All she saw was blood. Ouma Ibrahim knew it was not normal to have so much blood after delivering her son at home. She consulted a midwife at the nearby Dagamanet Clinic near her Agadez home, who sent her to the regional hospital five kilometres away.
But as evening approached, Ibrahim could not find a neighbour willing to drive her.
Normally, a taxi should have cost US$0.50, but the only taxi driver she found charged $3, “Just because they know they can,” said Ibrahim. “No one wants to be on the streets at night. It just is not safe. Neighbours will pretend they don’t hear knocking, and pleas to borrow their car. If it had been any later, I would have just had to stay at home and wait until morning.”
Fear spreads in Agadez
Agadez, a main entry point to the Air Mountains bordering the Sahara desert, is under a state of alert after northern desert rebels took up arms a year and half ago against the government. All buses and private cars travelling to the north can only do so every other day when military convoys are available.
Until 2007 the town was at the centre of a thriving tourist industry receiving charter flights direct from Europe, but today the government says it is too dangerous for any tourists to visit.
The fighters demand more community investment and a larger share of mining profits from the resource-rich north.
Violence has spilled from the mountains into Ibrahim’s hometown of Agadez, which contains a regional military base in charge of government military operations against the rebels.
Agadez has one of two regional state-funded hospitals that cover the entire northern half of the country.
Drop off at hospital
Last March, government officials decided the Agadez hospital had outgrown its space in the town centre. The available plot of land on the edge of town to construct a new hospital faced the military base. The military base is perceived to be a potential rebel target.
Ibrahim arrived to this hospital 21 August at 20.30, more than 40 minutes after she started bleeding. The hospital’s lead gynaecologist, Dr. Hamadou Idrissa, said the patient was severely anaemic upon arrival, and needed a blood transfusion.
“Since we moved to this site, I have seen a large drop off in those coming to the maternity ward. We have not had any reports of the military stopping people from seeking services at the hospital, but people cannot get past the psychological barrier of seeking care so close to the base.”
The doctor said fear, rather than actual experience, makes people think the military may block them. The military sets up check points at 19.00.
Agadez mayor Abdoulaye Hama said he has ordered a car that will serve as a town ambulance, which is expected to arrive next month. UN Population Fund (UNFPA) has pledged to cover gasoline costs.
Conflict cuts off access
Since violence broke out again last year, Mahaman Hanissou Ouedraogo, director of the UNFPA Agadez office, says it is hard to reach expecting mothers who live beyond town limits, which is roughly where paved roads end. Access to the mountains, which has been the centre of much of the fighting, is strictly cut off.
The most recent information on maternal mortality in Niger was gathered before the latest surge in violence. According to the Niger government, in 2006 about 14,000 women died from pregnancy complications.
“Because of the insecurity, UNFPA does not have access to patients in the mountains [centre of sporadic attacks]. We must send everything through the government. We can’t follow up, and must trust that it is getting to the women, and they are using the kits correctly.”
UNFPA has given 6,000 birthing kits for home deliveries and 3,000 hygienic kits to government officials for distribution in the 15 communes that make up Agadez (the region’s largest commune is also called Agadez).
According to regional statistics, there are 40 functioning government-funded health centres and 79 smaller “huts” in more remote areas in the bush, in addition to the two regional hospitals. According to a government census last month, there are about 400,000 people scattered throughout the desert, mostly nomads far from towns.
Previously, health centres sent out staff in all-terrain vehicles deep into the bush to offer care. But the government has discontinued these mobile health clinics because of the violence.
Ouedraogo says nurses from health centres still use motor bikes to distribute medicine because it is easier for them to manoeuvre the bikes through the risky terrain.