Humanitarian organisations face an uphill struggle in Central African Republic as they take on the massive challenge of moving the embattled country firmly out of conflict into recovery.

Years of fighting between rebels and a weak government have decimated a fertile land rich in natural resources, making it one of Africa's poorest nations.

The north of the country has suffered the worst of the violence, which has forced almost 300,000 people from their homes. Rebel groups and mercenaries raid villages for food and livestock, sometimes raping and killing.

But in the wake of a fragile peace agreement, the past 18 months have seen the arrival of a wave of nongovernmental organisations, determined to begin rebuilding CAR's shattered infrastructure and restore the morale of its people.

Healthcare agency Merlin set up a new programme a year ago with the aim of tackling some of the main scourges of life in CAR. Maternal mortality rates are high, 20 percent of children die before their fifth birthday and malaria, diarrhoea and malnutrition are widespread.

"The task is huge," Merlin's CAR country director, Bruno Fugah, told AlertNet in an interview. "There's a lot to be done, in every sector...Health must be tackled, education must be tackled, infrastructure must be tackled, livelihoods must be tackled so that the people start regaining the ability to live."

Efforts so far have largely concentrated on the task of assessing the many needs and setting up coordinated systems so aid agencies can provide the systems needed in a holistic way.

But the challenges are legion.

With the health and social care system in tatters, one of the first priorities is to rebuild capacity to a basic level. Money to pay health workers' salaries and to provide training is desperately needed, something that Merlin is highlighting in its campaign, Hands Up for Health Workers.

Other factors exacerbate the difficulties of providing healthcare services. With a population of only 4 million, CAR is vast - 622,000 square km (387,000 square miles) - and its transport infrastructure is so limited that there are areas of the country where government bodies and aid agencies have no presence at all.

It takes seven hours to get to one remote area in the southeast close to Uganda, so the locals almost never see anyone who can provide services, Fugah said.

"When the U.N. and a humanitarian organisation once went there, the people felt so much, 'Wow, it shows that the international community cares,'" he said. "So to get out of this, the international community should be ready to go there and know what is happening."

Continuing insecurity also affects how much Merlin can do to improve health, with people fearing raids on their farmlands by armed bandits.

"They know that anything they do now they will come and destroy," Fugah said. "It makes nutrition a problem. They can grow crops, but they are afraid to do it. It's a problem that other organisations are also having to battle with. Insecurity is crippling the mind and the spirit of the people."

He acknowledged that CAR's low profile among the media and donors in the international community also made it hard to get sustainable funding.

"The pattern of conflict in CAR is not a burning conflict situation ... It's a different pattern of conflict," he said. "There's no noise about it, but people are silently suffering."

Nonetheless, Merlin has invested its limited resources in two of CAR's 16 prefectures, establishing 11 health centres in the north serving a population of 125,000 and three health centres in the west where around 256 000 people live.

Fugah was optimistic about the agency's chances of making a difference in the foreseeable future.

"We have an initial three-year strategic plan within Central African Republic within which we are confident we should be able to do something substantial," he said.

In the meantime, the prospects of reconciliation engendered by peace deals signed by government and rebels over the past two years are also a cause for hope. In December, the country begins a promising period of national dialogue.

"It's a milestone in the life of Central African Republic," Fugah said, adding that the benefits could have a stabilising effect on the country that will allow humanitarian organisations to operate more effectively.

But it is clear that, with so many needs to meet after years of conflict, the stakes are high.

"The problem in CAR is if we let them (the people) go back down, the likelihood of them to go many years back will come and establish again," he warned.

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