MSF emergency response activities
International Activity Report 2019

The Sahel: Civilians trapped in a deadly spiral of violence

A complex security crisis has been developing across the Sahel since 2012, due to the emergence and proliferation of armed groups across the region. Beginning in northern Mali and then spreading to its central regions, the crisis has gradually engulfed northern Burkina Faso and western Niger and is threatening the stability of all the other neighbouring countries.   

Government forces have responded to the violent activities of these groups, and there has been increasing international intervention, with the Barkhane counter-terrorism operation led by France in the G5 Sahel member states,The G5 Sahel is a framework created in 2014 by five countries (Burkina Faso, Chad, Mali, Mauritania and Niger) to collaborate in terms of development and security. and the deployment of United Nations forces in MaliIn the framework of the MINUSMA (Multidimensional and Integrated United Nations Mission for Stabilization in Mali) deployed under a UN Security Council mandate. .

In this volatile context, access for Médecins Sans Frontières (MSF) and other humanitarian organisations has become increasingly difficult, yet ever more urgent. The fragile health systems in these countries are struggling to function and the risks of food insecurity and epidemics remain very high. 

The tragic example of Mali 

One of the most serious problems caused by the clashes between these armed groups has been the explosion of intercommunity violence. Longstanding quarrels among ethnic groups – traditionally grain or livestock farmers – have been exploited and exacerbated by the different parties to the conflict. In central Mali, we saw attacks on an almost weekly basis in 2019, often in areas where there were no government representatives or any basic services. Our teams collected numerous testimonies from survivors, describing scenes of unprecedented violence: children and women burned alive, entire villages razed to the ground. More than 4,700ACLED, Armed Conflict Location and Event Data Project.  deaths were reported in 2019, the highest number since the conflict broke out in 2012, and almost twice as many as in 2018.  

To date, neither the government nor international efforts (which have been largely limited to military actions) have been able to contain this violence or protect the civilian population. On the contrary, the state has lost control of entire areas, and the lack of protection and the fear of retaliation have given rise to a climate of hostility towards international forces. Furthermore, organised crime has increased significantly, since these conflicts are taking place around the country’s main roads, and especially along the only road that connects the south and the north. This road, which is extremely dangerous in places, with kidnappings and carjackings common, undermines humanitarian operations.  

Despite the extremely difficult situation, MSF, which in some places is the only humanitarian organisation present, continues to provide medical care, mental health support, protection and other types of assistance to people displaced and affected by conflict.

Haibata and her granddaughter in Barsalogho IDP camp
Haibata and her granddaughter in a camp for internally displaced people in Barsalogho. They escaped a massacre in their village during which Haibata’s husband was killed. Centre Nord region, Burkina Faso, January 2019. 
MSF/Caroline Frechard

Civilians, trapped between belligerents  

Unfortunately, it is civilians, as usual, who bear the brunt of this spiralling violence. Not only do they face targeted killings, kidnappings, displacement, looting, death or injury from mines and harassment by the various armed groups, but also restrictions on their movements and access to basic services, such as healthcare and food supplies. On many occasions – and because of this juxtaposition of conflicts – entire populations are criminalised, ending up being directly associated with one of the warring parties, according to their ethnicity.

In addition to the lack of basic services, one of the main humanitarian needs for civilians is protection; they live in permanent fear of new attacks, which forces them to leave their homes and search for a place of safety in other regions of their countries or across borders.

Frequently, they choose not to settle in camps, out of fear, and instead seek refuge in neighbouring villages, where it is more difficult for MSF to reach them. They have lost everything and need urgent help: food, shelter and medical care, as well as mental health support, due to the violence they have witnessed. Often these people return to their village of origin, even if it is has been burned to the ground and no assistance is available there.

The limited humanitarian response 

Access – for both humanitarian workers to reach people, and for people to reach services such as healthcare – is tremendously complex, due the presence of many small, highly mobile armed groups and physical barriers such as road blockages. This explains in part the limited presence of aid providers on the ground. Many do not have the capacity to react to violent events or forced displacements, or they do so too late.  

Another problem is the instrumentalisation of humanitarian aid by military forces in the region. In Mali, for example, international armies (one of the main parties in the conflict) have taken it on themselves to distribute medicines in facilities supported by MSF in order to win the hearts and minds of the population, without any concern for the transfer of the risk of being associated with these parties to MSF staff and the population. In such a polarised context and with so many armed groups with different interests fighting on the same territories, it is essential that humanitarian action is carried out in a neutral and impartial way.

In this cross-border armed conflict that severely affects the civilian population, MSF remained the main health provider in this part of the Sahel at the end of 2019, with projects in Koro, Douentza and Ansongo in Mali; Djibo and Fada in Burkina Faso; and Tillabéri in Niger. We are firmly committed to continuing our activities in the region, assisting people in distress and fighting to preserve humanitarian principles and space.

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