Despite some appearances of relative calm in Mali in recent weeks, the emergency is not yet over for the vast majority of the population in the country’s northern reaches. Doctors Without Borders/Médecins Sans Frontières (MSF) has been supporting medical facilities in two of three regions in northern Mali since April 2012 to ensure access to free medical care for the vulnerable, but ongoing insecurity is still limiting the teams’ ability to carry out activities in rural areas. Meanwhile, hundreds of refugees continue to cross the border into Mauritania every day.
While fighting has moved south towards the Kidal region, people in some rural areas in the north remain afraid to leave their houses, and the general atmosphere makes it difficult to get a clear picture of the health needs. “Due to the insecurity,” says Rosa Crestani, MSF emergency program coordinator, "we cannot assess the needs of those living outside the urban areas in which we are working.”
"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 forced thousands to flee to the country’s center or across the borders. Many Malian medical professionals fled along with them. "The conflict has weakened and disrupted health facilities that were already fragile and affected by drugs shortages," explains Crestani.
MSF and Malian volunteers have been running activities in the regional hospital of Timbuktu in northern Mali since April 2012. Teams have performed more than 50,000 consultations, assisted with 400 births, and treated 50 wounded patients in the hospital or in health centers supported by MSF in this region. Ambulances are also transporting referral patients to Timbuktu from the Niafounké and Gourma Rharous district hospitals, along the Niger River.
In the Mopti region in central Mali, MSF supports a community health center in Konna and a community and reference health center in Douentza. Since November 2012, MSF has treated nearly 8,000 people. Since February, MSF has treated five wounded individuals injured by unexploded munitions in Konna. In Gao and Ansongo in eastern Mali, teams have treated nearly 1,500 patients 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.
Nearly 170,000 refugees have reached 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 for refugees in these three countries. Mauritania has the most Malian refugees at present, with the camp in Mbera accommodating nearly 70,000 people. In late January and early February, the border point in Fassala, Mauritania, registered an average of 300 arrivals a day—most of them women and children from Timbuktu, Lere, Goundam, Larnab, and Niafounké.