Let's talk Burkina Faso: The world’s fastest growing humanitarian crisis

Avril Benoît:

Here we go. Now I'm unmuted, that'll work. You'd think by now I would know how to do this properly. Welcome. Thanks for joining us. I'm Avril Benoît, the Executive Director of Doctors Without Borders in the United States, that's Médecins Sans Frontières, or as we're known internationally, especially on the ground in humanitarian crisis zones, MSF. So when you hear MSF, that means Doctors Without Borders, and of course, Médecins Sans Frontières.

So this is a series we've been doing since the beginning of the pandemic, bringing you into our work in different parts of the world to give you a sense of how the pandemic is affecting what we do. And today, it's a little bit different, because we're going to pay attention to a part of the world that is experiencing a really devastating humanitarian crisis. And while we're all focused on the pandemic, and of course, even there as well, we sometimes forget that there are ongoing and exacerbating crises in the world, and this is certainly one of them.

As usual, this is a discussion that will go approximately 45 minutes and you have an opportunity to ask your questions. If you're watching on Zoom, you can send your questions in to the Q&A option. On Facebook Live or Twitch, send the questions in to the comments or the chat section. They will be fed to me, and then I will ask our guests to see what they have to say based on your questions.

Now today, we're talking, as I mentioned, about an under-reported emergency, Burkina Faso. Over the last couple of years, up to one million people and possibly more have been forced to flee their homes due to a rise of conflict of violence in different parts of the country, especially in the north. The Sahel region of Sub-Saharan Africa, is always close to my heart, since I spent nine months, better part of 2015, working in a region that was receiving refugees from the Timbuktu region of Mali. And over on the other side of Mali, we have Burkina Faso, which at that time was much more stable and now is the place where there is so much displacement.

So today, I'm joined by two of our colleagues who are joining us from Ouagadougou, and we're very glad that we got the lines going today. It was a little bit iffy just before we went live. We have both of them to give us different perspectives on what is happening on the ground, what the medical teams are seeing. Dr. Marc Couldiaty, is our Medical Coordinator for MSF in Burkina Faso, and Tommaso Santo, is the Head of Mission for MSF in the country as well. Welcome too both of you, really glad to have you. You're both on mute. I see we're getting off mute all together. Thanks so much for being with us. There we go. Dr. Marc, tell me about your work. What is it that you do in Burkina Faso, which is your home country?

Dr. Marc Ounténi Couldiaty:

Absolutely. My work is to evaluate the needs on humanitarian. Certainly, as you explained that we do have a lot of peoples, more than one million, they leave their house... Now we do have also a health system, which is overwhelmed. So our main focus is to identify the gaps, what are the needs, and how to support and implement the activities to meet the requirements of the displaced population. That's what we are doing in overall countries and what will happen.

Avril Benoît:

All right. And Tommaso, tell us about your work.

Tommaso Santo:

Hi, I'm Tommaso as you said, I'm an Italian, Head of Mission here in Burkina Faso. And actually, I would like to say a word about the complexity and the nature of this conflict because it's quite new in the country, just a few years. And there are many actors involved in the conflicts, there are obviously, the army, the armed group, voluntary militia, international forces with also the participation of the Western country, and also there is an inter-ethnic conflict ongoing. So just to give you an idea of the different levels of the conflict and the complexity.

Avril Benoît:

It's a situation that obviously people in the region have seen grow and build and become more complex over the last couple of years. Maybe Tommaso you can describe why people are fleeing, what is causing so much displacement?

Tommaso Santo:

First of all, insecurity, because those actors that I mentioned before are quite active, especially in some part of the country, in the north, in the border with Niger and the boarder with Mali. So people are seeking for security and safety, and they're fleeing from the conflict. So some of the schools are closing down, most of the health structure are closed, WHO reported more than 300 health structure closed. So obviously, the population is seeking for security, and is going to the big city, where they find more security.

