphol. Bicyclists ring their bell at me as I navigate the bike paths, sidewalks, tram tracks, and roads. Teenagers run past me as I lumber down the stairs, tugging my too heavy and bulky luggage with me. I miss the first metro. I push my way through the Dutch people and the interminable tourists with my bags to check in for my flight to Central African Republic. Finally! I’m going back to Africa! Back to the field. 9 months and 2 weeks after I started my job, I’m finally getting what I was promised a year and six weeks ago – my first trip to peer inside the inner workings of MSF.

I booked the tickets a month ago when the dates where confirmed. I carefully save my emails in a highly regimented systems of Active and Other. Inside the Active folder, there is a folder called trips. I keep all the emails of my itineraries in there. While I haven’t been to the field, I’ve taken approximately 15 trips to London, Berlin, Brussels, Geneva, and Paris since starting the job. I know the travel agency well. But Desiree (what a name for at travel agent) is leaving us for greener pastures. She’s entrusted my travel well-being to two new people. So far so good, I got an itinerary that while not perfect suited my needs. Yes, I’m traveling through Libya but I’ll make it to Berlin for my friends birthday and I’ll get to spend 10 good hard days in the field before that.

Smugly, I arrive at the Air France/KLM ticket counter and try to log in on the kiosk. I had attempted an online check in earlier but was not dismayed when it didn’t work because after all, I’m traveling to Africa. It was only 1 year and six weeks ago that we insisted on paper tickets because of the unreliability of electricity in Northern Uganda. I’m going to Central African Republic – a much more difficult context! Of course electronic tickets won’t work. So I use my elite boarding pass to circumvent the approximately 200 Korean passengers waiting in line and go straight to the Business class baggage check. I have two hours before my flight to Paris (despite lingering on the phone with my father) and I feel pretty good. WRONG.

Africa is always waiting to throw a wrench in your path when checking in for flights. It’s Africa’s way of saying “Don’t be so arrogant. You don’t know anything. You need to slow down, be patient, and wait for things to happen. And if you push or are bitchy, well, you had better believe its only going to get slower.”

“Madam, the computer will not allow me to check you in because you are too late for your flight!” But I have two hours. “Go to the Ticket Counter”. I go to the Ticket counter. “I’m sorry Madam, but you are not on this flight. You were booked on an Air Afrique flight to Libya at 9:30am this morning”. My itinerary clearly shows that I’m on an Air France flight for 8pm tonight. It’s 6:30. Time is ticking. Something went wrong. Somewhere in my meticulous planning of balancing a trip to Portugal, a trip to Berlin, a trip for work, I ended up doing something wrong. Or did I? I never approved a 9:30am flight to Libya that would end me right back to Amsterdam. Somewhere the wires were crossed. Another previously discarded itinerary was booked.

I must have known. I was doubtful that things would go smoothly for me. I was knocking on wood and throwing salt over my shoulder. This afternoon, I stopped by the travel agency to check on my ticket and to get a copy of my electronic ticket number. The new Non-Desiree was being trained. He was harried. He was speaking rapid Dutch with another woman. I waited patiently to double check. He handed me the paper. All I did was check to see if it said Bangui. It did. I didn’t double check the times. I left because I already felt a bit of a prat with my questions, my desires for guidance, my demands for protocols and checklists to make me feel a bit more at home. How could it be harder to go to Africa with a giant organization that moved medicine and eager white doctors and nurses all over the world than it was when it was me, another woman (usually), some money and a passport. I landed in Syria and drove into the Lebanon war. I was on the plane with women being trafficked into Liberia 2 months after Charles Taylor stepped down. I flew alone through Ghana Airways into Sierra Leone and navigated a ferry crossing. I drove in a car through the mountains of Rwanda and survived a near death incident. And here – a Dutch travel agent flummoxes me.

But that’s the experience of being an expatriate. It’s the daily humiliations, my friend Jennifer told me. The inability to make a flight from the most modern and convenient airport in Europe. The inability to take a minute and swallow my pride and double check things. The fear of being thought a simpleton. An American! A person without a travel background! Not ONE OF US. My pride. My insecurity.

It’s a good lesson for Africa. Africa is filled with arrogant white people demanding that their way be the way that Africa goes. I do not know the Central African Republic but I’m sure they have more than their share of pushy Western development and relief experts. A good reminder to try not to be one of them.

I made my plane.