By Abdallah Hussein, Doctors Without Borders/Médecins Sans Frontières (MSF) head of mission in Burkina Faso
While COVID-19 makes headlines around the world, less visible humanitarian crises continue to escalate. In the villages of Burkina Faso’s eastern region, killings, abductions, and looting are now a regular occurrence. This is one of the areas most affected by the conflict between Burkino Faso’s national security forces and various armed groups, which has seen large numbers of people displaced from their homes.
Out of sight, vulnerable communities endure enormous hardship. Amid conflict, poverty, and recurrent epidemics, tens of thousands of people have limited access to basic services, including health care, and live in fear of violent attacks and shortages of food and water.
The coming months will be even tougher: The rainy season and the so-called hunger gap, both of which start in June, generally trigger a spike in severe malnutrition and malaria, one of the main causes of death in the country. There has not yet been a confirmed case of the novel coronavirus in the area, but it adds another layer of complexity to the already huge challenge of providing aid in such an insecure setting.
MSF has been providing free, quality health care, water, and basic relief items to people in eastern Burkina Faso since May 2019. But more needs to be done. Humanitarian assistance must be urgently scaled up to prevent more needless deaths and suffering.
Humanitarian needs and psychological scars
“Unknown people came to our village, and asked us to start wearing headscarves even when washing ourselves. They killed our husbands. They raped us. And they promised to come back. That’s why I took my three children and fled here, to Matiakoli, when they left. Our main challenges are the lack of space to live [and] food and water, which is always insufficient. We learned about COVID-19. They told us that it is a disease for which there is no medication to treat it, only measures to prevent it. We are worried because they said it propagates very quickly. We hope to be able to go back to our houses in the future.”
Assatou, 59, received care from MSF in a displacement camp in Matiakoli, eastern Burkina Faso, where she and her family have lived for a year.
In the past two months, a new wave of attacks against remote villages in Burkina Faso’s eastern region has uprooted thousands of families, who have fled to the towns of Gayeri and Fada. Our team has heard harrowing testimonies from survivors who suffered or witnessed extreme violence and had to walk for days to reach a safe haven, leaving behind everything they owned.
Many had loved ones who lost their lives in the attacks. For some, the psychological scars are deep. From January to May, our teams treated more than 5,300 patients suffering from mental health issues.
The lack of adequate shelter is worrisome, with many displaced families living in structures made of straw or plastic sheeting. Even more alarming is that many people, including the host communities, have too little clean water and food.
Conflict and supply shortages have pushed Burkina Faso’s health system to the brink
After four years of violence, the health system in eastern Burkina Faso is very fragile. According to the World Health Organization, more than 30 medical facilities in the area have either closed or are barely functional. Drugs and medical equipment are in short supply, often due to looting or because insecurity prevents transport of supplies.
There is also a shortage of medical staff. Extreme violence has compelled many doctors and nurses to move to safer urban areas. In this volatile environment, emergency referrals from rural communities to specialist medical facilities can be particularly challenging.
Ambulances have been attacked in the area, despite the fact that this is prohibited under international humanitarian law. Fear is widespread. Some people are reluctant to seek health care out of concern that they might be associated with one side of the conflict and could become targets for violence.
Violence hinders the provision of aid
“I’m very afraid of insecurity. There is violence in the eastern region, but also around our town. And I have the impression it gets worse every day, because people are disappearing. I’m also afraid of the coronavirus, because it kills and there is no remedy for it. Our situation has deteriorated. There is no shelter for everybody, especially for the displaced people who arrived recently due to attacks in their villages. Access to water and food is harder as well. Those are our challenges at the moment. We feel vulnerable. We don't know who to trust, with all these problems.”
Amadou, 52, lives with his wife and six children in Matiakoli.
The insecurity in eastern Burkina Faso is hampering aid efforts and poses enormous challenges to health workers trying to reach some communities, especially people living in remote villages. On April 16, for example, MSF had to cancel a visit to the village of Tawalbougou, where thousands of displaced families are sheltering, after armed men fired shots at one of our medical teams. We managed to resume activities in the area later and were able to assist the affected communities, but this is not always the case.
