Why are we there?
- Conflict
- Endemic/epidemic disease
- Healthcare exclusion
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Mali crisis update: 12th March 2013
We have been supporting medical facilities in two of the three regions in northern Mali since April 2012 to ensure access to free medical care for the vulnerable.
However, the insecure environment is preventing the medical teams from carry out activities in rural areas. Hundreds of refugees are continuing to cross the border to Mauritania every day. The emergency is not yet over for the vast majority of the population in northern Mali.
While fighting has moved towards the more southern region of Kidal, there are still inaccessible rural areas where the people are afraid to leave their houses.
"Due to the insecurity, we cannot assess the needs of those living outside the urban areas in which we are working," explains Rosa Crestani, MSF Emergency Programme Coordinator.
Access to healthcare
A general environment of tension and distrust among the local population may further undermine access to healthcare. "We fear that some patients remain trapped at home," she continues.
“It is difficult for these people to access food, and the risk of malnutrition is significant.
"The people must not be the target of violence and must be able to safely access the vital medical and humanitarian aid they need”.
For nearly a year, fear of violence in northern Mali has forced thousands to flee to more central parts of the country or to neighbouring countries.
Faced with the risk of violence, some vital Malian medical staff have also been forced to flee the area. "The conflict has weakened and disrupted health facilities that were already fragile and affected by drugs shortages," explains Rosa Crestani.
Timbuktu and Mopti
MSF and Malian volunteers have been running activities in the regional hospital of Timbuktu in northern Mali since April 2012. More than 50,000 consultations have been performed, 400 births have been assisted and 50 wounded have been treated in the hospital and the health centres supported by MSF in this region.
Ambulances are also referring patients to this hospital from the Niafounké and Gourma Rharous district hospitals, along the Niger River.
In the Mopti region in central Mali, MSF supports a community health centre in Konna and a community- and reference health centre in Douentza. Since November 2012, MSF has treated nearly 8,000 people. Since February, MSF has treated five wounded hit by unexploded munitions in Konna. In Gao and Ansongo in eastern Mali, nearly 1,500 patients have been treated since September 2013.
“The objective of MSF's activities is to ensure access to free medical care for those who really need it,” says Crestani. "We primarily treat malaria, respiratory infections and obstetrical- and gynecological cases. Being a doctor in times of conflict does not just involve treating the wounded, but also ensuring that a mother can give birth in safe and sanitary conditions", she says.
Refugee camps
Nearly 170,000 refugees have reached the refugee camps in Burkina Faso, Mauritania and Niger, where MSF teams are providing primary and secondary medical care.
Since the start of the year, MSF has carried out nearly 12,000 medical consultations and 5,000 vaccinations in these three countries. Mauritania has the highest number of refugees, with the camp in Mbera accommodating nearly 70,000 people.
Around the end of January and the beginning of February 2013, the border point in Fassala, Mauritania, registered an average of 300 arrivals a day. These are mostly women and children from Timbuktu, Lere, Goundam, Larnab and Niafounké, who are still living in poor conditions without any hope to return home in the near future.
Historical
Although significant progress has been made in reducing child mortality in Mali, 178 of every thousand children born in the country still die before they reach the age of five.
Malnutrition and malaria
Malnutrition and malaria are the cause of at least half of all these deaths, and malaria is the leading cause of illness and death throughout the country.
In southern Mali, Médecins Sans Frontières/Doctors Without Borders (MSF) runs two paediatric programmes, focusing in particular on these two deadly conditions.
Malaria treatment in Kangaba
The number of people who die from malaria is especially high in Kangaba, Koulikoro region, and MSF has been providing treatment for the disease since 2005.
In 2011, MSF supported 11 health centres in the province, delivering free basic healthcare to 6,500 people, about half of whom were children under five.
To improve access to care, a team of 66 malaria experts, elected by local communities, has been trained and equipped to screen and treat people living in villages more than five kilometres away from a health centre.
In five years, the mortality rate among children under five has dropped by 50 per cent. Eight times as many people are attending health facilities.
In April, MSF handed the project over to a Malian association, the Medical Alliance against Malaria, which is continuing some of the activities in partnership with an international non-governmental organisation, Alliance for International Medical Action (ALIMA).
A paediatric consultation in Konseguela, Sikasso region. © Antoine Prus / MSF
Healthcare in Koutiala
In Koutiala district, Sikasso region, MSF has worked in five health centres and the paediatric ward of the district hospital since 2009.
In four of the centres, MSF assists Ministry of Health and community health centre (CSCOM) health workers, providing additional staff, supervision, donations of drugs and logistical support in carrying out outpatient consultations and vaccinations, as well as screening and treatment for malnutrition. Staff treated 53,000 children – 30,000 of them for malaria.
In the fifth, Konseguela, MSF offers comprehensive health services for children. Healthy children aged between six months and two years receive supplementary milk-based food, routine vaccinations and mosquito nets, and are seen every three to six months.
In 19 villages in the health area, community health workers test for and treat malaria. They also refer people with other conditions, such as malnutrition, to the centre. The community health workers treated 7,500 people for malaria in 2011.
MSF carried out 20,000 paediatric consultations at Konseguela health centre, and provided 1,700 children with supplementary food.
Paediatric care
In Koutiala hospital’s paediatric ward, MSF has also set up a therapeutic feeding centre and a paediatric intensive care unit.
During the annual malaria peak, between August and November, the hospital is able to receive up to five times the normal number of admissions, as total capacity is increased to 350 beds.
In 2011, more than 6,600 children were admitted to the paediatric ward, and another 4,800 were admitted to the therapeutic feeding centre.
In 2012, MSF plans to start offering antimalarial drugs to all under-fives as a preventive measure during the annual malaria season, since this age group is most at risk of developing severe malaria.
At the end of 2011, MSF had 360 staff in Mali. MSF has worked in the country since 1984.