Avril Benoît:

And what kind of conflict are we talking about? Is it all at once, is it low grade constant? Is it small little flares in different regions? Maybe you can just help us to understand or visualize what it's like.

Tommaso Santo:

It's extremely difficult to understand also for me, that I dedicated my day to try to understand it. And between, obviously there is the state, they're fighting against the armed group, then there's the local militia civilians, with weapons, they are fighting against armed groups. Then among the armed groups, they're fighting each other because inside the government groups, there are two main function. One, it's somehow the Al-Qaida branch affiliated, and the other is the Islamic State affiliated group, so they're fighting each other. And then, there is this inter-ethnic conflict, mostly from one part of the population that traditionally was a cow breeders and nomads, and the other part of the population that was traditionally farmers and land owners. And so, as you can imagine, the population is trapped in the middle, and they're the real victim and target of all these actors fighting each other.

Avril Benoît:

Dr. Marc, you have worked in many other conflict zones yourself, with MSF, with Doctors Without Borders, and you're from Burkina Faso.

Dr. Marc Ounténi Couldiaty:

Right.

Avril Benoît:

Which is one of the 10 poorest countries in the world. Can you compare what this conflict zone? And what this conflict is? How it compares to the other places where you've worked?

Dr. Marc Ounténi Couldiaty:

Yeah. I can definitely say that here, it's more complicated, the needs are really huge compared to where I used to work, because from these places, the health systems before the conflict, were already strong, but unfortunately, in our context here in Burkina, even before the conflict, the health system was weak. So now, due to the conflict, we do have more complex crises in terms of... I mean, there are some problems. I mean, I can say, they really need support as MSF is doing to respond to the needs. Otherwise, things will be more worse than what we do. We do have now with the support of the MSF and then yesterday, MSF was with the Ministry of Health.

She really appreciated the help and the support done by our organization. And she asked also to continue and to increase our support in terms of primary health care and to reinforce also the competencies of the health workers, which is also weak in this kind of context. So definitely, compared to where I used to work, I can say that, we really addressed the need and the support is also appreciated by the government and the health authorities.

Avril Benoît:

We have a question for you, Marc from Monica, who is asking it on Facebook. Are you seeing much COVID-19 in Burkina Faso? And if so, what is MSF doing?

Dr. Marc Ounténi Couldiaty:

Yeah. At the beginning of the pandemic, there was an increase, as it was a new disease, no one was not really comfortable on how the spread can be. So MSF really gave a huge support, to take care of the patients. So I mean, in the big centers of the country, which are the referral centers, MSF really support also the Ministry of Health, in terms of medical equipment, in terms of reinforcement of the capacity of the health workers. And then, in terms of supply, in droughts also to respond. But with time, we saw that the trend was not going really up. So we strive to readapt our support, which is still there, but it's a bit light, in terms of monitoring the cases around the country, and how to respond and to support our partners.

Avril Benoît:

This is one of the things that really is striking about this pandemic, is where it has been very serious and where we have not seen such an influx of patients into the hospital with it. Why do you think Burkina Faso has not had a worse crisis of the pandemic of COVID-19?

Dr. Marc Ounténi Couldiaty:

Yeah, me I could say mainly, first of all, I think the people are young also compared to the western countries, that can be an explanation. I can say also that we do not have a lot of chronic diseases, so this also can explain. So some conditions we can be more worse if you get COVID-19, so in our population, we don't have really how proportions of population, which has this kind of disease. So I can say the main two things can explain a bit why we don't have... So I can say to many patients in hospitals, but in the other end, we don't also have a good numbers, because the testing centers are not also enough in overall country. So that's what I can say for COVID-19.

Avril Benoît:

Right. And Tommaso, as the Country Director, I suppose that this is mixed in adding to the complication of trying to respond to the displacement in Burkina Faso. Can you explain how it is that we managed to balance the two both, the fact that we were trying to be there for the medical needs of people who are displaced? And maybe you can describe the kinds of things that they need, and they've gone through? And then, how the pandemic has complicated things?

