Doctors Without Borders ambulance at Mamfe Distric Hospital © Scott Hamilton/MSF
Ako Stephanie sits with her two children after being brought to Mamfe District Hospital by the Doctors Without Borders ambulance © Scott Hamilton/MSF
Sadly, Rosemary’s story is not unusual in Cameroon’s North-West and South-West regions, where a political crisis initially linked to demands for more autonomy evolved into a crisis of armed violence between Cameroonian security forces and armed separatist groups. Armed clashes have become a daily reality, severely curtailing the populations’ access to medical care and facilities as well as other basic services. The so-called “anglophone crisis” has caused untold suffering to the population. Acts of extreme violence have been enacted upon civilians, healthcare workers and schoolchildren; lockdowns (enforced restrictions on movement) have been imposed, and access to health dwindled.
Doctors Without Borders medical staff conduct their rounds in Mamfe District Hospital, South-West Cameroon © Scott Hamilton/MSF
According to the United Nations, close to one in five healthcare facilities is no longer functioning in these two regions due to the ongoing crisis, while over 700,000 people have been displaced. These two statistics combine to create a difficult reality for people in need of essential medical care. Those who have fled the violence often take refuge in the bush, far from any health facilities, vulnerable to malaria, infections or snakebites, in locations often inaccessible for emergency vehicles such as ambulances, or even motorcycles.
Doctors Without Borders Operations Coordinator for the South-West Region, Zakaria Mwatia, has this to say.
The reduced access to medical facilities, coupled with the fact that many cannot afford health care provided by the state, means that even in urban environments, obtaining treatment is a challenge. For this reason, the provision of a free ambulance service, and referrals for free medical care, is no less than a lifeline.Zakaria Mwatia, Operations Coordinator
Doctors Without Borders surgeon, Dr Jules, operates on a patient suffering from a hernia in Mamfe District Hospital, South-West Cameroon © Scott Hamilton/MSF
Since 2018, Doctors Without Borders has been running a 24/7 ambulance service, community-level care and support to health facilities in the two regions. In 2020, almost 9,000 referrals were completed through the ambulance service. However, in December 2020, Doctors Without Borders medical services were suspended by Cameroon’s authorities in the North-West Region; this suspension has not been lifted.
In the South-West, the ambulance service performed 3,956 referrals in the first six months of 2021. The majority of call outs were for medical issues unrelated to violence, such as women in labour. Every Monday there is a lockdown, imposed by armed groups, barring people from leaving their homes – this makes it extremely difficult for people to get to hospital if there’s a medical emergency. During these lockdowns Doctors Without Borders’ ambulance call centre responding to emergencies in the Kumba area saw an increase of more than 20 per cent in the number of calls received, compared to regular days. There is no other organization providing a free ambulance service in the South-West Region, let alone during lockdowns.
While the nature and frequency of the call-outs Doctors Without Borders receives illustrate some of the needs in the South-West, it’s also clear that substantial gaps remain in terms of healthcare for the population.
The effects of this crisis on the population must not be underestimated. Our support to hospitals, our community health workers, and our ambulance service are vital for people here, but the needs are massive, and by comparison, our work is a drop in the ocean; more needs to be done.Zakaria Mwatia, Operations Coordinator
After being involved in a serious traffic accident, bystanders called the Doctors Without Borders ambulance to pick up Ndip Kingsley Endeley. He was taken to Kumba district hospital and admitted for treatment. Though he was not at home when he had his accident, Ndip Kingsley Endeley notes that the ongoing crisis has made it harder for people in his community to access health care. © Scott Hamilton/MSF
Even as the scale of this crisis is highlighted, attacks on healthcare staff, facilities and ambulances, perpetrated by armed men continue. From kidnapping and threats, to acts of violence in medical facilities, it’s clear that the space afforded to medical workers and humanitarians is shrinking. Since Doctors Without Borders began operating an ambulance service in the North-West and South-West regions in 2018, the nurses, drivers and patients in the ambulances have regularly been harassed, threatened and intimidated by armed men. However, patients continue to be treated in the South-West without distinction, just as they were in the North-West prior to suspension: wounded soldiers of the state, as well as wounded separatist fighters and civilians are all human beings, and receive medical care from Doctors Without Borders when they need it, in accordance with international humanitarian law, article three of the Geneva Convention and medical humanitarian ethics.
While these threats and violent incidents are recorded by Doctors Without Borders’s teams, other medical actors, including those of the humanitarian community and Cameroon’s Ministry of Health face the same risks. Ultimately, it is the local community who pays the price for this.
Ambebila Jude, a Doctors Without Borders nurse, talks to community leaders in Mbakwa Supe Village South-West Cameroon. He talks about Doctors Without Borders principles as well as the services offered - such as community level treatment for issues like simple malaria and diarrhoea, referrals, the ambulance service, and the places where Doctors Without Borders is providing more complex healthcare for free. He also gives advice on how to report health issues in the community to prevent serious outbreaks. © Scott Hamilton/MSF
Doctors Without Borders has been working in Cameroon since 1984. Today we run medical humanitarian projects in the far north, and in the South-West regions of the country. In the far north we have been present since 2012, with services such as surgical care, maternal and obstetric care and medical care, and psychological care. We have been working in the North-West and South-West since 2018 to provide maternity and obstetric care; surgical care; treatment for sexual violence; treatment for diseases like malaria, cholera and COVID-19; and an ambulance service available seven days a week, 24 hours a day to get people to hospital during emergencies. In December, 2020, our activities in the North-West were suspended by the Cameroonian authorities, with no restart obtained so far. We work in each of these regions based on our assessment of people’s need. All the care provided by Doctors Without Borders is free of charge, and carried out in accordance with medical ethics.