Access to medical care remains very limited in the north of Mali due to a lack of medical staff and supplies, and clashes between armed groups continue despite a peace agreement.

In Ansongo town, Gao region, Doctors Without Borders/Médecins Sans Frontières (MSF) supports the 48-bed referral hospital, providing outpatient consultations, inpatient and emergency care, surgery, maternal healthcare, treatment for chronic diseases, nutrition and laboratory services. The team also offers mental health support to victims of violence, and treats victims of sexual gender-based violence. Another team supports the district health centre. In the rural areas of Ansongo district, we arrange referrals from the community to health centres and the hospital.

From the MSF International Activity Report:

Persistent insecurity, particularly in northern and central regions, has resulted in an overall deterioration in the national health system and basic social services in Mali. MSF runs programs in several parts of the country to increase access to healthcare for the most vulnerable.

Angsongo

MSF has been supporting the reference hospital in Ansongo town, in Gao region in eastern Mali, since 2012. Teams support outpatient consultations, emergency care and admissions, surgery, maternal healthcare, chronic disease treatment, nutritional care, neonatology, paediatrics and treatment and psychological support for victims of violence, including victims of sexual violence. MSF also provides basic care for pregnant women and children under five years of age at the community health centre in the town.

In Ansongo district, MSF refers patients to community health centres and transfers severe cases to Gao hospital. Between July and December, when nomadic groups migrate, teams ensure they have access to healthcare by training community health workers to diagnose and treat the most common diseases. A monitoring and referral system for serious cases is also in place.

Kidal

In Kidal, north of Gao, MSF supports six health centres in and around the city in partnership with local authorities. Teams provide primary healthcare to the entire population as well as epidemiological surveillance, and refer complicated cases to the referral health centre (CSRef) and Gao hospital.

In Douentza, MSF supports the CSRef in the management of malnutrition, emergency surgery, hospital admissions for children under 15 years of age and mental health services. It also provides referrals to the CSRef, and transfers urgent cases to Mopti city.

In Koutiala, in the south of the country, MSF focuses on children under the age of five. The team supports nutrition services at the CSRef, as well as in 15 community health centres. In addition, MSF deploys extra community workers in the health district during the peak malaria season. MSF is currently constructing a 185-bed paediatric care unit at Koutiala CSref.

In Ténenkou, MSF’s priority is care for women of childbearing age. Staff support the maternity ward, operating theatre and the outpatient department at the CSRef. MSF also deploys ‘malaria agents’ to hard-to-reach communities during the peak months (August to November) and mobile clinics offering basic healthcare.

Emergency response team in the Sahel

An emergency mobile team, composed of medical, paramedical and logistical experts, has been in place since 2015 in the Sahel. Its purpose is to monitor the epidemiological situation and to respond, within 24 to 48 hours, to medical and humanitarian emergencies in the region, mainly in Niger but also in Mali.

'People arrived exhausted': MSF provides emergency medical care after an attack on Tindinbawen village in Mali

On July 27, 2018, non-state armed groups attacked the village of Tindinbawen, Ansongo district, in northern Mali. Several people were killed and around 80 families were forced to flee to Tin Hama, a village located 80 kilometres away.

“The people we met told us how the attackers stormed the village, burned houses and executed a number of men. People had no choice but to flee for safety in the surrounding villages,” said Rodrigue Nganaboy, MSF field coordinator in Ansongo. According to their testimonies, pregnant women, children and the elderly had to walk the 80 kilometres to Tin Hama. “People arrived exhausted; they ran out of water and food and had to travel through the middle of a storm during their journey.”

An MSF team travelled to the village of Tin Hama to assess the immediate needs of the displaced people.

“When we first arrived, the living conditions were deplorable: access to water and food was limited, and people had no household or hygiene items,” Nganaboy explains. “There were also no shelters or mosquito nets to protect them from the elements. None of the children were vaccinated and pregnant women hadn’t received any medical attention.” Apart from some food donated by the local community, displaced people in Tin Hama had little else.

 

Photo Story: MSF medical services in northern Mali

In northeastern Mali, in the towns of Ansongo and Douentza, MSF provides a range of medical services.

