The Central African Republic (CAR) is home to one of the world’s most severe, and most underreported, humanitarian crises. In early 2013, a coalition of rebel groups marched on the capital, Bangui. This move, and the response of other groups, triggered waves of bloodshed and displacement, and resulted in unimaginable suffering across the country. Communities that had coexisted peacefully for decades were torn apart.

Even today, the United Nations estimates that more than half of the country’s population – around 2.5 million people – needs some form of humanitarian assistance. One in five Central Africans are displaced.

In late 2013, at the peak of the political and humanitarian crisis, the International Federation of Red Cross and Red Crescent Societies (IFRC) was asked to take over as Principal Recipient of a country-wide malaria programme, funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria.

What followed was an experience that highlighted the many complexities – and hidden opportunities – of working in fragile settings.

“We achieved something that no one thought would be possible”

Jason Peat leads IFRC’s work with the Global Fund in CAR. “We took over a programme that,  because of the violence and insecurity, had ground to a complete halt,” he said, recalling the difficult early days of the programme.

CAR has some of the highest malaria rates in the world. Children and adults were dying of a preventable disease. Something needed to change.

“Our goal was to get bed nets and malaria treatment to the local health facilities that Central Africans rely on, but that, because of the emergency,   did not have the supplies to do the job effectively,” said Peat.

“When we started working with Global Fund, our target was to reach 166 health facilities and surrounding communities. Our advantage was that our partners were the Ministry of Health and the Central African Red Cross, giving us a presence in facilities and communities across the country.”

Working through the Ministry of Health and networks of Red Cross volunteers, the programme quickly gathered speed. Before long, the initial target of 166 health centres was surpassed. New targets were quickly set. Eventually, 632 health centres were reached and supported.

“We achieved something that no one thought would be possible,” said Peat.

Between 2014 and 2017, despite the ongoing emergency in the country, IFRC managed one of the most successful large-scale mosquito net campaigns ever conducted in Africa. More than 2.8 million nets were distributed, providing protection to more than 5 million people. In addition, more than 4.1 million malaria treatments were administered, averting tens of thousands of child deaths.

Uncovering frontline problems

In late 2014, as a result of its success on the malaria programme, IFRC was once again approached by the Global Fund, this time to take over as lead recipient of the HIV and Tuberculosis grant. Working again through the Health Ministry and the Central African Red Cross’s unparalleled community networks, the programme extended antiretroviral therapy to more than 30,400 people – an increase from 14,000.

“Our approach on both the malaria and HIV grants was to get life-saving commodities out to communities as quickly as possible. We could see the needs, and we could see how the insecurity was quickly making those needs worse,” said Peat.

The commodities – medicines and bed nets – were stored in a series of warehouses in the capital Bangui before being shipped to the provinces. These warehouses – so critical to the efficiency and effectiveness of the programme – were also an example of how humanitarian efforts can be undermined by a very basic but common risk: the theft of commodities in operations where humanitarian need is high and systems are weak.

Stopping theft

According to a Global Fund report released last week, malaria and HIV medicines were stolen by a person working for the agency that was managing the warehouse. The value of the stolen medicines was just less than one per cent of the Global Fund financed medicines purchased in CAR by IFRC since 2013.

IFRC   uncovered and reported the theft to the Global Fund in early January 2017. IFRC also took immediate steps to strengthen security and oversight at the warehouse, including changing locks and key control protocols, limited the number of people entering the warehouse, undertaking an immediate inventory of the warehouse, changing private security companies, and installing additional security lighting at the warehouse.

“Although we were not directly managing the warehouse when medicines were stolen, as principal recipient and in order to protect life-saving medicines, we intervened and quickly    strengthened security and control processes  ,” said Peat.

“It was a painful experience that really underscored the impact that issues as seemingly simple as warehouse security and oversight can have on efforts to save lives.”

Strengthening security

IFRC’s focus immediately turned to fixing the problem, says Peat. Within days of reporting the theft, IFRC took over direct management of the warehouses.

The IFRC teams in Bangui and Geneva also worked closely with the Global Fund team undertaking the investigation, and the organizations are now working together to make sure that all the issues raised in the report are addressed.

As a result of this collaboration, a series of additional measures have been undertaken to strengthen management of the warehouse, including the upgrading of inventory management software, an increase in the number of people working in the warehouse, and the contracting of a third party to provide independent oversight for commodity management, particularly during the inventory process

Shining a light on real-world humanitarian challenges

“We welcome the publication of this report,” says Peat. “It’s painful that this happened –   systems weren’t robust enough, and   people exploited this. But this kind of report is absolutely necessary.

“The reality is that working in places like CAR – or in any environment where security is an issue – is complicated. As a humanitarian organization, we need to do a better job of talking about this. These challenges aren’t unique, and they won’t be overcome until we bring them into the light.”