Tommaso Santo:

Well, I will start with your second question. Also, the added value for us for being here, is to stay close to the health system, because obviously, they have already a limited capacity. And if they dedicate the few resources that they have, for respond to the pandemic, other disease, really deadly disease, such as malaria, malnutrition, they'll be somehow neglected, and this is our fear. So this is why we stay close to the health structure, to the community, to the Ministry of Health, to support them to not just forget about malaria, and malnutrition and dengue, now, we are also at the peak of dengue. So obviously, they're deadly disease, even much worse than COVID.

So this is why we stay here to support them also for not just dropping down things. And regarding... and I also would like to add another thing, we have to understand that, as I said before, the conflict is quite new, so people, they didn't have time to develop what we call coping mechanisms. So the population is not that resilient as it happened in other country that unfortunately, are living in a conflict, like Central African Republic or Democratic Republic of Congo, South Sudan, where there is a conflict that somehow it's part of the day life. Here the conflict is quite new, it's just two years conflict. People, they're not used to, they develop mental health problems, post-traumatic stress syndrome for stress disorder, because they don't use, they were living in peace until a few years ago. And now, when you see the numbers of the internal displaced people, you can see that there's a sharp increase from 8000 people in January 2018, we reached now October 2020, 1.3 million, that it's more or less the 7% of the total population, just to give you some preview.

Avril Benoît:

You actually touched on something that Rick is asking, through Zoom, to speak a little bit more about the mental health needs of the displaced people in Burkina Faso. Dr. Marc, can you describe for us what sort of things that they are telling us they have been through, what they have experienced?

Dr. Marc Ounténi Couldiaty:

Yeah, for the mental health, is one of the weakness of the Minister of Health as we're seeing, I can say it's something which is not integrated in the system. So it's something which is innovative for MSF to bring it into the health system and to strengthen the system also. I mean, what we are providing, is the whole package of the mental health disease since the community side to improve the awareness of the mental health issues, because there is a lot of all sorts of stigma around, this kind of topic. So our team in the village, in the communities is trying to improve the awareness of this such kind of disease, to have also support from the community leaders. So in the health system, we are also doing trainings to the health workers for them to be able to provide counseling to such kind of patients and also to give drugs if there is a need.

So we are also planning to have a curriculum of training for the whole package of the mental health gaps, to be able to provide quality of care. If there is a need, we will provide also a specialized care like a secret care to these kind of patients. So we're really providing the whole package to this kind of patients. The need is really huge, in terms of drugs, in terms of trainings. And so, we are working on that right now.

Avril Benoît:

The people who are coming with mental health problems, who have been through so much, what have they told us about what they witnessed or experienced themselves?

Dr. Marc Ounténi Couldiaty:

So we have a lot of rapes, for example, which is traumatizing. Two weeks ago, for example, we had one which unfortunately, is now pregnant, due to the rape. So we have these kind of situations, and then we have also some patients when they get birth, it's not really working well, so they will be depressed. So this is kind of the most complicating cases due to the rape, or when they lost the baby in our facility. So all of those needs are addressed by MSF. And as I was saying, It's new for the country, even, in the curricula of the training of the health workers, this kind of specialties of topics are not really known, because there is more priority for the... I mean, the health authorities, as Tommaso was saying, like malaria. So these kind of things are not really known by the health system.

Avril Benoît:

A question for you Tommaso, from Kathy, who's asking it through Zoom. She's asking about a drought in Burkina Faso this year. And a related question, about climate change and how that may be exacerbating or making more complex, the insecurity in the country. Can you speak to that?

