Mali: Violence escalates, access to healthcare decreases

The Malian army, with supported from its Russian partners, is fighting non-state armed groups in central and northern Mali. "In recent weeks, we have had to evacuate some of our teams and partially put on hold certain medical activities in the Ségou and Timbuktu regions. We are often the last humanitarian organisation to work in sensitive areas. When MSF decides to leave, it's because the situation has become very critical. We are concerned for people who are not taking part in the conflict, but who are nevertheless exposed to the violence and whose access to healthcare is compromised. When we started operations in Toulé and Toladji, some people told us that they hadn’t seen a doctor for seven years," explains Aissami Abdou, operations coordinator.

In recent months, other episodes of violence have also had the effect of restricting people's access to healthcare. ​

From August to December 2023, the Jama'at Nusrat al-Islam wal-Muslimin, JNIM, a non-state armed group, prevented goods and basic necessities from entering Timbuktu. The city and its surrounding areas were almost inaccessible by land and river. As a result of various attacks and threats, the authorities issued a curfew, and the cost of living rose while food and fuel rations were cut.

"This town’s isolation also had an impact on some of MSF's activities," explains Jean Jacques Nfon Dibie, MSF project manager in Timbuktu. "Because of the difficulty of access and lack of security, MSF has had to limit activities and movements, evacuate some staff, and contend with the problems of medicine supply, logistical equipment, and fuel. Some medical supervisions have been temporarily suspended. This has had an impact on our activities.”

In Niafounké, also in the Timbuktu region, MSF and Ministry of Health teams treated 29 wounded, including two women, in the hospital's emergency department following an attack on a military camp on Friday, 24 November. To treat the wounded, MSF helped to triage the injured according to the seriousness of their condition and provided medical drugs and material.

In September, an MSF vehicle transporting a medical referral from Hombori to Douentza was shot at in Mopti. The vehicle was carrying a pregnant woman who, due to complications, had been referred to Douentza hospital. The pregnant woman was accompanied by her mother, who was killed, while she and two other passengers were injured.

Fatal accidents involving explosive devices are also becoming increasingly frequent. On the night of Saturday 22 to Sunday 23 October, three fairground vehicles returning from the market were blown up by explosive devices at three different locations on the Gossi - Hombori road in central Mali. Eight people were killed instantly and around forty injured, including 11 with serious injuries, all of whom were admitted to the Hombori community health centre where MSF teams work.

The general security situation in the centre and north of the country is worrying. The violence is impacting the population, who find themselves trapped, as well as MSF. "We remind all parties to the conflict that our staff, our ambulances and our health structures must be respected and spared. Our mission is carried out in compliance with medical ethics, which impose in particular the duty to provide care without harm and to assist any person in danger, with humanity, impartiality and respect for medical confidentiality. Our medical activities must be preserved. Children, pregnant women and the injured must be treated," concludes Abdou.

MSF has been present in Mali since 1985. In 2022, MSF carried out 552,800 outpatient consultations, hospitalized 68,000 people,, performed 1,830 surgical operations, and treated 900 people for intentional physical violence and war wounds.

MSF currently runs regular projects in the regions of Kidal, Gao (Ansongo), Timbuktu, Niafounké, Mopti (Ténénkou, Douentza and Koro), Ségou (Niono) and Sikasso (Koutiala), as well as in the capital, Bamako. The organisation also provides a wide range of emergency services to meet the major needs of people across the country.

Our services include maternal care (consultations, deliveries, and Caesarean sections), paediatrics, neonatology, mental health, prevention (vaccination and health promotion), cancer screening and treatment, protection, assistance for displaced people (non-food kits, access to water, and construction of latrines), construction and rehabilitation of health facilities, and referrals of patients to appropriate health facilities.