Outside of Bangui, the capital of Central African Republic (CAR), the country is back in open and increasingly fractured warfare with even more areas affected - recently, Paoua in the north west of the country where Doctors Without Borders (MSF) has been working since 2006.

Members of Revolution and Justice (RJ) and fighters belonging to the Movement for the Liberation of the Central African Republic People (MNLC) have been engaged in violent clashes since Wednesday, 27 December, 2017.

About 30,000 people have fled the fighting in the area to take refuge in the town of Paoua. They tell of torched villages, exactions and indiscriminate attacks on anyone found in the zone. The situation remains extremely tense.

Since the beginning of the clashes the MSF team in the Paoua hospital has treated 13 victims. Given that 30,000 people have fled the fighting in the area it’s concerning for MSF doctors that only a few people have managed to seek medical assistance.

“This is very little, taking into account the number of displaced people who reached Paoua and the extreme violence they report to our teams. Many tell of men on horseback shooting at anything that moves, of dead and wounded people left behind in the bush,” explains Gwenola François, MSF’s head of mission in CAR. “We are very concerned by the situation there.”

33-year-old farmer Léonard Gangbe was one of the wounded who made it to the hospital in Paoua. When the fighting broke out, he and several neighbours fled their village to a house in the forest. While trying to stop armed men stealing the cattle he had taken with him, he was shot in the left cheek and the bullet tore through his nose and top lip.

Because of the fighting, MSF has been obliged to suspend its work in the seven health centres in outlying districts of Paoua where its teams provide assistance. Three of these centres have reportedly been looted.

A region made vulnerable by persistent violence

The region of Paoua was relatively spared from the fighting and escalation of violence throughout the past year. Yet, even where the security is slightly better compared to other parts of the country, people have been subjected to pervasive and sustained violence.

The violence is not only characterised by fighting opposing armed groups, targeted attacks against the population and the numbers of people left dead or wounded. The violence is fostered by the incapacity of state authority to provide security in much of the country and the proliferation of armed men who live off people’s backs. These men use any excuse to impose a tax—happening to be on a particular road, owning cattle, or even living in one’s own home. Josianne Wankian is 37 and mother to nine children. Her story is one such example.

Now living in Paoua, Josianne is from a village a few kilometres from Paoua called Betokomia. At five in the morning on 28 December 2017, she heard gunshots near her home. Her husband and 13 year-old son ran off because rumour had it that, although women don’t get hurt, the men would be killed immediately. So, she was alone with her children when armed men came demanding food and money. Josianne borrowed 12,000 francs CFA (R268) from a goat trader so that she and her children could leave their village unharmed and seek refuge with her older sister who lives in Paoua.

This is far from being the first time armed men have demanded money from Josianne and her family. In August 2017, they even torched her home. “My husband’s a farmer. We had four cattle, so we were able to grow more and sell our produce to increase our income,” explains Josianne. “When armed men see a decent house, they demand food, cattle or money. They ordered us to pay a tax of 50,000 francs (R1,130) for our cattle and 120,000 francs (R2,722) just to carry on living in our home. We don’t have that kind of money. I gave them 25,000 francs (R565), which was everything I had. As the house didn’t have a roof yet, they said they’d come back when it was finished. But it didn’t stop them stealing our belongings and setting the house on fire. After that, my eight children and I spent several months living out in the fields. We’d just started rebuilding our house in Betokomia when the fighting flared up again a few days ago.”

Like Josianne, 30,000 people or more in the Paoua region have fled neighbouring villages and sought refuge with family in the town that is also becoming less safe. Each local household often hosts over 40 displaced people, and provision of sufficient water and food will soon become an issue.