Mangaize Health Centre – new maternity ward under construction (Photo UNHCR. Louise Donovan)

The protracted and complex nature of the conflict in Mali has meant that many refugees in Niger cannot return home or do not wish to. Following the outbreak of the crisis in 2012, Niger witnessed an influx of refugees into the Western part of the country. UNHCR created three refugee camps and two Refugee Hosting Areas (ZARs – Zone d’Acceuil des Refugies) to host these refugees, while many also chose to settle in Niamey. The current number of Malian refugees in Niger is approximately 52,897. Initially emergency services for all basic needs, including water, sanitation, food, shelter and healthcare were provided by the humanitarian community. However, as the situation continues, a new approach must be taken in order to integrate the refugees into the socio-economic fabric of the societies in which they are living. The situation is no longer in an emergency phase, evidenced by the fact that the standards of living have increased significantly in the past three years for Malian refugees living in Niger. For example, in 2012 30% were considered vulnerable, whereas this has decreased significantly to just 20% in 2015. Numerous other indicators, for example school enrollment, access to credit etc. indicate very positive changes for Malian refugees. Therefore the situation is now seen to be in a ‘transition phase’.

Numerous innovative initiatives are being undertaken under the guidance of UNHCR in order to integrate Malian refugees into the societies where they live. Health care is a prime example of this. UNHCR, in collaboration with the Ministry of Health, Niger, have developed a comprehensive Strategy for Integration of Malian refugees into the Public Health Care system in Niger. This approach is being successfully piloted in both Mangaize and Aballa refugee camps. The objective of the project is to eliminate the need for parallel health provision systems and for refugees to access public health care structures on the same terms as the local host population. As noted by Dr Boubé Issoufou, the Head Doctor in Mangaize health centre, “It’s the best situation, everybody wins…all of the advantages are shared with refugees and local populations. Parallel systems don’t work. All people should be at the same level, as stated by national health protocols”.

UNHCR are aiding this process through the provision of support to the local health centres. Refugees are required to bring their attestation papers when they visit the health centres. The fee for a consultation (900FCFA) is borne by UNHCR. As for the general population, children under five years and pregnant women receive consultations free of charge. In addition to monetary support for consultation fees, assistance is provided in the form of additional staff who are paid by UNHCR at the same level as staff employed directly by the state. Additional medications are provided to the local health centres, as well as an ambulance and fuel for the transport of patients – both from the refugee population and also the local population. Additional funding is received for the construction of necessary buildings, for example a new maternity ward at Mangaize health centre (pictured above). A UNHCR focal point is responsible for the project at each of the centres, who works closely with representatives of the Malian refugee population. Sensitization campaigns are also carried out within the camps to raise awareness amongst the population regarding the benefits of attending the health centre. One of the main changes witnessed amongst the refugee population is their habits - before many were hesitant to attend the clinics, but now many more are attending on a routine basis.

The system aims to promote equality amongst the refugees and the local population. No distinction is made between patients at the health centres, and there has been no conflict between the populations. It is hoped to expand this project to the third camp and the two ZARs in 2016, however logistical issues make this more difficult, as health centres are located farther from the camps and ZARs, however alterative ideas are under discussion. Additional problems also exist, mentioned by members of the Refugee Health Committee in Mangaize camp, particularly regarding shortages of medication available. However these problems are being addressed. This is one of numerous projects focused on the peaceful integration of Malian refugees into Nigerien society. Other projects include Cash for NFIs, livelihood and income generating projects and integration of the parallel water provision systems into the public system.