Military coup triggers health crisis in northern Mali

Abstract

Health workers in Mali are warning of an increasingly desperate health situation in the north of the country following a military coup and violent clashes. Paul C Webster reports. Medical relief workers in northern Mali say medical conditions across a region home to 5 million people have become intolerable due to the collapse of the government-run health system. They say shortages of food, medical supplies, and health workers have steadily worsened since a military coup toppled the country's democratically elected government on March 22. At the regional hospital in Timbuktu, the second largest city in northern Mali, Abdel Aziz Mohamed, coordinator for the Alliance for International Medical Action (ALIMA), a group based in Montreuil, France, which operates medical teams in West Africa, the Middle East, and the Caribbean, says large numbers of government health workers have fled fighting between rebel groups in the city of 56 000. “All five community clinics in the city are closed”, Mohamed explained. “Here at the hospital, only 24 of 60 beds are usable. Many patients were abandoned when staff fled from the fighting.” Doctor shortages are a perennial problem in Mali, but in Timbuktu now, says Mohamed, just four physicians from ALIMA are working in the hospital alongside a nurse from Médecins Sans Frontières (MSF) and a skeleton crew of about six local staff. Conditions are deteriorating rapidly, Mohamed reports. “The national health system is broken right across the region. Several patients requiring caesareans had been abandoned when our team arrived here on April first. The main problem is a near total lack of medications. Newborns are not being vaccinated. We are treating increasing numbers of respiratory infections, malaria, and diarrhoea.” With the malaria season beginning now in a region where the disease accounts for 62% of all reported deaths and 68% of deaths in children younger than 5 years “there is a desperate shortage of drugs and food”, says Mohamed. “That means that children will likely die this year in much larger numbers than usual.” Officials from the World Food Programme (WFP) and the UN High Commission for Refugees (UNHCR) say that as political violence intensifies across northern Mali, more than 200 000 people have fled to neighbouring countries while at least another 130 000 displaced remain in camps inside Mali. “The north of the country is now very dangerous due to the proliferation of armed groups in the region”, UNHCR spokesperson Fatoumata Lejeune-Kaba says. “We had limited access before the coup but access to the north is now totally impossible. This is preventing UNHCR and other aid agencies from reaching those in need of assistance. There is widespread discussion of the need for a humanitarian corridor to allow aid to get in.” The WFP says that the uprising comes after late rains led to a poor harvest that put around 1·7 million people in Mali at risk of hunger. Malnutrition levels are high in Mali even at the best of times, the WFP notes. A July, 2011, national nutrition survey showed that the prevalence of acute malnutrition among children under 5 years old was 10·8%, with critical levels in the northern regions of Gao (14·1%) and Timbuktu (15·4%). The WFP hopes to support 1·2 million people this year, but the fighting has disrupted plans. The backdrop to these developments is increasingly desperate, said ALIMA director Augustin Auger. On April 6, a group called the National Movement for the Liberation of Azawad (NMLA) declared that northern Mali was seceding from the south. The Economic Community of West African States (ECOWAS), a regional group of 15 West African countries, subsequently refused to recognise the new state. On April 26, ECOWAS decided to send troops to Mali to support national unity. Alongside government resistance, the NMLA faces violent opposition from other armed groups in the north. Speaking from Bamako, Mali's capital, Guillaume Baret, the country coordinator for ALIMA, explained that although medical conditions there and across the rest of southern Mali were not substantially affected by the coup, that is not the case in the north. Thousands of medical consultations done by ALIMA staff in the north in recent weeks indicate that around 25% of children are malnourished, with about 5% in extremely serious condition, Baret added. “We are seeing a very high number of extremely serious obstetric cases. Women and children are in the greatest jeopardy.” Joanne Sekennes, coordinator for MSF in Bamako, says reports from four MSF teams in northern Mali confirm that the conditions in all other northern cities are similar to those in Timbuktu. “Our teams are working alongside a handful of brave government physicians and nurses who are still working”, she said. “But the situation is becoming increasingly serious, especially for children under 5 [years].”