The largely Muslim militia has been fighting to stave off a counter-coup attempt by forces of the Christian majority in this ’state’ in the capital Bangui and the northern city of Bossangoa.
Because they get no pay, they pay themselves by looting the population they claim to protect: notably the Christian population.
In Bouar’s hospital with one broken generator and no running water, the staff receive the results of the mayhem beyond its walls.
Little three year old Josuie has been shot through the buttocks.
Wide-eyed, staring, unsmiling, he clings to his father who says: ” I lost my three other children and my wife. You see now – he is all I have left.”
On the bed next door another little girl Lesley eats as best she can with her left arm. The right has been shot off. She is six years old.
The doctor here – like the patients – cannot be named for their own safety. He is a 33 year-old who is still a trainee, hoping to become a general practitioner.
We meet one morning as he prepares for an operation. It starts at the outside waterpump where an orderly carries a jug of water on her head to a primitive heater.
Finally, decanted to a kettle, the trainee doctor – there are no surgeons here – can finally begin scrubbing up.
The light in the operating theatre is broken. The sterling vat is broken. A gerry-rigged overhead light will work for operations as will the fan in the searing equatorial heat – but only when there is power.
So here’s the problem. A Muslim man (religion suddenly matters in spiralling sectarian violence) has a bullet entry wound but no exit.
It’s in there somewhere. In a British NHS hospital, a brief x-ray followed by electronic real-time imagery would locate the foreign object so that surgeon could carry out an operation.
Quick, fast, not without pain – but routine.
Here, our trainee GP has no choice but to expose the man’s intestines and begin feeling his way in, hoping to touch some pea-sized hard foreign body.
He delves into the exposed intestines, looking away into space, intent upon fingertipped sensation from his bloody, white plastic gloved hands.
That is not all. Without power and equipment anaesthetic cannot be accurately monitored. So the man is restrained by thick leather straps across knees and wrists, in a crucifix position.
With the minimum level of anaesthetic, he moans with pain throughout, teeth clenched. It takes ninety minutes to locate and extract the bullet.
It is through the efforts of Save the Children that free health care is available here. And with 57,000 patients to this one doctor you might think the place would be overwhelmed.
It is all but empty. And the reason is simple: fear.
The Seleka militia recently attacked the hospital. The Muslim gunmen looking for supporters of the Christian Anti-Balaka movement.
Heavily armed Cameroonian and Gabonais soldiers from the African UN peacekeeping force have since been deployed in the hospital grounds. But people have no faith in the peacekeepers, who are anyway to few in number to cope with a full scale assault. It was only on Thursday that the UN Security Council passed a resolution that gave the foreign troops the authority to use force to impose peace.