The city of Carnot rests in the peaceful hills of western Central African Republic. Like many parts of the country, the town’s economy relies on mineral wealth, in the form of diamonds.
But when the foreign-owned diamond exchanges left town in the midst of the global financial crisis in 2009, people began to suffer.
Luke Fagende, a tailor who repairs clothing on a sewing machine outside of a shuttered diamond exchange in Carnot, says when the foreigners left, the local economy dried up.
“Now they are gone,” he says, “there is nobody here. There is no money to buy drugs to cure our sicknesses and we have become very poor.”
When the diamond money stopped, Carnot suffered a serious malnutrition crisis, prompting the medical aid agency Doctors Without Borders, known by its French initials MSF, to intervene.
The group ran emergency nutrition programs for the first year, but then discovered deeper health problems in the region, including a child mortality rate that is three times above what is considered an emergency level, as well as elevated rates of HIV and tuberculosis.
Serge St. Louis, the head of mission for MSF-France, which runs operations in Carnot, says they decided to set up longer-term projects in the town, assisting the Ministry of Health to improve hospitals.
He says, “You just step, you just put a foot in the hospitals, any hospitals outside the capital, you just find needs. Big needs. (A) population that has no access because (there are) no medical personnel in quantity and quality in those hospitals.”
A Chronic Health Crisis
Carnot is just one small example of the dismal health conditions in Central African Republic. The country ranked 179th out of 187 countries on the United Nations human development index, with a life expectancy of just 48 years of age.
According to MSF, the country has the highest HIV prevalence in Central Africa, with malaria and tuberculosis among the biggest causes of death.
While economic conditions have accounted for the health crisis in the west, conflict has been the cause in the east.
According to the United Nations, over 100,000 people are currently displaced by fighting with rebel groups, including the notorious Lord’s Resistance Army, creating even more difficult conditions for providing medical care.
Throughout the country, the lack of investment in health care systems, including the building of hospitals and training of doctors, remains one of the biggest challenges to improving conditions.
The government is either unwilling or unable to provide that assistance.
Central African Republic is a poor country, and only allocates about $30 million a year to health care for a population of 4.5 million people -- the fifth lowest expenditure rate in the world according to the World Health Organization.
The mayor of Carnot, Pierre Dotwa, says the government’s health care development plan in the country involves continuing the programs established by MSF.
“MSF has done good work,” he says, “with the government of President Francois Bozize, we have helped the situation together.”
MSF-France's St. Louis said MSF and the government are still trying to negotiate the terms of their cooperation in Carnot. He described their relationship as “not perfect” but “improving.”
While the government’s own investment in health care is lacking, the international community also has kept its distance from the country.
The United Nations appealed for $140 million in 2011 for humanitarian assistance but only received 45 percent of that amount.
The head of the U.N. humanitarian affairs office in the capital of Bangui, Amy Martin, says the country has to “rebrand” itself by rebuilding universities and improving basic social services.
“Until that happens,” she says, “I don’t see C.A.R. going very far very fast.”
The Central African Republic has made tentative progress in recent years, reaching peace agreements with rebel groups and working to strengthen democratic institutions.
But it is clear that, as was the case in Carnot, the slightest disruption can have devastating consequences for the health of the nation.