Violence also makes it difficult to collect information about the scale of the displacement, or to get a full picture of the mortality and health situation in certain areas. Our ability to reach the most vulnerable people is often constrained by instability and by the multitude of armed groups. As a result, thousands of people remain isolated and deprived of basic services, including health care.
The collateral impact of COVID-19
Burkina Faso has reported more than 800 cases of COVID-19 since the outbreak was first confirmed in the country in March. Although the eastern region has so far been spared, the risk is there and, unfortunately, the pandemic is having a negative collateral impact on our work.
We have stopped all non-essential medical services in health facilities, and we have adapted certain other activities. Psychological support, for example, is now carried out remotely, over the telephone and through radio programs and awareness-raising leaflets.
COVID-19, combined with violence, is also making vaccination campaigns more challenging. To cite an example: Following a recent measles outbreak, we agreed to immunize children in Pama district. The first challenge was the safety of our teams, as the area has a history of violent incidents against health workers and ambulances.
The second challenge involved the strategy itself: With mass gatherings no longer possible due to COVID-19, we had to reconfigure our usual setup, going door-to-door rather than vaccinating the children in health centers. We also had to ensure that all vaccination teams had personal protective equipment to minimize the risk of infection.
This approach demanded significant organization and time. It was like preparing for the control of two outbreaks simultaneously. Finally, as some households had initially resisted the measles vaccine due to rumors that it had something to do with COVID-19, our community mobilizers had to put a great deal of effort into clarifying the issue. Despite these obstacles, we managed to reach our target and vaccinate more than 40,000 children against measles.
Getting access to personal protective equipment for our staff has also been problematic, and this curtails our capacity to provide assistance. It took more than two months to receive a delivery from abroad of coveralls, face shields, and similar gear. At the same time, international travel restrictions are preventing us from bringing more experienced staff into the country, from specialist doctors to midwives and logisticians.
Particularly worrisome are the facts that many displaced and host communities live in precarious conditions, that medical services have been reduced, and that intensive care and resuscitation services for severely ill patients are extremely limited. This is why it is paramount to continue stepping up preventative measures at the community level, even if it is not always straightforward.
How, for example, do you implement “social distancing” in an overcrowded tent? How can you wash your hands frequently when you don’t even have enough safe water to drink?
The pandemic should not overshadow other acute needs
COVID-19 is an emergency within an emergency. It is just one of many priorities and it should not drive away resources from other lifesaving medical interventions.
It is essential to keep this pandemic under control and to prevent any knock-on effects, but that should not be done at the expense of other critical humanitarian initiatives. In Burkina Faso’s eastern region, COVID-19 is not necessarily people’s main concern. For displaced people and host communities alike, simply surviving is already hard enough. They are afraid the rainy season will destroy their makeshift shelters; they fear hunger and thirst, rather than a virus that has not yet reached the area. Tackling the pandemic should remain a priority, but it must not overshadow other acute needs nor divert much-needed funding, staff, and aid from improving living conditions for the most vulnerable people.
MSF first worked in Burkina Faso in 1995. Our teams currently provide medical and humanitarian assistance to both displaced people and host communities in the East, Sahel, North, and North-Centre regions, including primary and secondary health care; vaccination campaigns; water, sanitation, and hygiene; and ad-hoc distributions of basic relief items.
Following the outbreak of COVID-19 in Burkina Faso in early March, we set up two specific projects aimed at tackling the disease in the capital, Ouagadougou, and in the country’s second city, Bobo-Dioulasso, with treatment centers in dedicated facilities and support to other health facilities and community outreach activities. We have also integrated COVID-19 prevention and case management into the rest of our projects.
In eastern Burkina Faso, MSF has provided pediatric and maternal health care in two district hospitals and six health posts in Fada and Gayeri since 2019. We have also set up a network of community health workers trained to treat common illnesses and detect and refer patients who require urgent medical attention. And we’ve been working to improve access to water, initially through water trucking and later by drilling and repairing boreholes.
From January to April 2020 we conducted 29,248 medical consultations, including 5,969 antenatal consultations. In early May we distributed emergency relief items, including soap, buckets, mosquito nets, and kitchen utensils, to some 3,500 newly displaced people in Fada town to help improve their living conditions.