Tommaso Santo:

Yeah, this for sure is a worsening factor, because it's adding another level of complexity. So the drought and the flooding this year, we witness a phenomenon, that probably it's linked to bigger climate change phenomenon like El Niño, or others. So suddenly, all the region of Sahel was flooded, that happened from South Sudan to Burkina Faso. And a lot of people lost the few things they already had like the smaller shelters, the small houses made in plastic sheeting. So we had to provide an initial help to those people that were losing everything for security and for the flood. And then suddenly, now it's not raining already since a month. And I think it would be like this forth until next June. So definitely, climate change is worsening the climate crisis.

Avril Benoît:

Right. And the cascade, I suppose with the conflict, with the displacement. How is all of this affected food security?

Tommaso Santo:

Yeah, as I said, people doesn't have access to health care, but also doesn't have access to food. They're really dependent from the humanitarian aid. And these numbers of people dependent from humanitarian aid, including food, it's rapidly increasing every month. So that's obviously, we are really worried about. And on top of it, I insist, sorry, on the violence aspect, because I saw also another question after the one from Sandra, saying that the government say that now the situation is more secure and especially, in the north and central north region, and probably, they also want to pass this message because there is election now. The 22nd of November, the people from Burkina Faso will be voting and definitely the message from the government is a message that was, despite drought, despite the lack of food, despite the security, but what we are seeing in the field, it's really different. We don't see situation getting better. As Marc said, we see people raped, people killed, people abducted, looting.            

And just for telling a story, just yesterday, I was speaking with a good colleague of mine, a nurse, and I said, "Where are you from in Burkina Faso? Can you show me your village in the map?" And he pointed out a small village in the border with Mali, and I said, "Wow, and explain to me how you can go there to see your family because I would like to have the same access and to send my team there to check the humanitarian situation there." And he said to me, "Well, it's incredibly complicated, because I have to call my father first. He has to greenlight my visits. I will go there for lunch, and then I cannot sleep there in the house of my father and my mother, because as I'm a nurse, I'm under threat to be kidnapped, because I would be an asset in this conflict." And I was really sad knowing that imagine that this guy working with us, cannot even sleep at his father and mother home and has to come back because it would not be safe for him.

Avril Benoît:

That's something that we see in other conflict zones, isn't it? The targeting of especially, medical workers, people who can be useful in conflict situations, and it makes it that much more difficult. So there is this question from Borchueh Wu on Zoom about the election, and how it's affecting things. So you mentioned that the government is trying to send a message of reassurance. But you're seeing and hearing other things from the people. Dr. Marc, how are the elections likely to change things in the crises? I mean, not to comment, we're obviously not taking sides, we're neutral in this. But what do we expect of the movement of people and maybe flare ups of more violence during this election period?

Dr. Marc Ounténi Couldiaty:

Yeah, I can say also, during this election period, we do have an increase of violence. We already have where we are working, the more thefts are also due to the violence. So with the elections, we are waiting and plan to respond to more wounded and then some mass casualty also can happen in our health facilities. So we know that the context is not so really helpful, so we are planning in case, we will be able to react and respond at the good moment.

Avril Benoît:

Sam on Zoom is asking about the opening and closing of health facilities amidst all of this instability and crisis. How stable is the presence of health facilities of small clinics in villages and in towns, right now? Are they able to remain open?

Dr. Marc Ounténi Couldiaty:

No, for me, all of this is a bit due to the elections. So the authorities, they're trying to reopen, but health facility is not only to be open, so we have to think on the health workers, we have to think on the drugs to apply, we have to think on... I mean, there is a lot of things. So politically speaking, so they are saying, we are reopening, but they are not really functional. It's still weak, and then even some health workers, it's not safe for them to be in such areas. Definitely, I can say the situation is really going a bit worse, because we are in the field, we are in the village, we are really with the peoples, we are seeing that... I mean, there is no change, positive change, I can say for that question.

Avril Benoît:

Tommaso, you in your role as the Country Director, have a lot of interaction with other providers from the humanitarian community. Natalie on Zoom is asking about the presence of other organizations such as UNHCR. Who are the others that are working in also in response to the crises in Burkina Faso that we have some interaction with as MSF?

