Burkina Faso is located in the centre of the Sahel Region, in West Africa, and is bordered by Benin, the Ivory Coast, Ghana, Mali, Niger and Togo.
Historically, it is one of the most impoverished countries in the world — according to the Human Development Index (HDI) from the United Nations Development Programme (UNDP), it was classified as the 8th poorest country in the world in 2019.
Its 21-million-inhabitant population, spread across a surface area of 274,200 km2 (half of Spain), predominantly lives in rural areas, although an increasing number of people are heading for the country’s major cities in search of work and better living conditions. In 20 years, the percentage of the population living in urban areas has jumped from 17% to 30%, with 10% of the country’s population — 2 million inhabitants — concentrated in the capital Ouagadougou, as are the large majority of basic services, including health care.
Burkina Faso has a very young population — 44% are under 15 and 65% under 25 — and the country has a life expectancy of 61. Only half of the population (52%) is literate and only 10% are able to access higher education.
In recent years, the Sahel Central region, made up of Mali and Niger as well as Burkina Faso, has been highly unstable. In Burkina Faso’s case since 2014, following the exit of President Blaise Compaoré, who, after 27 years, was forced to resign in the wake of violent protests and the threat of an uprising, followed by a failed coup d’état attempt in 2015. Since 2016, the north of the country has suffered from a heavy, multi-causal decline in security and has witnessed numerous Jihadi attacks against State representatives and the civil population. In 2016, 2017 and 2018, the capital suffered three terrorist attacks, leading to the death of scores of civilians. In the first, in January 2019, hundreds of civilians were killed by inter-community violence in the north of the country, with a total of 60,000 people internally displaced and forced to flee their homes. This grim attack triggered, after three years of isolated incidents of armed violence, national and international recognition that the country was entering a humanitarian crisis. The Burkina Ministry of Women, National Solidarity and Family incorporated a portfolio of Humanitarian Aid and the United Nations (UN) set up a system of international coordination to help the country, yet it wasn’t until December 2019 that work groups from the humanitarian community called “clusters” (“Cluster Health”, “Cluster Nutrition”, etc) were officially activated in order for emergency relief to reach the most vulnerable populations, or at least the most accessible.
At the present time, civil-military coordination is being put in place in Burkina Faso; however, the challenge for civil society in general, and NGOs in particular, is to ensure that both the armed forces and the UN listen and take into consideration proposals and positions — given that they do not share the same modes of intervention and values of neutrality and independence — in addition to ensuring that armed groups do not consider them “enemies” or a risk.
Despite these efforts, some of the country’s zones remain inaccessible not only to authorities, but also to NGOs and the UN, which means aid does not reach the populations most in need. This inaccessibility is marked by a high level of insecurity and a lack of clear mediation, particularly non-governmental, to take part in possible processes of dialogue and negotiation.
Attacks by armed groups have increased exponentially since January 2019. Five of the 13 regions in the country, in the north and the east, are facing humanitarian crises. In August 2020, more than a million people were internally displaced; that is, 17 times more than in January 2019, not to mention the 30,000 Mali refugees who have been living in the country since 2012.
According the UN’s Office for the Coordination of Humanitarian Affairs (OCHA), 2.9 million people require humanitarian aid, amounting to 14% of the Burkina population. Of those people, 2.1 million require food aid and 1.5 million are directly denied access to health, with 95 health centres closed and another 199 either working at a bare minimum and/or intermittently, negatively impacting primary health care. Fortunately, and despite serious deficiencies in services – even more so with COVID-19 — the country’s hospitals, and generally those in the Sahel Region, are still operating.
The Burkina Faso humanitarian crisis is framed inside a broader crisis that is destroying the Sahel Region, especially Central Sahel, with a pronounced food crisis and constant deterioration of farming and livestock production over the past four years. In August 2020, the rates of severe acute malnutrition in children under five — in places with a regrouping of displaced people — exceeded, in different areas, the critical limits set by the World Health Organisation (WHO): more than 15% of children suffer from moderate malnutrition (the situation is urgent for over 10%) and more than 4% suffer from severe acute malnutrition (urgent for over 2%). Furthermore, the nutritional situation is becoming even more critical in certain areas; for instance, in support centres for children under five with severe acute malnutrition and due to complications in the Dori Regional Hospital, which was receiving up to 100 patients per day in October 2020 when its capacity is only 35.
Therefore, the global health situation is highly troubling, and hundreds of thousands of people have been displaced and are grouped together in rural areas and urban areas such as Djibo (Sahel) and Kaya (Centre-Nord Region), combined with the already existing population and health centres that did not and do not have — now even less so — the capacity to support the whole population. The State and organisations present in the country, such as Médicos del Mundo, NGOs and the UN, are opening advanced and provisional health posts, made up of tarpaulins and tents with a minimum of equipment and staff available to respond to needs. Mobile clinics can no longer travel further afield from urban centres due to the threat of attacks and are therefore unable to provide care for people further away. These circumstances are leading to a situation that is unsustainable.
Since 2018, health staff, both from the State and NGOs, have been the target of various attacks, resulting in kidnappings by armed groups and attacks on vehicles. Numerous ambulances have been stolen or destroyed by gunfire, and evacuations and referrals of patients, including those with complications, are nigh on impossible to carry out in some zones. In the face of this situation, health agents in these areas are leaving their posts and requesting relocations, without the arrival of replacements due to safety concerns.
Since 2020, with the increase in humanitarian aid, attacks on civilians (including community, ethnic and religious leaders) and administration staff (soldiers, mayors, health staff) have increased, as has the theft or destruction of vehicles and humanitarian relief goods (supplies, materials, medicines, etc.). To try to facilitate access, after a year and a half of negotiations by NGOs, the UN and donor organisations present in the country, in October 2020 the United National Humanitarian Air Service (UNHAS) has been deployed to reach some of these zones.
Nevertheless, there is a patent lack of sufficient financial resources for these ambitious interventions and forms of assistance. Burkina Faso is not yet among the priority countries for the majority of donors and there is little clarity on how to address different problems. During the first half of 2020, only 26% of funds requested for the humanitarian response (around 40 million euros) arrived as needs keep on growing, and the lack of funding is becoming increasingly worrying. As 2020 draws to a close, there is still no sign of the additional 384 million dollars needed by humanitarian actors to avoid a deep-seated and life-threatening humanitarian crisis that will leave the country stricken for years.
NGOs like medicusmundi and Médicos del Mundo, present in the country for several decades now, insist that the triple nexus is the best way to respond to the immediate needs while ensuring long term financing to address the systemic causes of conflict and vulnerability, and contributing to reducing the impact of recurrent crisis and to foster peace, which is critical to ensure the sustainability of development gains.