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Nomadic groups challenge measles vaccination effort for 400,000 children in Mali

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A measles epidemic has hit northern Mali. Médecins Sans Frontières (MSF) is providing treatment to sick people and has launched a vaccination campaign for approximately 400,000 children between six months and 15 years of age.

Measles is a contagious disease that mostly affects children. The disease can be fatal or cause serious complications, including blindness and pneumonia. Measles can be prevented by vaccination but in the affected areas in Mali, very weak vaccination coverage is a major factor in the spread of the epidemic.

In order to prevent this, MSF started in May a vaccination campaign in the Timbuktu region, an area where the epidemic threshold had been reached. So far, MSF and Ministry of Health teams have vaccinated 160,000 children in Timbuktu city and in the surrounding ‘circles’ (areas). The vaccination will continue in the Timbuktu region and another campaign will soon start in the neighbouring Gao region.

Populations on the move

Among the population, many are ‘Tuareg’ and other nomadic populations who are heading south of Timbuktu in search of water. Teams have also vaccinated certain ethnic groups, who are currently heading to the shore of the Niger River in search for fish.

“People are constantly on the move and this is a big challenge,” explained Louis Kakudji Mutokhe, MSF medical coordinator. “It is extremely difficult to follow their migration. Two or three days before the vaccination we have to send a team of educators to let people know about the vaccination and to ask them not to move! But if it starts raining somewhere, then they move on to these places where they can find better water points for the cattle.”

There have been more than 2,500 patients with measles so far in the regions of Timbuktu and Gao. MSF has set up three measles treatment centres in Timbuktu and another two in Gao. In addition, four mobile teams are doing outreach searches to locate sick people, care for them and refer complicated cases to treatment facilities.

In such a vast and underpopulated area (about one inhabitant per square km), MSF had to mobilise significant logistical needs. On top of that, the poor condition of the roads means that moving from one place to another takes a long time. So in Timbuktu region only, 12 teams of MSF staff, Ministry of Health staff, and representatives of civil society, are working on the vaccination campaign. About 20 cars take the teams to the vaccination sites.

The temperature at this time of year in Mali is almost 50 degrees Celsius. However, to be effective, vaccines must be kept at a low temperature – between two and eight degrees Celsius.

“We have to keep the ‘cold chain’ right up to the most remote places,” explained Louis Kakudji Mutokhe. “The cold chain is based in Timbuktu and at least two vehicles bring icepacks and vaccines to the field. You really need a lot of resources if you want to avoid giving ineffective vaccines to the kids.”

Overall, around 100 MSF staff, the majority from Mali, are working to address the measles outbreak.

MSF has worked in Mali since 1992. In Timbuktu, MSF operates on women suffering from obstetrical fistula and in the southern Kangaba district, MSF runs a malaria project.