At the Auaris Health Center in the Yanomami Indigenous territory in Brazil’s Roraima state, hammocks serve as hospital beds for recovering patients.
Signs in the Sänoma and Ye’kwana languages, in addition to Portuguese, direct people through the hallways of the center, which was renovated and expanded through a partnership between Doctors Without Borders/Médecins Sans Frontières (MSF) and the Indigenous health authorities.
Federal authorities declared a health emergency in the Yanomami Indigenous Land in January 2023 due to several factors, including rising malnutrition, falling health budgets, and increasing prevalence of malaria. Between January and June 2023, there was 70 percent increase in cases of malaria compared to the same period in 2022, according to data from the Ministry of Health. MSF began working in Auaris that May, providing general health care with a focus on malaria diagnosis and treatment as well as mental health.
After almost three years, MSF has concluded its health care activities in Roraima state. We are focusing on ensuring a smooth transition and sharing lessons learned to help inform future health responses for Indigenous communities in Brazil and beyond.
Incorporating traditional knowledge and improving care
The Yanomami Indigenous Land is the largest Indigenous territory in Brazil, with a population of just over 30,000 people spread across an area larger than Portugal. The Auaris Health Center is located in its most densely populated region, which is mainly home to the Sanöma and Ye’kwana peoples.
A key feature of MSF’s work with Indigenous communities has been the adaptation of medical approaches, valuing and respecting the traditional knowledge of those who protect Brazil’s forests and biodiversity. To ensure smooth interaction within the Yanomami community, MSF staff worked with anthropologists and intercultural mediators. This openness was key to developing awareness activities and providing clear information, allowing the community to understand malaria treatment and prevention. Once people were more aware, they began seeking care at the early stages of illness, which resulted in a reduction in mortality rates.
Respect for the culture and practices of Sanöma and Ye’kwana people is at the core of MSF’s contributions to improving the infrastructure of health centers in the region. This is evident not only in the physical space, such as placing hammocks in medical facilities, but also in the practices adopted. Instead of just handing out a prescription, for instance, health care providers take the opportunity to listen and learn.
"Now health care is integrated, with Sanöma and serenapi (non-Indigenous) people working together—shaman and doctor," says Miro Sanöma, a resident of the Kululu community in the Auaris region. "If a person becomes very ill, first they perform xapori [a healing ritual], then take them to the health center."
Mental health care for Indigenous patients
The mental health of young people has become a growing concern in Indigenous communities, partly because of the friction caused by breaking with traditions.
Over three years, MSF teams carried out group and individual psychoeducation sessions, community awareness and mobilization, psychological first aid, psychosocial activities, and support groups, reaching 5,582 members of the community. Overall, we conducted 523 individual consultations, a significant portion with female patients (70 percent) and young adults (51 percent).
MSF also worked to raise awareness among workers of the Yanomami and Ye’kwana Special Indigenous Sanitary District, providing training on the subject and holding regular meetings with the agency’s mental health team.
Building a strong foundation to continue care
"When I arrived there was an average of one severely ill patient per day due to severe malnutrition, advanced-stage malaria, dehydration, or snakebite accidents," says Carlos Camacho, an MSF doctor who has worked in the Yanomami Indigenous Land since early 2024. "As prevention efforts improved—mainly due to health promotion activities in the communities—we noticed a decrease in severe cases. Today, I hardly ever see severe patients here in Auaris."
Dr. Camacho’s observation aligns with official numbers released by the Ministry of Health that show drop in malaria cases by more than 20 percent in the first half of 2025, compared to the same period in 2024.
The data indicates that although transmission remains high in the Yanomami Indigenous Land, there has been a marked improvement in diagnoses and a significant reduction in severe cases and deaths. Between January and June 2023, there were 10 deaths, with a slight drop to nine in 2024, and then down to three in the first six months of this year.
As activities in Roraima draw to an end, MSF has taken efforts to ensure a responsible and sustainable transition. Our teams have provided training for health professionals and community members to support a smooth handover of medical and operational responsibilities.
“The transition process is an opportunity to ensure that the progress of recent years can continue to benefit Indigenous communities here in the future,” says Damaris Giuliana, MSF project coordinator in Roraima. “We arrived with knowledge about diseases and treatments in non-Indigenous contexts and learned about spiritual illnesses and the cures performed by shamans. We remain committed to sharing the knowledge gained in Roraima so that future initiatives—within and outside MSF—can build on this experience.”
Although many challenges remain, local care capacity has been strengthened, which is expected to help communities continue receiving higher-quality care.
MSF’s work in the Amazon
MSF’s work in the Yanomami Indigenous Land was the most recent chapter in our long history of supporting Indigenous health in the Amazon. Our first project in Brazil was in response to a cholera outbreak in the early 1990s. A few years later, MSF responded to a malaria outbreak in Roraima state and, more recently, supported Indigenous communities during the COVID-19 pandemic.
