ALGERIE TOMBOUCTOU MAURITANIE TESSALIT ABEIBARA GOUNDAM TIN-ESSAKO KIDAL BOUREM NIGER GAO MENAKA DIRE GO URMA-RHAROUS NIAFUNKE ANSONGO YOUVAROU DOUENTZA YE L IMA N E NIORO NARA NIO NO MOPTI DIEMA TENENKOU KAYES BANDIAGARA KORO MACINA SENEGAL KOLOKANIBANAMBA BAFOULABE SEGOU DJENNEBANKASS TOM IN IA N KITA KO U LI K OR O SAN BARAOUELI BLA KENIEBA KA T I DIOIL A KOUTIALAYOROSSO KANGABA BURKINA FASO SIKASSO BOUGO UNI GUINEE YANFOLILA KOLONDIEBA distances en KADIOLO k 0 20 0 40 0 600 COTE D’IVOIRE Implementation report on the health activities in response to the humanitarian crisis in Mali April 2014 [Yellow: Zone occupied by armed groups Red: Zone with high concentration of displaced persons Purple: Zone with low concentration of displaced persons] Mali in figures 16 586 000 inhabitants 9 regions 2 500 000 inhabitants in 703 communes the northern regions (684 rural and 19 urban) 174 129 refugees 450 000 children in (Total number of Malian need of humanitarian refugees reported by assistance UNHCR at 6 June 2013) 472 000 displaced 210 000 children at persons risk of malnutrition 2 Table of Contents Summary 4 Introduction 5 Background and justification 6 Objectives 7 Priority needs 8 Main outcomes 9 Lessons learned 24 Constraints and challenges 26 Recommendations 27 Conclusions 27 Outlook 28 3 Summary WHO response to Mali crisis In order to address the impact of the complex humanitarian crisis on the health of the Malian population, the WHO Office in Mali implemented a number of planned emergency and early recovery interventions. Through these interventions WHO was able to: provide medicines and other medical supplies for outbreak control and health service strengthening; enhance surveillance; assess the risk of epidemics; respond to epidemics; organize preventive immunization and outbreak response campaigns; assess health facilities in response to the crisis; strengthen health services, including the blood bank; strengthen Health Cluster coordination; provide capacity building for health staff; organize humanitarian missions; advocate for partners and support resource mobilization; and produce bulletins and situation reports; create a Health Cluster website and database. These interventions have helped to strengthen WHO leadership, facilitate the flow of health information, strengthen the capacity of the health services and ensure continued care in health districts and hospitals in the crisis-affected northern and central regions of Mali. 4 MANAGEMENT OF THE CRISIS Introduction In light of the complex humanitarian crisis, central regions of Mali and ensured the which has had serious consequences for implementation of disease-control the Malian population, the WHO activities. These actions have helped to Representative Office in Mali implemented save human lives at critical moments a set of actions through the Health Cluster, during the crisis and to reduce overall which is under the leadership of WHO. morbidity and mortality. The results achieved represent a step towards the The health interventions strengthened the early rehabilitation of the health system. capacity of the office and the coordination of health partners. The activities implemented throughout the crisis have also improved access to health care for vulnerable populations in the northern and 5 Background and justification Acknowledgments The humanitarian and security situation in Mali The World Health Organization would like Since January 2012, Mali has been facing a complex to take this opportunity to humanitarian situation caused by armed conflict, and thank the Ministry of socio-political and economic turmoil. This situation, Health and the partners of which occurred during a food and nutrition crisis due to a the Health Cluster for drought in 2011, has seriously affected the populations in their cooperation, which both the north and south of the country. It has had a facilitated the particularly severe impact on women and children. implementation of the activities. In addition to mass displacement, the population has experienced problems such as: We would also like to thank the other Clusters - limited access to health care due to the destruction and OCHA which have and/or looting of facilities, and the interruption of worked tirelessly to health services (with the departure of staff and ensure that the non-governmental organizations (NGOs): 94% of interventions were community health centres were no longer successful. functional. Most of the health facilities that remained open did not have the qualified staff and WHO would like to medicines required to meet the needs of the express its gratitude to population. the Governments of Finland and the United - shortages of medicines and medical supplies States of America along including blood