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Central Mali is currently the deadliest region in the country for civilians. In the last three years, the violence has escalated considerably, presenting alarming numbers and outlook of injuries, fatalities and displaced persons forced from their homes. Doctors Without Borders (MSF) works in the region supporting the health system and accessing isolated populations through a community healthcare model.

“Criminals came to our village during the night and killed my husband, burned our house and took all our livestock,” says A *. “I collected what was left of our possessions and fled with my four children. Since that day, my youngest son has not stopped crying. Every time she sees a man, she thinks he’s her father. “

This mother, now a widow, has taken her son to the MSF mobile clinic. She and her children have found refuge in a village 40 kilometers from the city of Koro, in central Mali.

A.’s story is one of many similar stories. The central region of Mali, bordering Timbuktu to the north and Burkina Faso to the southeast, is currently the deadliest and most dangerous area in the country for civilians. The Peul herding and Dogon farming communities, the majority in this region, are the main victims of the massacres, destruction and looting.

In the last two years, violent incidents have increased in both number and severity. The population of the center of the country is trapped between armed groups, self-defense groups and even national or international security forces. To all this are added local intercommunity conflicts. Aware of these rivalries, armed groups have taken advantage of certain communities to launch them against each other. The result is that violence against civilians and indiscriminate attacks against entire villages are ubiquitous in a heavily armed area.

The Government of Mali is involved in various armed conflicts with various groups that have been identified as terrorist organizations, conflicts for which it has the support of regional and international contingents. The situation implies the overlapping of mandates: both the maintenance of peace and the fight against terrorism. The activities of the armed groups and some repressive security measures that have been implemented to combat terrorism have impacted on the population. In some cases, civilians have been taken for combatants and criminalized for belonging to a particular ethnic group.

In Mopti, a border region with Burkina Faso and the regions of Gao, Segou and Timbuktu, the national government has lost control of entire areas to armed groups. A climate of violence permeates the daily life of its inhabitants. More than 300,000 people are displaced in Mali according to the International Organization for Migration.

Armed groups have forcibly isolated many villages, including Mondoro (in the Douentza circle), Diankabou (Koro circle) or Boulkessi (Douentza), leaving them without access to basic services, especially medical care. Between January and October, MSF teams in the Mopti region have gained access and support to 56 isolated or hard-to-reach villages. In other localities, its residents cannot move freely, cultivate their fields or go to markets due to inter- or intra-community conflicts.

Most of these people have to leave their homes and take refuge in neighboring villages. In October 2020, there were 131,150 internally displaced persons in Mopti alone, a region where 1.6 million people live.

“For example, in a village 60 kilometers from Bandiagara, there is no camp for displaced people,” explains Ibrahim M., MSF deputy coordinator in Mali. “People who had fled the violence were housed in schools (until they opened and were evicted) or taken in by families. Others live in the fields, in caves or simply must sleep under the stars. When the schools were opened, these displaced people were expelled ”.

The capacity and the means of reception of people from neighboring villages who come to the aid of the displaced are limited. This is a population living in very basic conditions that already faces difficulties during the rainy season and the lean months. The displaced have lost everything and are living in extremely harsh conditions. Among affected communities, MSF teams identify and support unaccompanied children, female ‘heads of households’ and the elderly who have lost their support networks.

AO is a farmer who has taken in his home displaced people. “Three months ago, 35 displaced people came to our house,” he explains. “Even before they arrived there was a shortage of food. Newcomers make this situation even more difficult, but we do our best to help them. Accommodating 30 more people is not easy: six or seven sleep on the same mat, the women all sleep together in the same bedroom. When it rains, many spend the night in the open air because there is no roof for everyone ”.

Some displaced people have not found a space with host families and have had to take refuge in public buildings or in the mountains. “They entered our houses and destroyed everything,” recalls LT, displaced. We fled and after walking for two days, we arrived here in the middle of the night. Some of my loved ones have disappeared. I don’t know where they are. We are on constant alert. We are afraid that those armed men will come back to harm us. We do not have anything; no clothes, no food, no money and no place to stay ”.

In hospitals in the Koro and Douentza circles, MSF teams provide emergency medical and psychosocial care for people with conflict-related injuries. They treat patients with gunshot wounds, victims of improvised explosive devices, torture, survivors of sexual violence with severe physical and mental trauma. Between June and October, MSF has recorded 82 attacks on villages, 68 incidents of other types and 21 massive population displacements, with a total of 222 civilians killed.

This level of violence also complicates civilians’ access to medical care and results in malaria, measles and malnutrition becoming fatal. In the first ten months of the year, teams from the medical-humanitarian organization treated more than 57 thousand people with malaria in Koro and Douentza.

MSF also carries out emergency interventions in isolated or hard-to-reach locations through mobile clinics. In this same period, almost 53,000 external consultations were carried out through these devices.

“Some pregnant women who were forced to flee by the conflict have even given birth on the roadside,” explains Adiaratou D., MSF nurse midwife. Others, traumatized by fear, have had miscarriages. One of the ways we take care of them is by controlling their weight and accompanying them during childbirth. They have nothing, not even to eat, nor clothes to change or cover. “

Access to some areas remains prohibited due to the presence of improvised explosive devices used against the security forces, which have also caused many victims among the civilian population. Access to aid remains one of the main concerns. Aid organizations are subject to the same risks and problems, including robberies, unofficial arrests and checkpoints, mines and kidnappings.

Insecurity is not diminishing and is inevitably depriving more and more people of healthcare and humanitarian assistance. “In light of the numerous violations, we call on all parties to respect, preserve and allow access to humanitarian aid so that communities affected by the conflict can receive vital assistance,” says Boulama El hadji Gori, general coordinator of MSF in Mali.

“Furthermore, we call on all actors in the armed conflict to stop abuses against civilians and to abide by the principles of international humanitarian law and the principles of precaution and distinction. MSF is asking aid organizations to expand their response to meet the needs of this population, particularly in terms of shelter, food and protection in the medium and long term ”.

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