Building weather resilience in Mali

This article outlines the experience of International Medical Corps in Mali over the past two years, as our team became increasingly aware of the effects of extreme weather on the populations we serve and began to incorporate mitigation activities into our programming.

With an operational history in Mali that stretches back to 2013, International Medical Corps is a global first responder that delivers emergency medical and related services to those affected by conflict, disaster and disease. We also train people in their communities, providing them with the skills they need to recover and build self-reliance.

The health situation in Mali is poor. The under-five mortality rate is 93.8/1,000, and a World Bank Survey from 2019 found that ‘51% of Malians forego healthcare for financial reasons’. In recent years, the challenges of a poorly developed and underfunded health system have been increased by armed conflict in the north of the country. Faced with this broad range of challenges, International Medical Corps has been focusing on providing services related to nutrition, maternal and newborn health, family health, and violence against women and girls. In early 2023, we began to focus on sustainability and resilience related to the effects of extreme weather.

Becoming aware of the threat

Like other countries in the Sahel, Mali is very exposed to extreme weather, which poses a major threat to the wellbeing and lives of Malians. Mali has a long history of drought, and the frequency and severity of droughts are forecast to get worse. At the same time, communities living along the Niger River say that flooding is becoming more frequent and more intense. The occurrence of extreme heat in 2024 in some regions was unprecedented and is expected to worsen. Malian media has reported that rises in temperatures have led to increased mortality rates among the elderly and children, while
a hospital in Bamako recorded more than 100 deaths in four days following a heatwave.

The health system in Mali is not yet prepared for the effects of extreme weather. For example, government institutions and private-sector organisations have not mounted a formal response to the health consequences of high heat. People are unprepared to deal with the impacts of extreme weather, especially in areas prone to heatwaves. Furthermore, at the national, regional and district levels there are no functional disaster risk-management platforms able to provide communities with the necessary
knowledge, resources and tools that can help them develop resilience to weather-related threats, such as extreme heat and flooding.

Recognising that there was an important gap, and with support from an internal fund created by International Medical Corps to support such work, we initiated a pilot project in the Timbuktu region of Mali, with the purpose of strengthening the resilience of local communities and health providers by raising awareness on the impacts of extreme weather and preparedness planning.

Identifying and designing programmes

To design the pilot programme, International Medical Corps conducted a desk review of secondary data and information on current and projected weather-related impacts in Mali, with a specific focus on the region of Timbuktu. In addition, International Medical Corps implemented a baseline survey in
10 zones of the Timbuktu health district that constitute a useful package of primary data on health trends. Recognising that this was a new topic for many stakeholders, we realised that it would be important to develop an approach involving local authorities, health personnel and their representatives at regional level, as well as local media and grassroots community health and nutrition volunteers who work closely with the health committee in each International Medical Corps-supported health facility. As a result, one of our first steps was to conduct a number of consultations with these key stakeholders.

The combination of desk review, baseline survey data, key informant interviews and consultations helped identify damage caused by extreme weather and visible gaps in terms of health preparedness and response planning at a regional level to tackle and minimise disaster risks. In particular, it became evident that heatwaves and unpredictable and recurrent flooding situations cause widespread damage for populations in both urban and rural settings, including nomadic people and people in riverine villages on the banks of the Niger River. This damage includes the limitation of access to basic health services, increased risks of disease outbreak and of severe acute malnutrition, loss of livestock, destruction of shelters and increased displacement of people into the Sahara Desert. Some population groups were particularly vulnerable, including children below the age of 5, pregnant and lactating women, and elderly persons.

Although weather-related disasters have been happening for many years, they have recently become more frequent and intense. It was evident that the preparatory, operational and organisational capacity of the Ministry of Health at regional and district levels was not adequate to respond to the potential consequences of such events. In particular, health staff and communities were not aware of the impacts of extreme weather on health, and health facilities were not prepared to respond to the needs caused by such events.

Based on this assessment, International Medical Corps launched a programme based around two pillars. The first was to support health system efforts to become more resilient to climate-related disasters. This focused on preparedness planning for health facilities, training of health managers and health professionals, and training of community health workers. The second pillar aimed to build community understanding of weather-related threats, and focused on the development and dissemination of community health messaging around weather and health issues. The programme built on International Medical Corps’ long-standing humanitarian assistance experience in the Timbuktu region as well as our experience in training and capacity development, close relationships with health authorities and communities, and network of community health workers.

