Why such poverty in the land of gold and diamonds?
Brooks Newmark visits Central African Republic with Merlin.
When I told my mother I was going to the Central African Republic, she replied, "The Congo, isn't that terribly dangerous?"
"Not the Congo," I explained patiently, having only recently located CAR's capital on a map myself, "it's just above."
But by then I knew she'd stopped listening.
My mother is not alone in her lack of interest for this landlocked country at the geographical heart of Africa. Some may have heard of Emperor Bokassa and his alleged penchant for cannibalism but today CAR is one of the least well-known countries in the world. Even the estimated 300,000 people who have been forced to flee their homes as a result of conflict fail to register on the global radar.
Landing in Bangui on the only weekly flight from Europe I wondered why so few people had heard of CAR. The facts alone make it worthy of attention: one of the lowest GDPs in the world at nearly $1.8 billion - the same as Sierra Leone and only one fifth of Haiti - with a male life expectancy lower than Somalia and the highest HIV/AIDS prevalence in the region. The country ranks 172 out of 177 countries on the UNDP Human Development Index and 67 percent of the population live on less than 1 dollar a day.
Travelling north with international medical aid agency, Merlin, we pass abandoned villages and fallen, burnt-out huts. Bouncing along unpaved roads, many impassable when the rains come, I can't help but think of the contradictions with the country's gold and diamond deposits and uranium reserves.
Lush vegetation and loaded fruit trees juxtapose swollen bellies and market stalls selling just half an onion. "If you drop a seed anywhere in this country, food will grow," explains Merlin's country director, Bruno Fugah. Why then is one in three children under the age of five chronically malnourished?
It is because persistent clashes between rebels, the army, bandits and civilians have left families constantly on the move and 96 percent of arable land uncultivated.
A visit to Bouar Hospital, which as yet receives no NGO support, proves that it is not just agriculture that has hit crisis point. Wards are left in darkness by broken generators and stand empty except for rusted beds without mattresses. Holes in the ceiling let in rain and medicine cabinets stand empty. We see only a handful of patients in a hospital that serves a community of 258,000 people, many lying on the floor for want of a mattress.
Do the people of this district not get ill? With the highest HIV/AIDS rate in the country and another meningitis epidemic looming, the people are desperately in need of healthcare. But they simply do not come to hospital. With virtually no government support and staff who have not been paid for over two years, Bouar Hospital is forced to charge for its services. Unable to pay, people simply stay away, left to suffer and in many cases die at home.
Merlin, for its part, is rehabilitating and equipping 14 health facilities in two districts of CAR, training Ministry of Health staff to fill vital skills gaps and providing free primary health care to over 140,000 people.
But, for their support to make a real and lasting difference, the country needs long-term peace and stability. And international donors need to make the commitment to be here for the long-haul.
A lack of control in the north has lead to a relatively open circulation of light arms. This, in combination with an absence of real economic opportunity, has encouraged violent banditry. Three different rebel groups, meanwhile, are in talks with the government but peace has been stalled by a failure to agree on an amnesty law.
"CAR is caught in a cycle of conflict," explains the Prime Minister in a meeting in his office, referring to the long line of coups the country has suffered since independence from France in 1960. Insecurity prohibits development, yet the failure to develop brings about more conflict.
Accompanied by UNICEF, we head into the bush to meet Lakoue, a regional leader of the Popular Army for the Restoration of the Republic and Democracy (APRD), the rebel group that controls much of northern CAR.
"While I am talking to you, children are dying," begins the tracksuit- and ski hat-clad Lakoue in French. "The government is doing nothing for its people, nothing to protect them from the bandits. Fear is engrained in everyone." He explains that people do not settle to grow crops and send their children to school.
To glance at a map of Africa, it is clear that even if CAR is forgotten, its neighbours most definitely aren't. With Democratic Republic of Congo in the south, Sudan in the east and Chad in the north, CAR borders some of Africa's most notorious killing fields. While Sudan's Darfur crisis hits the headlines almost weekly, more Central Africans flee into Sudan than the other way round.
No one we met was of the opinion that CAR's problems were anyone's but its own. Yet, the country's strategic location at the heart of this "triangle of death" does give stability here a much wider regional significance.
As Jean-Sebastian Munie, head of the Office for the Coordination of Humanitarian Affairs (OCHA), points out, CAR serves as a vacuum for instability in the region, as proved by recent attacks by the Lord's Resistance Army from Uganda in the south-east. According to local media reports, villages were pillaged, women raped and children abducted.
It is not just the international press that has forgotten CAR, so too have the donors. While development aid to Sub-Saharan Africa rose by 87 percent since 1985, it fell by 49 percent for CAR. Britain for its part gave a mere £2.7 million to CAR this year, compared to £50 million for nearby Rwanda.
The number of international humanitarian agencies working in CAR may have increased from three in 2006 to more than 20, but more needs to be done to save this country from total collapse. And its stability could make or break regional stability for millions more people.
Boarding my flight back to Paris, words from a meeting with the minister of health earlier in the day rang in my ears: "We need help."
Arriving home, I called my mother to put her mind at rest. "How was the Congo?" she asked. "