The Central African Republic (CAR) is one of the most challenging rehabilitation environments in Africa. Landlocked and sparsely populated, the country sits at the centre of the continent and has faced repeated cycles of conflict, displacement, poverty and health-system disruption. The World Bank describes CAR as one of the poorest and most fragile countries in the world, despite its natural resources, and notes more than two decades of recurrent crises.
For prosthetics and orthotics, CAR represents an urgent humanitarian and health-system priority. Demand is shaped by conflict-related trauma, road injuries, untreated childhood disability, poverty, malnutrition-related developmental delay, displacement, limited specialist rehabilitation services and low access to assistive technology.
For IMEA CPO, CAR should be viewed as a country where the future of O&P depends on practical, locally anchored rehabilitation capacity: trained professionals, reliable workshops, affordable devices, repair systems, referral pathways and long-term follow-up.
The Central African Republic is bordered by Chad, Sudan, South Sudan, the Democratic Republic of the Congo, the Republic of Congo and Cameroon. Its capital, Bangui, is the main administrative and healthcare centre, but much of the population lives in rural or difficult-to-reach areas.
The country’s geography and security situation make rehabilitation access difficult. Patients with limb loss, deformity, neurological impairment or mobility disability may need to travel long distances to reach a centre capable of assessment, fabrication, fitting and follow-up.
CAR’s political and humanitarian context has a direct effect on rehabilitation. The World Bank notes that the country has experienced recurrent crises, including the 2013 Séléka seizure of power and later violence linked to the Coalition of Patriots for Change. These conditions create trauma, displacement and service disruption — all of which increase the need for prosthetic and orthotic care.
Reliable disability data in CAR remains limited and outdated. The African Disability Rights Yearbook notes that the 2003 census recorded 50,636 persons with disabilities, or 1.3% of the population, but such figures are likely to understate real need because of underreporting, limited survey coverage and conflict-related access constraints.
The same review highlights a key problem for rehabilitation: people with disabilities in CAR face major access barriers in public buildings, transport, education, vocational training, healthcare, employment and justice. It also notes a lack of doctors specialised in re-education and rehabilitation.
For O&P, this means that assistive technology cannot be viewed only as a product issue. A prosthesis, orthosis, wheelchair or walking aid is only useful when the person can access assessment, fitting, training, repairs, follow-up and inclusive community support.
CAR remains one of Africa’s most severe humanitarian contexts. The Norwegian Refugee Council reported that, according to OCHA, 50% of the population relies on humanitarian assistance to survive, while 25% are displaced either internally or in neighbouring countries. As of October 2024, CAR had 465,499 internally displaced people, with 675,000 Central Africans living as refugees in neighbouring countries and 214,000 returnees registered.
This displacement has major implications for prosthetics and orthotics. People fleeing conflict may have untreated fractures, amputations, spinal injuries, burns, neurological trauma, chronic pain or mobility impairment. Many may lose access to assistive devices during displacement, while others may need repairs or replacements but cannot return to their original clinic.
Humanitarian rehabilitation in CAR therefore needs to include:
CAR’s prosthetic and orthotic service landscape remains limited. A 2019 Guardian report described a prosthetics clinic in Bangui as the country’s only centre of its kind at that time, serving people whose lives had been affected by conflict and limb loss.
Humanity & Inclusion has also played an important role in rehabilitation services in CAR. In 2018, in partnership with MSF Holland, HI introduced rehabilitation activities at Bambari General Hospital, providing physical rehabilitation care, technical devices and psychosocial support. In 2022, HI opened an integrated rehabilitation service at Bangassou hospital, similar to the Bambari model.
These developments matter because they show a gradual move toward decentralised rehabilitation. For a country as fragile and geographically difficult as CAR, access cannot depend on Bangui alone. Regional rehabilitation units, mobile outreach and referral systems are essential.
Conflict remains one of the largest drivers of prosthetic and orthotic need in CAR. Gunshot injuries, blast trauma, amputations, fractures, nerve injuries and untreated wounds can all lead to long-term disability.
For CPOs, conflict-related cases are often complex. Patients may present late, with poor wound healing, pain, contractures, infection history, psychological trauma and limited ability to attend follow-up appointments. Rehabilitation must therefore be realistic, durable and adapted to local living conditions.
