Conflict and violence in the Central African Republic (CAR) continue to be all too frequent across the country. Since 2007, the International Committee of the Red Cross (ICRC) has worked to curb the consequences of these clashes.

Last October, an ICRC medical team helped a woman deliver a baby boy in the bush on their way to a health center we support in Grévaï, a small town in the north-central region of CAR. On her way to the market, by foot, the woman went into labour and only by chance did not have to go through it alone, surviving along with her baby. That same year, my colleagues at the main hospital in Nana-Grébizi prefecture surrounding the town of Kaga-Bandoro helped a young couple deliver triplets – a moment of joy but also one that made the father cry, concerned about how to feed his family of now seven children. Our team at the hospital’s nutritional unit, where we help treat malnourished children, already knew they would see the three baby boys again before long. Our doctor there also told me about premature babies who had to be revived several times during their first days before their health eventually stabilised.

These stories are just a glimpse into what people here face every day when it comes to accessing basic goods and services, such as food and health care. These things cannot be taken for granted. The local health workers at the Kaga-Bandoro hospital and the nearby health centers in Grévaï and Ouandago are doing the best they can with the limited resources they have. But the needs remain enormous and working conditions remain difficult due to insecurity, making it hard to recruit and retain personnel, allowing impunity and criminality to reign and hampering development of proper infrastructure.

The crisis in CAR is a neglected one, receiving little attention despite the humanitarian consequences it has triggered since the outbreak of civil war around 2013. More than half of the country’s 4.9 million inhabitants live in desperate need, making it one of the worst, but most poorly known, humanitarian crises in the world. Sporadic violence is pervasive. Security conditions are volatile. Armed groups maintain a presence throughout the country, and acts of criminality, such as armed burglaries, are reportedly widespread. Communal tensions – related to resource competition between farming and pastural communities, for instance – give rise to violence.

It has been two years since the signature of the latest peace agreement in February 2019 between the government and 14 armed groups. These groups control some 70 percent of the country. And as CAR struggles with post-electoral violence, conflict, insecurity, and criminality, the compounding impact of climate change and COVID-19 are making a bad situation even worse.

For weeks now, the country has been experiencing a new period of violence between a coalition of six armed groups who have launched an offensive to disrupt the presidential elections and take the capital Bangui. Before this latest violent outbreak, one in four Central Africans had been forced to flee their homes – living on the streets, struggling for survival in the bush, or sheltering in displacement and refugee camps. Some of them had started returning home, but this violent outbreak has made that impossible, forcing even more people to flee. Many people have had to abandon everything and start over several times in the last few years. Over years of crisis, many of our Central African colleagues at the ICRC have also been displaced, lost their homes and loved ones, and carry memories that will never fade. I truly hope they don’t have to go through that again.

The widespread violence in CAR continues to have a serious impact on people’s lives. Citizens’ homes and livelihoods, such as crops and livestock, have been looted or destroyed. Access to safe drinking water is difficult in many places due to insecurity or lack of proper water infrastructure. A mother I met lost her baby because of unsafe drinking water – another loss that could have been prevented. Not least, sexual violence related to this insecurity is underreported, affecting mostly women and girls who work in the fields, go fishing, search for firewood, or fetch water for their families. Violence in general is frequent, leaving generations with physical and mental scars. In Nana-Grébizi, our mental health team works with displaced children who have experienced violence as well as with survivors of sexual violence. They try to help them learn to live with their trauma that is almost impossible to forget.

CAR also remains one of the most dangerous countries for humanitarians, making it difficult to access certain areas and communities, due to widespread instability, crime, and the range of armed groups. The more actors, the more difficult it is to build structured dialogue and to obtain reliable security guarantees. During the rainy season, some areas are also unreachable by road for months, and transport infrastructure remains underdeveloped in many places. During the ongoing clashes last year, the ICRC’s office in Bouar, in the Nana-Mambéré prefecture in western CAR, was raided, forcing us to drastically reduce our activities in the region until security in the town could be restored. Such attacks only punish the local communities, depriving them of desperately needed help.

In the wake of the peace agreement, violence briefly declined in the country. However, since September 2019, this trend has reversed, with recent clashes only making it worse. For sustainable results, authorities and their partners should address insecurity and impunity in the long run. Insecurity is a scourge that prevents Central Africans from helping themselves and moving forward with their lives. It hampers the ability of the ICRC and other organisations to assist in these efforts.

To curb the worst of the violence, and in support to the Central African authorities, the ICRC continues to engage with the Central African armed and security forces, armed groups, and international forces to raise awareness of their obligations under international humanitarian law and human rights law. The ICRC is also stepping up its support of the Kaga-Bandoro hospital and nearby health centers in Nana-Grébizi, alongside partners from CAR’s Ministry of Health and the World Bank. This complementarity between political, humanitarian, and development actors is key for the country to move towards peace, prosperity, and dignity. The people of CAR have paid the price of this crisis for too long.

This article is part of the “Forgotten Conflicts” series by the International Committee of the Red Cross in partnership with AIIA, highlighting the serious and often overlooked humanitarian consequences of armed conflicts and other situations of violence.

Bruce Biber is Head of the ICRC Delegation in the Central African Republic.