‘I SAW NOTHING BUT ARMED PEOPLE, BOTH CIVILIAN AND MILITARY’
Première Urgence Internationale has been working in Mali since 2013 despite difficulties gaining access to the population. In fact in October 2017, The UN Secretary General’s annual report stressed that the humanitarian and security situation has ‘significantly deteriorated’ in Mali. Moustafa Saadou has spent 10 months in the country as medical coordinator for Première Urgence Internationale.
HOW HAS YOUR YEAR IN THE COUNTRY GONE? HAVE YOU FELT THAT SECURITY IN MALI IS UNSTABLE?
I’ve been doing humanitarian work since 2005. This has been the first time I’ve found myself in a security situation like this, like an armed conflict zone. I’ve travelled in many crisis settings, but security in Mali is like nowhere else.
For example, when I arrived in Gao in the north of the country, I had the impression that I was in a military camp. I saw nothing but armed people, both civilian and military. In this area, people are afraid to move around for fear of getting attacked. This crisis context has deeply damaged the health system. The population is suffering terribly. Our presence in the country is essential and, even if it is not easy to work there, it is satisfying to know that we are working in areas where needs are significant and where so few NGOs are present, in particular in Kidal.
WHAT ARE THE HEALTH-RELATED NEEDS IN MALI?
Because of the crisis, many health infrastructures have been destroyed. On top of this, the whole health system organization had collapsed. Before the crisis, communities managed health facilities autonomously throughout the country. They were clustered within ‘ASACO’ community health associations. An ‘ASACO’ is a non-profit private association bringing together inhabitants from the same geographical region, named a ‘health area’, which takes responsibility for the management of a community health centre and carries out health promotion and protection work.
With the crisis, the population’s buying power has decreased considerably. Many Malians, in areas affected by the crisis, were robbed and many could no longer afford health care. After the crisis, the government therefore declared that health care would be free. But the old system could no longer cope. In fact, the associations needed money to keep these health centres alive.
Health needs are now, as a result, very significant in the country. In the north of Mali, inhabitants suffer more from malnutrition, respiratory infections, malaria and diarrhoea. Première Urgence Internationale has a presence in Ansongo Cercle and the Kidal region, and is working with 26 health facilities (10 in Kidal and 16 in Ansongo). We are rebuilding health facilities, supporting these facilities with human resources, training staff and supervising their work.
HOW COMPLICATED IS IT TO WORK IN MALI?
We have also implemented mobile clinics, which travel to areas where there are no functioning health facilities, and to nomadic populations who live in remote areas. These clinics are made up of doctors, nurses in charge of vaccinations or in charge of the pharmacy, midwives or obstetric nurses. They go out for 9 days, twice a month, to populations who cannot move around. The mobile teams are highly sought after in these areas where there is no access to medical care.
Our teams must therefore travel regularly. The security problems in Mali sometimes make these journeys difficult. The teams’ movements are decided on the same day that the mobile clinics set off, as the situation is unpredictable. When I first went to the area, I heard that a lorry had exploded in the area around 2 hours before I had arrived. An anti-tank mine had been placed right in the middle of the tarmac.
DOES THIS SITUATION MAKE THE TEAMS’ WORK DANGEROUS?
We have a security consultant in the country who does a regular sweep and who checks each journey according to Mali’s security context. Première Urgence Internationale is also well received in the area. We work with local people who know the region very well. They are used to dealing with the authorities at a local level. We do not put our teams in danger and sometimes we are forced to stop our work because the situation is too tense. It has happened a few times and of course it is the people we are trying to help who suffer. This year, I have not been able to get to the Kidal area because of security problems in Mali.
We will not put our teams at any risk but at the same time, we really want to get to the areas that are difficult to access where there are significant needs and where there are no NGOs. This is something specific to Première Urgence Internationale and the Mali teams are proud of it.
© Photos by Traoré Aboubacar