This article is part of our special report Nutrition and Child Survival.
Braving minefields and sporadic fighting, health workers have carried out a campaign in recent days to vaccinate thousands of children in northern Mali against measles, polio and other deadly diseases.
The 10-day operation ahead of World Immunisation Week, which runs through Saturday, highlights the challenges of EU and international efforts to improve health, nutrition and food security in Mali and the rest of Africa’s fragile Sahel region.
The European Commission unleashed €250 million in development aid for Mali last month to help the struggling government in Bamako, which sought French help to repel a rebel advance from the nation’s impoverished north.
Fighting between the internationally backed southern government and northern rebels has subsided since France sent an intervention force on 11 January, but months of unrest took a toll on health facilities, disrupting medical services and the delivery of vaccines and nutritional assistance to children.
Providing vaccinations has been “very, very challenging,” Dr George Ameh, health manager for the UN’s children’s agency Unicef in Mali, told EURACTIV by telephone from Bamako. “You don’t have skilled manpower, the [refrigeration] facilities are non-existent, vehicles are non-existent and have been looted. But we also have a humanitarian obligation to go in and make sure that the children have protection against preventable diseases.”
The immunisation campaign comes on top of a measles outbreak two months ago and reports of more than 200 cases of cholera in the northern part of the country last year that left at least 19 dead.
Mali is at the epicentre of the broader Sahel, a formidable region where the Sahara desert transitions into savannah. Along with Mali, Burkina Faso, Chad, Niger and Mauritania have all faced drought, food shortages and insecurity in the past two years.
Some 10.3 million people in the region lack sufficient food and 4.5 million children under five are vulnerable to severe to moderate malnutrition, EU and UN figures show. The UN estimates that 226,000 million children die every year from malnutrition.
The UN has requested $1.66 billion (€1.23 billion) in aid this year, $623 million for food and $273 million to avert malnutrition.
The EU responded by stepping up aid and development efforts in the Sahel, in addition to the €200 million in development aid and €172 million in humanitarian assistance it had planned for the region.
The EU has also set up Global Alliance for Resilience Initiative in the Sahel to improve nutrition.
Mali, a nation of 16 million, erupted in conflict last year when army officers deposed the civilian government while Tuareg fighters who had been sheltering in Muammar Gaddafi’s Libya returned home to renew their long-time rebellion. Civilian rule was restored, paving the way for the restoration of EU and international aid this year.
The French intervention has stabilised the south and the influx of aid has allowed relief organisations to begin restoring war-damaged clinics in populated northern areas despite continuing threats of rebel attacks.
Unicef estimates that there are more than 300,000 children under the age of five in northern Mali but precise numbers are unknown because families have sought refuge in the south and neighbouring countries.
The UN’s humanitarian agency reported on 10 April that 467,000 people had fled northern regions due to conflict and food insecurity. The International Committee for Red Cross says civilians continue to stay away.
"The fact that displaced people are hesitant to go back to their homes is largely attributable to a general sense of not feeling secure, and also to the impossibility of generating income amid such instability," Jean-Nicolas Marti, who heads the ICRC regional delegation for Mali and Niger, said in a statement.
Health workers face other challenges beyond vaccinating children for polio, measles, diphtheria and other conditions. Nutrition is major concern.
In 2011, before the northern rebel offensive began, the UN estimated that one in four children in the north ran the risk of acute malnutrition.
“And now, as you can imagine, the food security situation has worsened, access to healthcare has worsened,” said Ameh, who estimated that 40% of children had access to care before, and “now we estimate just about half of that, about 20% have access to care for the management of nutrition.”
Speaking at a recent UN meeting on the Sahel crisis in Rome, Kristalina Georgieva, the EU humanitarian aid commissioner, called the death rate from malnutrition among children “shockingly high, year in, year out.
“This year could yet be difficult,” she said. “In Mali, we will have to deal with the humanitarian consequences of last year's political crisis for some time to come – and of course these only add to the vulnerability of the region as a whole.”
Immunisation of children under five is a universal goal. The World Health Organization calls it “one of the most successful and cost-effective health interventions” and prevents up to 3 million deaths annually.
Vaccination can protect against diphtheria, measles, whooping cough, pneumonia, polio, rotavirus diarrhoea, rubella and tetanus.
But after decades of efforts to expand immunisation globally, the UN says 22 million infants are not fully immunised more than 1.5 million children under five die annually from ailments that could be prevented through vaccination.
- Through 27 April: Immunisation Week
- World Health Organization: Immunisation Week
- Unicef: Mali [FR] [SP]
- International Committee for the Red Cross: Mali : les personnes déplacées hésitent à prendre le chemin du retour