This programme marked the first time that the local authorities in the Timbuktu region had considered the topic of extreme weather and its effects on health, and reactions from administrative authorities and the Ministry of Health were very positive. They said that this was a unique programme, and that
prevention and response measures related to extreme weather constitute a big gap in the global strategy of the region.

Health and administrative authorities actively participated in the various activities, developing over the course of two workshops a preparedness plan for the health system in the region to respond to heat and flooding. Fifty-two healthcare professionals and 20 community health workers received training in the diagnosis of, and response to, weather-related health conditions, and provided positive feedback and evaluations of the training.

International Medical Corps also organised a series of awareness-raising sessions to sensitise the community to the impact of extreme weather on health. One of the outcomes of this project is the commitment of local leaders to promote environmentally friendly behaviour. However, social and behavioural change is a process that requires ongoing community education, so we are planning to ensure that the messages from this programme are communicated and updated beyond the end of the project period.

Challenges and constraints

Despite the overall success of the pilot, the International Medical Corps team encountered a number of challenges and constraints.

First, given that the topic of extreme weather and its effects on health is new to the Malian Ministry of Health, there are no standard training modules or resources available to the ministry. As a result, a lot of project time was devoted to putting together information deemed important based on the context and training needs. In future, we would hope to initiate a discussion at regional and national levels around this theme and develop modules that will be endorsed by the Ministry of Health and Ministry of Environment, Water and Agriculture.

Second, in developing materials, it became clear that there is a lack of information on the current impacts of extreme weather on health in Mali, and a lack of predictive data on the future prevalence of many weather-related diseases, including malaria, cholera, meningitis and mental health conditions. Where information does exist, it is scattered and can be hard to access. As a result, material development was slow, and some areas were not fully addressed in this first pilot.

Third, the International Medical Corps team is aware that the effects of extreme weather disproportionately affect women and girls, who have a wide variety of household and caring responsibilities. However, as women are under-represented in the healthcare system, it proved difficult to ensure a gender balance in training and planning exercises.

Emerging learning

The Mali project was part of a wider initiative across International Medical Corps to build knowledge and competence in addressing the impacts of extreme weather in the areas where we work. An important part of this is ensuring that lessons from each project are shared across the organisation and the humanitarian system more broadly. Here is a sampling of what we have learned so far.

• Demonstrating to health professionals (as well as talking about) the impact of extreme weather is important. In hindsight, the team would have allowed time for training participants to do more practical sessions (in addition to knowledge-sharing sessions) through visits to areas continuously impacted by the effects of such weather. For instance, trainees and trainers could have visited villages bordering the Niger River, close to Timbuktu, to see climate impacts, as well as previously forested areas that have become completely arid as a result of deforestation and extreme heat.
• Weather-related considerations must be taken into account in programme design. To take advantage of the funding window, many activities were conducted at an extremely hot time of year, which made it harder for participants to engage. As the weather gets progressively hotter in future years, seasonal planning of activities (where this is possible) will be increasingly important.
• Inclusion is critical. Despite efforts to ensure that all key stakeholder groups were included in the design and delivery of the programme, we would make additional efforts to engage women in the future, as the voices of women participants would contribute to widening awareness. Similarly, nomadic people were not involved in this pilot. Medics among these groups have great contributions to make by sharing traditional adaptative measures to the impacts of extreme weather.
• Local knowledge should be brought into community discussions of this topic. The population demonstrated a high degree of knowledge about extreme weather and are aware of its impacts, even if they are not aware of the causes.
• Many of the preparedness activities outlined in the plan would require additional expenditure in the event of a disaster, but it is not clear that government budgets would be available to cover these expenditures. Some form of anticipatory action fund for health might be one way to address this.
• Though preparedness is important, it ideally should be integrated with disaster risk reduction (DRR) in a ‘layered’ approach to managing weather-related risk. During preparedness planning, participants consistently returned to the importance of activities such as the construction of dikes in high-population, flood-prone areas, and of urban tree planting to increase shade and decrease temperatures in the city. Unfortunately, there is very little funding for this type of DRR in Mali.
• The project showed how important a multi-sectoral approach will be with respect to extreme weather, bringing together health, nutrition, water, sanitation and hygiene, and other sectors to address health impacts. Availability of clean water for drinking is, for example, a key element in responses to heatwaves, while protection of agricultural livelihoods can decrease the impact of floods on nutritional status. Preparing for extreme weather requires high levels of coordination across different levels and ministries of government, and between the humanitarian and development sectors.

Jean Mukenga is Country Director, Mali, International Medical Corps.

Jean Pierre Diowo Okitakoy is Acting Program Director, Mali, International Medical Corps.