Mali: increased surgical needs among women and children in Niono

In December 2023, Médecins Sans Frontières (MSF) began providing surgical activities at the Niono hospital in central Mali. MSF teams have now renovated the department, as well as providing additional resources to cater to the needs. People living in Niono and the surrounding area suffer the effects of armed conflict, with limited access to quality health facilities. In this MSF-supported surgery service, 69% of all operations carried out over the last four months have been on women and children, reflecting the toll this conflict takes on this population. 

Women, who have come from the outskirts of Niono with their children for a free consultation, are waiting to see the doctor at the Community Health Centre. ©MSF

At just nine years old, Kadidia Dembélé, has already faced the extreme violence that has gripped northern and central Mali since 2012. At the end of December 2023, during an attack on her village, Diagui Wèrè, she was shot three times, once in the abdomen and twice in the buttocks, her mother was killed during the assault. Djenaba Kelema, her aunt, took her for treatment. “She was dying. I didn’t think she would survive,” she recounts. “She underwent several open surgeries. Fortunately, my niece is now back on her feet and continuing her treatment.”      

Last year, the Ségou region, where Niono is located, saw a great deal of fighting between the security forces and non-state armed groups, marked in particular by the planting of improvised explosive devices. In Niono’s conflict-ridden outlying areas, it can sometimes be impossible for residents to move freely, cultivate their fields, go to the market or visit the medical centre. In early 2024, several clashes pitted Malian forces against armed groups around the town of Niono. In the villages where some of these clashes took place, the local population was caught between the different groups. Often with little or no access to health facilities in case of injury.

When we started operations in surrounded Nampala’s villages, in the Niono project, in 2023, some patients told us they hadn't seen a doctor for seven years. Against this backdrop, insecurity is only worsening an already difficult situation in terms of access to healthcare.
Aissami Abdou
Operations Coordinator, Mali
Surgical unit at the Niono referral health centre. The surgeon prepares to operate on the patient. ©MSF

Faced with the increase in violence, MSF renovated the surgical service at Niono hospital at the end of 2023. From December 19 to April 30, over a period of four and a half months, 230 surgeries were performed to treat patients injured in armed conflict or accidents. 69% of these interventions were carried out on women and children. Cases of violent trauma linked to conflict included gunshot wounds, stab wounds and injuries caused by improvised explosive devices. Around 50% of these interventions for armed conflict were carried out on women and children. Other emergency cases, included road accidents, burns and domestic accidents; children in need of non-trauma related surgery have also undergone surgical treatment, in some cases lifesaving treatment for conditions like appendicitis. 

Responding to other emergency cases, like road accidents 

Little Tiefing Traoré, aged 9, had fallen off a donkey, fracturing his arm. “Ever since he fell, he had been complaining of pain in his arm,” says his mother, Kadia Diarra. “We treated him at home using traditional methods. We waited several days hoping that he would get better. But the delay caused complications. Tiefing was treated at the Molodo community health centre and then referred to the Niono hospital, where we were told he would have to have his arm amputated. Over time, his hand and forearm had become gangrenous following a fracture of his humerus.” 

This new surgery project aims to assist the local authorities in caring for patients in need of surgery. Before the renovation and construction of the new surgical department, the hospital received several patients with bullet wounds who needed surgery. They were referred to the regional hospital in Ségou because the hospital didn’t have the resources to treat them. After the renovation and staff training, MSF began providing surgical care in December 2023. The new operating theatre has a capacity of 23 beds, additional medical staff, a larger medicine stock and biomedical equipment.  

Operation on patient in the surgical unit of the Niono referral health centre. ©MSF
In the paediatric ward of the community health centre, nurse Mariam Dembele takes a child's vital signs. ©MSF

For surgery at the maternity unit, which MSF has been supporting since 2019. Alongside the 230 violent and accidental trauma operations, 289 obstetric operations were carried out over the same period, 275 of which were caesarean sections. The other interventions concerned cases of uterine rupture or perforation, or retroplacental haematomas.    

An impartial, neutral and independent organisation   
MSF is one of the few international medical organisations present in the region. We treat all emergencies impartially. This means that MSF teams treat any patient who needs care, regardless of their community, gender, political or religious beliefs. We are neutral and do not take sides. Our only criteria for intervention are those that a doctor owes to his patients.
Aissami Abdou
Operations Coordinator, Mali
Nurse Samaboula Macalou hands over her newborn baby to its mother after giving it a bath in the maternity ward of the Niono community health centre. ©MSF
MSF has been providing care in Niono since 2019 focusing mainly on maternal and child health for children under 15, mental health and medical and humanitarian emergency response. In addition to the Niono hospital, the organisation works in six community health centres and 22 community sites, including two in Nampala, to provide health care for children, pregnant women and victims of the various conflicts. From November 2023 to April 2024, MSF had to evacuate its teams from Nampala following the upsurge in violence. Activities resumed in April 2024.   
MSF has been present in Mali since 1985. In 2023, MSF performed 976 surgeries, 1,342 caesarean sections and treated 126 casualties (ballistic victims and explosive devices). 
MSF currently runs regular projects in the regions of Kidal, Gao (Ansongo), Timbuktu, Niafounké, Mopti (Ténénkou, Douentza and Koro), Ségou (Niono) and Sikasso (Koutiala), as well as in the capital, Bamako. The organisation also provides a wide range of emergency services to meet the major needs of people across the country. 
Our services include maternal care (consultations, deliveries, and Caesarean sections), paediatrics, neonatology, mental health, prevention (vaccination and health promotion), cancer screening and treatment, protection, assistance for displaced people (non-food kits, access to water, and construction of latrines), construction and renovation of health facilities, and referrals of patients to appropriate health facilities. 

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