Tommaso Santo:

Well, definitely, we have interaction with all the actors. Definitely, we speak with them. When it's possible, we try to coordinate with them. So we don't try to duplicate services. But in general, there is still a need of scale for humanitarian assistance. The actor there now is not enough. The act of respond, that is ongoing, and one important things, in my opinion, is that these humanitarian assistance has to be impartial and independent, and not to link with the security and stability agendas. Because then, when we start to link the stability and security agenda with the humanitarian response, we lose neutrality, and somehow we're part, we're becoming another actor of the complexity of the conflict.

Avril Benoît:

Caroline is asking about where the conflict really is spreading, where it's located. I know, Tommaso you have a map ready to put up on your screen, if you maybe could explain to us and describe the zones that are hot, that are cooling down, that are heating up and what concerns us. If you can go ahead.

Tommaso Santo:

I can open Google Maps. Wait a sec, can you see Google Maps?

Avril Benoît:

Yes.

Tommaso Santo:

So we have... as you see Burkina Faso, there's a lot country doesn't have access to see. Now we're speaking from here, from Niger, the Ouagadougou is the capital. And MSF is mostly working in the border with Mali, so in the north west of the country, in the north. So we are working in the north of the country as well, in the triple frontier, what we call the triple border between Niger, Mali, and Burkina Faso, is a really complex area, because the armed group are really active there. And also, we are working in the east region, so all the border with Niger and the boarder with Benin. So our response consent, it's focused on north, north west and north east.

Avril Benoît:

And so, those are places where we are able to work and where we have a presence, where is the center of the conflict?

Tommaso Santo:

Well, there is not a center of this conflict. There is not, because the technique of this conflict are typical, what we call a hit and run for the armed group on the main roads. They're the international coalition and the states are doing strike with airplanes. So there is not a line of conflict, how it was Aleppo for the Syrian conflict a few months ago. There is not a specific geographic area of the conflict, it's all spread in this area that is called the triple frontier, the triple border.

Avril Benoît:

Carol on Zoom is asking that given that this current conflict really, which has been building up for the last couple of years, but has become even more of a crisis in the past 12 months, since it's a relatively recent development. Is there any hope of returning to peace soon?

Tommaso Santo:

Well, this is our hope. And I guess it's the hope of the people here from Burkina Faso. But unfortunately, as Marc said, not in the short term, we will see what happen with the election period, we will see what happen after the election. But the signal we see in the field, they're going through a worsening of situation.

Avril Benoît:

I have a comment to pass along for you, Dr. Marc, from a former colleague of yours who is tuning in on YouTube, Ghada is writing, "I worked in Burkina Faso in 2011, 2012 with Dr. Marc in Titao and it's so hard to imagine this country becoming a conflict zone."

Dr. Marc Ounténi Couldiaty:

Yeah.

Avril Benoît:

Now tell us about the other places you have worked and your decision to come back home.

Dr. Marc Ounténi Couldiaty:

Yeah. Now, I am just coming back from the Philippines. So in the Philippines, so we do have also a project there in Marawi City, due to the conflict also in 2017. So the situation is a bit different because Philippines has, for example, a strong health system. So you can find good nurses, good doctors, you can find also good hospitals around, good supply in terms of droughts, in terms of medical equipment. But here, we did not have this kind of, I mean, level. So due to this conflict, I can say that, the needs are really different and more needs here than in the Philippines, from my point of view. I also know that there is still need there, but as I can do also useful with my experience to my country. So that's why it was a pleasure for me to come back because I was graduated in 2009, and I joined MSF three days after in that I started in Titao. So I really worked and I like this work with MSF. Because as Heather was saying, if you see the situation, which was in 2019, in Titao, and today it's really sad and painful for us to see this kind of situation. So this is a bit what I can say on my prospects to work in my own country.