products; with the Central - overwhelmed health services in the southern Emergency Response regions, which were not prepared to deal with a Fund for their highly large influx of people; appreciated contributions to the health humanitarian - a significant number of dead and war-wounded activities in response to people brought to health facilities; the Mali crisis. - outbreaks of measles, cholera, malaria and anthrax due to overcrowding, deterioration in hygiene and sanitation conditions and poor access to safe drinking water; - human rights violations and acts of violence, including sexual and gender-based violence; - many deaths and injuries caused by landmines, explosive devices and bombings, which continue to pose a threat. 6 Since the Health Cluster was created in March 2012, it has coordinated various interventions together with the Objectives technical services of the Ministry of Health, NGOs, UN agencies and other Clusters in order to ensure an appropriate response to the unprecedented humanitarian crisis in Mali. The aim of the plan It should be noted that: presented by WHO is to “ensure the - Eight humanitarian missions were organized (an necessary leadership eighth mission is under way). Medicines and other and technical medical supplies were provided in order to support for the management of health issues related to the humanitarian crisis in Mali”. The ultimate objective of the Health Cluster is to “speed up the restoration of essential health services in order to save lives among the affected populations and restore and maintain an optimally functioning health system in order to reduce excess morbidity and mortality resulting from the crisis”. 7 Priority needs support the missions. The interventions undertaken have helped to strengthen WHO leadership, facilitate the flow of information, enhance the capacity of the WHO Office The health situation analysis and health services, and ensure continuity of care in carried out by the Ministry health districts and hospitals in the northern and of Health and partners central regions of Mali. WHO has been able to: during the early stages of - provide medicines and medical supplies to the the crisis (March – May Ministry of Health and to NGOs in order to 2013) highlighted the control outbreaks and strengthen health following needs: services; - Resumption of - assess the risk of epidemics, respond to activities in destroyed, epidemics, and organize preventive looted or vandalized immunization campaigns for outbreak response; health centres and hospitals are still - assess health facilities in response to the crisis; affected by staff - strengthen surveillance; shortages, the lack of qualified staff and the - strengthen health services, including the blood interruption of health bank; programmes. - produce bulletins and situation reports; According to the - provide capacity building for health staff; results of the health facilities assessment - strengthen Health Cluster coordination, survey, 70% of the - provide advocacy and support for partners in facilities had been order to mobilize resources through the partially or completely Consolidated Appeal Process (CAP) and destroyed in the Central Emergency Response Fund (CERF) regions of Kidal, 45% projects; in Timbuktu and 40% - map NGO interventions and strengthen in Gao; information sharing at Health Cluster level which has led to the creation of a Health Cluster - Regular provision of website and database. medicines and other In addition to a summary of the needs and objectives medical supplies; of the humanitarian response plan, this report will - Strengthening of the provide an overview of the interventions, main outcomes, lessons learned, constraints, challenges health system in the and prospects. southern regions in order to cope with the influx of internally displaced persons. / - Response to the effects of the “lean season” and epidemics 8 Priority needs MAIN OUTCOMES - Response to the increase in morbidity and mortality and particularly epidemics resulting from poor living conditions and the vulnerability of the population (measles, cholera, meningitis, malaria, anthrax); - Restoration of referral mechanisms for medical, obstetric-surgical emergencies, especially where there is a lack of qualified staff, medicines and medical supplies, and where water pumps and electrical installations in health centres have been destroyed. - Response to the critical nutritional status of With regard to the implementation of the children, in particular in response plan, the priorities established the northern regions and according to the urgency of the situation also in areas in the south were: which are hosting i) coordination of partner internally displaced interventions, production and persons. It is estimated sharing