Since 2012, we have supported services in the referral hospital in Ansongo, in the Gao region, including outpatients, emergency care and hospitalization, maternal health, treatment of chronic illnesses, nutrition, and neonatal and pediatric services. At the community health centre in the town, renovated by MSF, the teams provide primary health care to pregnant women and children under aged under five.

In Douentza, in the nearby Mopti region, MSF teams support the Referral Health Centre (CSRef) in nutrition, emergency surgery, mental health, and care and hospitalization for children aged 0-15. We also ensure the transfer of urgent cases to the city of Mopti. 

 

'Insecurity has pushed people to their limits': Q&A with an MSF coordinator about the humanitarian situation in Mali

Jamal Mrrouch has just returned from Mali, where he spent more than one year coordinating MSF’s work in the northern regions of Gao and Kidal, and in the central region of Mopti. With the first round of the presidential elections scheduled for 29 July, Jamal reflects on the humanitarian situation in the country.

What are the primary needs in the north and centre of Mali?

Insecurity has pushed people to their limits. Over five years have passed since the conflict broke out in 2012, and three years since the Algiers peace agreement was signed by several armed opposition groups and the government of Mali. Despite this, there has not been any progress and the ongoing conflict is becoming a chronic crisis.

People’s basic needs, such as health, protection and nutrition, are not being completely met. Inter-community conflicts are fuelling tensions and causing internal displacement. But while the political solution is stagnant, the international community is giving priority to military operations in northern and central Mali.

Has the situation improved at all in this last year?

The humanitarian situation has continued to deteriorate in recent years due to several factors. There has been no rain lately, which affects the harvest and access to food for the population.

In most of the towns in the north and central regions of the country, and especially in rural areas, insecurity is disrupting basic services. The ban on using motorcycles and vans in the centre of the country hinders access to healthcare, as these are the only means of transport to reach medical facilities. Since the ban has been in force, we have recorded a 40 per cent decrease in admissions to a hospital we support in Douentza, in the Mopti region of central Mali.

In addition, insecurity in the Sahel is causing many people to become displaced, which makes it difficult to meet even the most basic humanitarian needs. According to the UN refugee agency, UNHCR, more than 130,000 Malian refugees have sought refuge in neighbouring countries such as Burkina Faso, Mauritania and Niger. And given the situation in the northern and central regions, they are unable to return home any time soon.

MSF started working in the Mopti region a year ago. Why?

Since 2013, several armed groups have gradually occupied the centre of the country and today it is one of the most tense areas in Mali. It is a very densely populated region and different groups compete for the exploitation of the land.

The clashes between the Fulani and Dogon communities, traditionally farmers and pastoralists, have become even more complicated with the ongoing crisis. One or other community is accused of collaborating with armed opposition groups in the area, which in turn stigmatizes different members of that community. This results in violent confrontations, with civilians injured or killed.

In this tense climate, state services and aid organizations have left the area. Many organizations cannot guarantee the protection of their staff and their operations against crime and violence, which has increased a lot in the area over the past year.

 

Mali: An MSF psychologist on providing mental health care for migrants expelled from Algeria

Sonya Mounir is an MSF psychologist. She has just returned from Gao, in northern Mali, where MSF has been providing psycho-social support to migrants returning home having been expelled from Algeria.

You were in Gao, a town in Mali through which hundreds of migrants expelled from Algeria have passed. What was the situation there?

MSF started working in Gao at the end of April 2018, after learning that more than 700 sub-Saharan migrants expelled from Algeria were passing through the town before being returned to their countries of origin.

When I arrived, I found people from various sub-Saharan African countries; all were exhausted by the return journey and the ill-treatment they had experienced. Gao had makeshift structures set up to accommodate migrants, but nothing was offered to meet their major health and psychosocial support needs. That's why we distributed hygiene kits to more than 500 people and provided urgent psychological assistance to 260.

 

By the numbers: MSF's work in Mali, from the 2017 International Activity Report

Outpatient consultations: 178,200

Number of staff: 763

Expenditure: $19.2 million CAD

Year first worked in the country: 1992