Avril Benoît:

We have a few questions from people such as Natalie on Zoom asking, "What can we do to help meet the needs of MSF and MSF patients, our patients and all the patients that we work with of course, the government health facilities?" How can people who are watching support efforts to raise awareness of this crisis? So it's not forgotten and that more help comes.

Dr. Marc Ounténi Couldiaty:

Yes. So I think that this kind of webinar is really helpful, so to raise the awareness of the current situation. So from my side, I think our communication team are also really working to raise the awareness. Because we cannot really have the real situation happening in the field, if it's not the humanitarian actors as MSF, which are close to the peoples, who live with the peoples every day, we knows their real needs. So it's really our organization, who have to raise the real information around this crisis, which is not known around the world.

Avril Benoît:

Tommaso, when you interact, as you often do in your role with the local authorities, national authorities, also with international aid organizations, such as ours, is there is there optimism? What are you hearing about the future in terms of that analysis?

Tommaso Santo:

Well, the hope is the last to die. We have for sure optimist, it's a sort of mantra and energy that make us work better, and we're try to do our best every day. And we will never lose the hope and the optimist every day. But it's a really difficult situation and for us, as I said also, or as I think also other question asked, one of the most important things is to ensure access to health care, and to ensure this kind of neutrality and impartiality of the health structure that we support because it's the only way that we can provide safety also. And not only health care, we can also provide a safe space to these people they're fleeing from violence and from the war, actually. The hope is still there, but we are also realistic, and we have this moment to multiply our efforts in order to be able to respond to these incredible increasing needs.

Avril Benoît:

I'd like to give you the last word, Dr. Marc. What is it that gives you hope to keep going and working for your people in Burkina Faso?

Dr. Marc Ounténi Couldiaty:

Yeah, for me, is the capacity of MSF to respond when there is really a need. This is really useful for the displaced population. We know that, as I was saying, the health system is really weak. The needs is really dynamic, it's increasing but fortunately, we are able to really respond when there is a need in a short period and with a good result. So this is really exciting because we can have this kind of feedback also, from the community, from the patients. And then also yesterday, our meeting with the Minister of Health, was a really nice because she recognized that we are friends. It's really difficult for them. They are overwhelmed but MSF is a friend. MSF is here, because there is need. They really know what we are doing. And they are also asking us to continue. They know that the need is really huge, but they also ask MSF to really help and continue to help. And then, this is also happiness also for us as we are helpful. This is what I can say about what is really relevant to work in my country.

Avril Benoît:

And for those who are watching, we just want to thank you for joining us to learn about this. And also for your ongoing support of our work. We really could not do it without you. We are financially supported by millions and millions of donors around the world, people who make it possible for us to do everything we can in places like Burkina Faso, that are not always in the news, especially in a pandemic. So thank you both for joining me today. That's all the time we have, a good place to end. Dr. Marc Couldiaty, Medical Coordinator for us and Tommaso Santo, Head of Mission or Country Director both joining us from Ouagadougou. Thanks so much and may you have courage, strength and be safe also in your working.

Tommaso Santo:

Thank you for your support.

Dr. Marc Ounténi Couldiaty:

Okay. Thank you.

Avril Benoît:

Thank you so much. And again, thanks for joining us, If you're watching. Apologies if we didn't get to your question, but really stay in touch. You can stay connected with us at Doctors Without Borders, at MSF by emailing us. The team that puts on these webinars can be reached at [email protected]. For more information, of course, just go to our website, we have doctorswithoutborders.org also msf.org. You can find us on Twitter, on Instagram, on Facebook, you name it. And we'll be back in another couple of weeks with another edition of this, Let's Talk webinar discussion, that'll be on November 12th, so we hope to see you there. I'm Avril Benoît. Have yourself a great day. Bye, bye.

Tommaso Santo:

Bye, bye.

Dr. Marc Ounténi Couldiaty:

Bye.