In Senegal, a mother’s ordeal exposes a health system under strain

A difficult birth offers a glimpse into the pressures facing Senegal’s public healthcare system.

A nurse prepares medical equipment in an ambulance of the Emergency Medical Service (SAMU) before an intervention at Fann Hospital in Dakar, Senegal [Seyllou/AFP]

Dakar, Senegal – Twenty-four hours before health workers across Senegal were due to walk out on strike, Awa Diba went into labour.

Her first child was coming into the world as hospitals prepared to limit services to emergency care.

“There is a lot of shouting,” Diba says.

“I saw things inside the hospital that shocked me.”

Her labour lasted 24 hours.

Her husband and other relatives were absent. She shared a room with four other women. Cracks ran across the ceiling. The fan did not work. Some rooms had air conditioning; others did not. Electricity was intermittent.

Women cried. Some were frightened. Sometimes, she says, their cries were met with: “Be quiet.”

A system she never expected to enter

Diba entered the hospital as a trainee nurse and left as a mother, carrying a healthy daughter. The experience left her feeling that the system itself was unwell.

She grew up in Casamance, in southern Senegal, and studied digital communication at university in Ziguinchor.

“It is difficult to find work with that here,” she says.

In the first quarter of 2026, Senegal’s unemployment rate among people aged 15 to 34 was 28.4 percent, according to the country’s National Agency of Statistics and Demography (ANSD).

Nursing felt different.

“You can have paid internships, or clinics can take you on to do shifts.”

She moved to Dakar and retrained, completing placements at Hopital Principal de Dakar and the Albert Royer children’s hospital.

A health system under strain

At the end of 2024, 5,236 doctors were registered with Senegal’s National Medical Council, including 4,407 working in the public sector, according to figures provided by the council’s president.

Dr Marc Manga, a member of the medical union SAMES in Ziguinchor, says the problem is not only about numbers.

An anaesthesiologist works in an operating theatre at Fann Hospital in Dakar, Senegal [Godong/Universal Images Group via Getty Images]

“How can we talk about quality of care when hospitals lack basic equipment and patients have to travel hundreds of kilometres to get a diagnosis?”

On September 16 and 17, doctors, pharmacists and dental surgeons went on strike, following a 48-hour stoppage the previous week. Emergency care continued, while routine medical activities were disrupted.

SAMES is calling for more recruitment, better career and pension conditions, and greater investment in hospitals and medical equipment, particularly outside Dakar. The union says its demands date back to 2023.

“We waited, we hoped and we followed up,” says Dr Diabel Drame, the union’s secretary-general. “Unfortunately, no plausible response was given to us.”

Waiting is something Senegal’s health system knows well.

Patients wait for doctors. Doctors wait for equipment. Unions wait for promises to be honoured. And the government waits for financial breathing space.

Senegal is now producing oil and gas, and its economy grew by 6.7 percent in 2025, according to the International Monetary Fund (IMF).

But the country is also carrying a heavy debt burden. The IMF estimated total public-sector debt at 132 percent of gross domestic product (GDP) at the end of 2024.

Government audits after President Bassirou Diomaye Faye took office uncovered previously undisclosed borrowing and led to major revisions of Senegal’s debt figures. The IMF said a reconciliation exercise revised central government debt from 74.4 percent to 111 percent of GDP at the end of 2023, primarily because of previously undisclosed liabilities.

The paradox is that Senegal is producing more wealth while finding itself with less room to spend it.

Foreign aid has also long supported healthcare. Cuts to United States aid have affected programmes covering HIV, malaria and reproductive health, according to reporting from Le Monde and other organisations working in Senegal.

President Faye has gone looking for room to breathe, to Washington for talks with the IMF and the World Bank, then to Abu Dhabi to meet investors and financial backers.

Faye has described the global debt architecture as “inadequate” and “inequitable”, arguing that it hinders access to essential public services, including healthcare and education.

At the United Nations, he is expected to call for wider debt relief for African countries.

Healing old and new wounds

Behind the numbers lies an older question.

In June, Ousmane Sonko, Senegal’s former prime minister, expressed support for economic reparations for Africa over the transatlantic slave trade and slavery, before an international conference on reparations in Accra.

African and Caribbean governments have increasingly pressed for reparatory justice over the transatlantic slave trade. At a June 2026 conference in Accra, Faye said Senegal was committed to advancing that cause.

Diba wants to help heal some of those newer wounds.

She plans to specialise in haematology, caring for patients with cancer, leukaemia and sickle-cell disease.

But what she notices first is fear.

“They are afraid of dying,” she says. “When they enter, they think: ‘I will never come out. I won’t leave here alive. I’m going to die.’”

Hospitals, she says, are too often the last resort.

“They wait until their illness is at the last stage before going to public hospitals.”

Public does not necessarily mean free. Consultations, tests, medicines and treatment all cost money.

They wait to have enough money to see a doctor. They wait for a diagnosis. They wait to give birth. They wait for the government to repair a broken health system.

A daughter named Myriam

After 24 hours of labour, the heat, the shouting and the fear, Diba left the hospital carrying her daughter.

She named her Myriam.

In the Quranic tradition, Maryam, or Mary, is the mother of Jesus, a woman who endures the pain and solitude of childbirth before emerging with a child in her arms.

For Diba, the name carries a story of its own: A daughter born on the eve of a medical strike, into a health system her mother has chosen to serve.

“I don’t want my daughter to experience this.”