Displacement interrupts healthcare. Patients may lose devices, miss appointments, or move into areas with no repair or follow-up service. Children may outgrow orthoses or prostheses without review. Adults may continue using broken or poorly fitting devices because there is no alternative.
This makes repair capacity one of the most important parts of O&P service planning in CAR.
Humanity & Inclusion reports that its teams in CAR have delivered stimulation therapy activities for children who experienced acute to severe malnutrition, with the aim of preventing and reducing developmental delay and disability linked to malnutrition.
This is relevant to paediatric rehabilitation because children affected by malnutrition, neurological impairment, congenital conditions or delayed development may require orthoses, standing devices, mobility support, physiotherapy and family education.
HI launched its first explosive ordnance risk education project in north-eastern CAR in 2022, alongside mental health and psychosocial support for populations exposed to explosive-device risks or psychological distress.
For O&P providers, explosive ordnance risk is directly linked to amputation and trauma rehabilitation. Prevention, emergency care and long-term prosthetic services must be understood as connected parts of the same protection and rehabilitation pathway.
CAR’s poverty and rural geography create major barriers to assistive technology. Even where a device is available, transport costs, food insecurity, insecurity on roads and lack of accommodation near clinics may prevent patients from accessing care.
This means rehabilitation models must be practical and decentralised. Outreach clinics, community-based follow-up and partnerships with local health workers can help reduce the burden on patients.
CAR ratified the UN Convention on the Rights of Persons with Disabilities (CRPD) and its Optional Protocol in 2016. The African Disability Rights Yearbook notes that CAR has disability-related laws and policies, including Law No. 00.007 on the promotion and protection of the rights of persons with disabilities and application measures under Decree No. 02.205.
However, implementation remains a major challenge. The same source notes that, in practice, people with disabilities face significant access barriers and that very little is done to ensure full access across public life.
For the O&P sector, the gap between legal rights and practical access is the central issue. Rehabilitation should be treated as essential healthcare, not as optional charity.
CAR urgently needs a stronger rehabilitation workforce. This includes prosthetists, orthotists, orthopaedic technologists, physiotherapists, occupational therapists, rehabilitation doctors, wheelchair technicians, social workers and community rehabilitation personnel.
Priority training areas include:
International partners can support training, but long-term sustainability requires Central African professionals leading services in their own communities.
Assistive technology needs in CAR include prostheses, orthoses, crutches, walkers, wheelchairs, positioning devices, paediatric supports, orthopaedic footwear and pressure-relief solutions.
The ICRC describes physical rehabilitation as including mobility devices such as prostheses, orthoses, walking aids and wheelchairs, alongside professional training and sustainable service provision. This framework is highly relevant for CAR, where manufacturing, fitting and follow-up must be connected to broader rehabilitation and social reintegration.
The most immediate priorities are likely to be:
Humanitarian organisations are central to CAR’s rehabilitation landscape. HI’s work in Bambari and Bangassou shows how rehabilitation can be integrated into hospital services outside the capital.
The next step should be to connect these initiatives into a broader national rehabilitation network. Humanitarian rehabilitation should not remain a set of isolated projects. It should support national systems, train local staff and help establish durable services that continue beyond emergency funding cycles.
Digital prosthetics and orthotics may have future potential in CAR, but any technology must be appropriate to the country’s infrastructure and service realities.
Useful digital approaches could include:
However, digital solutions should not be introduced as stand-alone innovations. CAR first needs reliable clinical pathways, trained professionals, materials, workshops and follow-up systems.
CAR’s rehabilitation sector has significant development needs, but also clear opportunities:
CAR’s O&P development faces serious constraints:
These barriers are significant, but they also show why coordinated investment in rehabilitation could have a high impact.
The Central African Republic is one of the clearest examples of why prosthetics and orthotics must be part of humanitarian health planning. Limb loss, disability and mobility impairment do not end when emergency treatment is complete. People need devices, therapy, training, repairs, follow-up and social reintegration.
For IMEA CPO, CAR should be understood as both a humanitarian rehabilitation priority and a long-term workforce development challenge. The need is not only for donated prostheses or orthoses. The need is for Central African capacity: trained professionals, functioning workshops, regional services, referral systems, and durable support for patients over time.
In a country affected by conflict, displacement and poverty, mobility is not a luxury. It is part of survival, dignity and participation. Building CAR’s O&P sector should therefore be seen as part of rebuilding the country’s health and social infrastructure.