A Poisonous Mix - Human Rights Watch

are paid by patients. As a result, access to health care is difficult for the poor, and
community health centers are underutilized. 270
Some specific health services are free of charge, notably health care for children under the
age of five, caesarean sections, and treatment of HIV and a few other diseases. Access to
health care has improved in these specific areas. 271
Health Access Barriers for Children in Mining Areas
Health care access in artisanal mining areas is often very limited, despite the heightened
risk of health problems stemming from mining. For example, there is only one referral
health center, with few medical doctors, in the health district of Kéniéba, serving
208,000 inhabitants. There are 19 community health centers, which are staffed with
nurses and midwives. 272
In some mines, there is a health worker, such as a nurse, who runs a small pharmacy and
refers cases to the nearest community health center. However, many other mines have no
public health facility. This is the case in one of the largest artisanal mines in the Kéniéba
region, Hamdallaye. 273
In the absence of public health services, several NGOs run HIV-prevention and treatment
programs in artisanal mining areas, but have limited resources to provide more general
healthcare. They do general awareness-raising, disseminate condoms, reach out to sex
workers, and assist patients in getting access to voluntary counseling and testing, and
treatment if necessary. 274
270 Mamadou Kani Konate, Bakary Kanté, Fatoumata Djènèpo, “Politique de santé communautaire et viabilité économique et
sociale des centres de santé communautaires au Mali: Etude de cas en milieu urbain et rural,” draft, September 2003,
http://www.unrisd.org/unrisd/website/document.nsf/(httpPublications)/F4478C9C2C2D0794C1256E200039D082OpenDo
cument (accessed August 15, 2011).
271 Ministère de la Santé, “L’approche sectorielle dans le domaine de la santé au Mali”, December 2009,
http://www.btcctb.org/files/web/publication/L'approche%20sectorielle%20dans%20le%20domaine%20de%20la%20
Sant%C3%A9%20au%20Mali.pdf, pp. 75-76 (accessed July 12, 2011); Ministerial Leadership Initiative, “What do we
know in 2011 about the new free care policies in Mali” 2011, http://www.ministerial-
leadership.org/sites/default/files/events/event_files/Microsoft%20Word%20-%20Eng-
Synthese2%20Free%20care%20Mali%204%2026%2011.pdf (accessed August 14, 2011).
272 Human Rights Watch interview with Dr. Coulibaly, CSREF, Kéniéba, April 2, 2011.
273 Human Rights Watch interview with private doctor, Kéniéba, April 4, 2011.
274 Human Rights Watch interviews with representative of CLUEDUCA, May 27 and June 8, 2011; Human Rights Watch
telephone interview with representative of Soutoura, June 30, 2011; Human Rights Watch telephone interview with
representative of SOS SIDA, August 12, 2011; SOS SIDA, “Rapport d’activités de la campagne de sensibilisation dans les
zones minières des cercles de Kadiolo et Sikasso”; Collectif du Groupe d’Intervention au Mali pour la Promotion et le
Développement Socio-sanitaire (CO-GIMPDS), “Rapport suivi monitoring. 2ème semestre 2010.”
61 HUMAN RIGHTS WATCH | DECEMBER 2011