一次难产让我们得以窥见塞内加尔公共医疗系统面临的压力。

在塞内加尔达喀尔的范恩医院，一名护士在急救医疗服务（SAMU）的救护车内准备医疗设备，准备进行急救。[Seyllou/AFP]

塞内加尔达喀尔——就在塞内加尔各地的医护人员即将举行罢工的前24小时，阿瓦·迪巴开始分娩。

在她第一个孩子出生之际，各大医院正准备将服务范围限制在急诊护理。

“到处都是喊叫声，”迪巴说。

“我在医院里看到了一些令我震惊的事情。”

她的产程持续了24小时。

她的丈夫和其他亲戚都不在家。她和另外四个女人合住一个房间。天花板上有裂缝。风扇坏了。有些房间有空调，有些没有。电力供应时断时续。

女人们哭了。有些人很害怕。她说，有时她们的哭声会换来一句：“安静点。”

她从未想过自己会进入这个系统。

迪巴以实习护士的身份进入医院，出院时已是一位母亲，怀里抱着一个健康的女儿。这段经历让她觉得整个医疗体系本身就存在问题。

她在塞内加尔南部的卡萨芒斯长大，并在济金绍尔的大学学习数字通信。

“在这里，靠这个很难找到工作，”她说。

根据塞内加尔国家统计和人口局（ANSD）的数据，2026 年第一季度，塞内加尔 15 至 34 岁人群的失业率为 28.4%。

护理工作感觉很不一样。

“你可以参加带薪实习，或者诊所可以让你来轮班工作。”

她搬到达喀尔并接受了再培训，先后在达喀尔主医院和阿尔伯特·罗耶儿童医院完成了实习。

医疗系统不堪重负

根据塞内加尔国家医学委员会主席提供的数据，截至 2024 年底，塞内加尔国家医学委员会注册医生人数为 5,236 人，其中 4,407 人在公共部门工作。

济金绍尔医疗工会 SAMES 的成员马克·曼加医生表示，问题不仅仅是数字的问题。

一名麻醉师在塞内加尔达喀尔的Fann医院手术室工作。[Godong/Universal Images Group via Getty Images]

“当医院缺乏基本设备，病人不得不跋涉数百公里才能得到诊断时，我们怎么能谈论医疗质量呢？”

9月16日和17日，医生、药剂师和牙医举行罢工，此前一周他们已经罢工48小时。急诊服务仍在继续，但日常医疗活动受到影响。

SAMES工会呼吁增加招聘，改善职业发展和养老金待遇，并加大对医院和医疗设备的投入，尤其是在达喀尔以外地区。该工会表示，他们的诉求可以追溯到2023年。

“我们等待、我们抱有希望、我们也进行了跟进，”工会秘书长迪亚贝尔·德拉梅博士说。“遗憾的是，我们没有得到任何合理的答复。”

塞内加尔的医疗系统对漫长的等待深有体会。

病人等待医生，医生等待设备，工会等待承诺兑现，政府等待财政喘息之机。

根据国际货币基金组织（IMF）的数据，塞内加尔目前正在生产石油和天然气，其经济在2025年增长了6.7%。

但该国也背负着沉重的债务负担。国际货币基金组织估计，到2024年底，该国公共部门债务总额将达到国内生产总值（GDP）的132%。

巴希鲁·迪奥马耶·法耶总统上任后，政府审计发现此前未披露的借款，导致塞内加尔债务数据大幅修正。国际货币基金组织表示，经核对，截至2023年底，中央政府债务占GDP的比重从74.4%修正为111%，主要原因是此前未披露的负债。

矛盾之处在于，塞内加尔创造的财富越来越多，但可用于消费的空间却越来越少。

长期以来，外国援助也一直支持医疗保健事业。据《世界报》和其他在塞内加尔开展工作的组织的报道，美国削减援助已经影响到涵盖艾滋病毒、疟疾和生殖健康等领域的项目。

费耶总统为了寻求喘息之机，先是前往华盛顿与国际货币基金组织和世界银行进行会谈，然后又前往阿布扎比会见投资者和金融支持者。

费耶认为全球债务体系“不足”且“不公平”，并指出它阻碍了人们获得包括医疗保健和教育在内的基本公共服务。

预计他将在联合国呼吁为非洲国家提供更广泛的债务减免。

治愈新旧伤口

数字背后隐藏着一个由来已久的问题。

6 月，塞内加尔前总理乌斯曼·松科在阿克拉举行的赔偿问题国际会议前表示，支持就跨大西洋奴隶贸易和奴隶制对非洲进行经济赔偿。

非洲和加勒比海各国政府日益呼吁就跨大西洋奴隶贸易进行赔偿性正义。在2026年6月于阿克拉举行的一次会议上，费耶表示塞内加尔致力于推进这项事业。

迪巴希望能够帮助治愈一些新近出现的伤口。

她计划专攻血液学，照顾患有癌症、白血病和镰状细胞病的病人。

但她首先注意到的是恐惧。

“他们害怕死亡，”她说。“他们进来的时候会想：‘我再也出不来了。我活不下去了。我要死了。’”

她说，医院往往是人们最后的选择。

“他们往往等到病情发展到晚期才去公立医院。”

公共服务并不一定意味着免费。咨询、检查、药品和治疗都需要付费。

他们等着攒够钱去看医生。他们等着确诊。他们等着生孩子。他们等着政府修复千疮百孔的医疗体系。

一个名叫米里亚姆的女儿

经历了 24 小时的分娩，忍受了酷热、叫喊和恐惧之后，迪巴抱着女儿离开了医院。

她给她取名为米里亚姆。

在古兰经传统中，玛利亚（或玛丽亚姆）是耶稣的母亲，她忍受了分娩的痛苦和孤独，最终怀抱婴儿而出。

对于迪巴来说，这个名字本身就承载着一个故事：一个女儿出生在医疗罢工前夕，而她的母亲则选择为这个医疗系统服务。

“我不想让我的女儿经历这些。”