Lily Séguin: “To fight Covid-19 in CAR, we must listen to the communities!"

In Central African Republic (CAR), Covid-19 has affected fourteen people. But how do you deal with a pandemic like this in a country ravaged by more than seven years of conflict, and where confinement is just not an option?

Oxfam hopes for the best, but prepares for the worst. Meet Lily-Madeleine Séguin, a whirlwind of energy from Canada, supporting our work with communities.

Tell us about your day-to-day work:

I work with communities to reduce public health risks. To put it simply, I ask myself these questions: what do communities experience, what do they think, and how can we put them at the centre of what we do?

In CAR, I first came to help our sanitation management teams in Bria and Batangafo [two areas in the north of the country where Oxfam works]. Then we were caught by Covid-19, and I was asked to stay on! Today we are faced with something completely new. How can we continue to deliver our essential humanitarian activities despite the pandemic? How can we adapt our health promotion activities? Even managing a small team has become difficult.

In 2018 and 2019, you were in the Democratic Republic of Congo (DRC) for Oxfam’s response to Ebola. What lessons have you learned from there?

We must involve communities right from the start. It helps to avoid misunderstanding, tensions between the response team and communities, violence, and can also help prevent a greater spread of the disease. The communities’ response to Ebola was violent in DRC. For example, the beds of those affected by Ebola were burned right in front of their houses. It’s very important that people don’t feel stigmatized. And it was commonly felt that because of the need for speed/urgency, that there was no time for community engagement. It’s true that discussions take time. But we can't do it properly without involving people!

And how can we fight the rumours, myths, and misconceptions?

At Oxfam, we focus on activities which directly address community perceptions. Our teams go out and meet people. We take the time to listen to them and discuss what needs to be done. Our teams pay attention to their feelings, their way of perceiving the disease, their questions. And we work with individuals who are trusted and influential in the communities to deconstruct rumours, dismantle myths, and work together on the best ways to protect themselves from Covid-19. It’s a very powerful tool to fight misinformation. A prevalent issue is the fact that this disease has been imported from elsewhere, and this causes problems. And there is a lot of talk around different conspiracy theories. We are all slowly learning about this new disease and this means that we cannot necessarily provide answers to every question being asked- so as humans we fill those gaps with our own ideas and theories. Some believe that black people are immune, others that it is a conspiracy from abroad to kill Africans. We must put an end to these kinds of ideas!

Many countries have imposed general confinement to contain the pandemic. Could this work in CAR?

No. So far the Government hasn’t put confinement measures in place here, opting instead for social distancing measures - which remain very complicated. Many people live day to day and will receive little or no financial help or any type of support if they cannot get out of their homes. Above all, most people live in small spaces. This is even the case in urban districts, but even worse are conditions in the internally displaced people’s camps and settlements where people have sought safety from conflict. The largest of these is the site in Bria in the centre of the country which is home to 45,000 people AR, where congestion is high, and the facilities are communal. Self-isolation is just not possible.

Without confinement, the risk of infection is great. What do you think should be done?

To fight Covid-19 in CAR, we must listen to the communities and find solutions jointly with them! Of course, we must work with the medical organisations too, but we should definitely not make the mistake of having biomedical conversations only. In the end, in my opinion, there are currently two, far from perfect options, available to communities: the isolation of people with the virus or the isolation of vulnerable people, such as pregnant women, the elderly, pregnant women, or those suffering from chronic, respiratory or heart diseases.

Are women more at risk?

Women are on the front line! In most cases, women are the ones who fetch water and take care of the family, sick parents or children stranded at home because the schools are closed. This is the tragedy with Covid-19, or Ebola: the people most at risk are those who take care of the sick. It attacks our very capacity for humanity, and this makes the disease even harder to deal with.

What is the worst scenario for CAR?

According to the United Nations, CAR is one of the least prepared countries in the world to deal effectively with Covid-19. It is one of the planet’s poorest countries, where one in two people is already in need of aid. The country’s health system is extremely weak. 70% of health services are provided by humanitarian organisations, which are already fighting epidemics of measles and malaria. The worst-case scenario would be a severe outbreak of Covid-19 combined with any upsurge in violence that would force NGOs to leave the country. There can be nothing worse than an epidemic in a civil war!

So do you see any hope?

Right now, we have a window of opportunity to act in CAR. There is no general lockdown and there are very few cases at the moment, so we can still move around and access the communities. But overall, the international community is overwhelmingly focused on how the pandemic is affecting their own countries. Our greatest hope is that it will not forget CAR, and that the Covid-19 response plan will be funded.

Interview by Aurélie Godet / Oxfam RCA.