Violence in Mali drives increased surgical needs among women and children

"Some patients told us they hadn't seen a doctor for seven years," said operations coordinator Aissami Abdou of MSF’s work in the Nampala area.

A mother holder her child while he is examined by a nurse in Niono, Mali

Mali 2024 © Mohamed Dayfour Diawara/MSF

Armed conflict and poor access to health facilities have made it difficult, if not impossible, for many people in Mali to move about or seek medical attention when they need it.

In December 2023, Doctors Without Borders/Médecins Sans Frontières (MSF) began providing surgical activities at Niono Hospital in Mali, where access to medical care remains very limited due to a lack of medical staff and supplies and spiraling violence between armed groups.

At Niono Hospital, 69 percent of all operations carried out over the last four months have been on women and children, reflecting the toll this conflict takes on people in surrounding communities.

Surgeons operate on a patient who was a victim of gun violence in Mali.
Surgeons at Niono Hospital operate on 9-year-old Kadidia Dembélé, who was shot three times in December 2023 during an attack on her village.
Mali 2024 © Mohamed Dayfour Diawara/MSF

At just nine years old, Kadidia Dembélé has already experienced the extreme violence that has gripped northern and central Mali since 2012. During an attack on her village at the end of December 2023, she was shot three times, once in the abdomen and twice in the buttocks, and her mother was killed. Djenaba Kelema, her aunt, took Kadidia for treatment. "She was dying. I didn't think she would survive," she recounted. "She underwent several open surgeries. Fortunately, my niece is now back on her feet and continuing her treatment.” 

Ongoing clashes impede free movement 

Last year the Ségou region, where Niono is located, saw a great deal of fighting between Malian security forces and non-state armed groups, including by planting  improvised explosive devices. In Niono's conflict-ridden outlying areas, it can sometimes be impossible for residents to move freely, cultivate their fields, go to the market, or visit a medical center. 

In early 2024, several clashes pitted Malian forces against armed groups around the town of Niono. In the villages where some of these clashes took place, the local community was caught between the different groups, often with little or no access to health facilities in case of injury. 

"When we started operations in Nampala’s surrounding villages in 2023, some patients told us they hadn't seen a doctor for seven years," explained Aissami Abdou, operations coordinator. “Against this backdrop, insecurity is only worsening an already difficult situation in terms of access to health care.” 

When we started operations in Nampala’s surrounding villages in 2023, some patients told us they hadn't seen a doctor for seven years. Against this backdrop, insecurity is only worsening an already difficult situation in terms of access to health care.

Aissami Abdou, MSF operations coordinator

Faced with the increase in violence, Doctors Without Borders renovated the surgical service at Niono Hospital at the end of 2023. Over a period of four and a half months from December 19 to April 30, 230 surgeries were performed to treat patients injured in armed conflict or accidents, and 69 percent of these interventions were carried out on women and children. 

Violent traumatic injuries linked to conflict included gunshot wounds, stab wounds, and injuries caused by improvised explosive devices. Around 50 percent of these interventions for armed conflict were carried out on women and children. Other emergency cases included road accidents, burns, and domestic accidents. Children in need of non-trauma-related surgery have also undergone surgical—in some cases, lifesaving—treatment for conditions like appendicitis.

A mother and boyo sitting on a hospital bed in Niono, Mali.
Tiefing Traoré, 9, fell off a donkey, fracturing his arm. After an infection developed, he was referred to Niono Hospital, where he had to have an amputation.
Mali 2024 © Mohamed Dayfour Diawara/MSF

Responding to road accidents and other emergencies

Tiefing Traoré, 9, fell off a donkey, fracturing his arm. "Ever since he fell, he had been complaining of pain in his arm," said his mother, Kadia Diarra. "We treated him at home using traditional methods. We waited several days hoping that he would get better. But the delay caused complications. Tiefing was treated at the Molodo Community Health Center and then referred to the Niono Hospital, where we were told he would have to have his arm amputated. Over time, his hand and forearm had become gangrenous following a fracture of his humerus."

The new Doctors Without Borders project aims to assist local authorities in caring for patients in need of surgery. Before the renovation and construction of a new surgical department, the hospital received several patients with bullet wounds in need of surgery, who were then referred to the regional hospital in Ségou for lack of resources to treat them. 

Doctors Without Borders began providing surgical care at Niono Hospital in December 2023 following renovation and staff training. The new operating theater has a capacity of 23 beds, along with additional medical staff and a larger stock of medicines and biomedical equipment.

Aerial view of surgical center in Niono, Mali.
Aerial view of the Niono referral health center in the Ségou region of Mali.
Mali 2024 © Mohamed Dayfour Diawara/MSF

Alongside the 230 operations for violent and accidental trauma, 289 obstetric operations were carried out in the maternity unit over the same period, including 275 cesarean sections. Other interventions were for cases of uterine rupture or perforation, or retroplacental hematomas.   
"MSF is one of the few international medical organizations present in the region," explained Aissami Abdou, operations coordinator. "We treat all emergencies impartially. This means that our teams treat any patient who needs care, regardless of their community, gender, politics, or religious beliefs. We are neutral and do not take sides. Our only criteria for intervention are those that a doctor owes to his patients."

About our work in Mali 

Doctors Without Borders has been present in Mali since 1985. In 2023, our teams across Mali performed 976 surgeries and 1,342 cesarean sections, and treated 126 casualties, including for victims of ballistic and explosive devices.

We have been providing care in Niono since 2019, focusing mainly on maternal and child health for children under 15, mental health, and medical and humanitarian emergency response. In addition to Niono Hospital, MSF works in six community health centers and 22 community sites, including two in Nampala, to provide health care for children, pregnant women, and victims of various conflicts in the area. From November 2023 to April 2024, MSF had to evacuate our teams from Nampala following the upsurge in violence. Activities resumed in April 2024.

Doctors Without Borders 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 organization also provides a wide range of emergency services to meet the needs of people across the country.

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