Articles on this Page
- 05/07/14--19:10: _Guatemala: Investin...
- 05/07/14--21:24: _Cameroon: CAR Neigh...
- 05/08/14--05:19: _Mali: Sécurité alim...
- 05/08/14--08:55: _Mali: Mali: SRP 201...
- 05/08/14--11:12: _Malawi: Purchase fo...
- 05/08/14--11:19: _Burkina Faso: Purch...
- 05/08/14--11:38: _Mali: Purchase for ...
- 05/08/14--11:48: _Mali: Mali : Aperçu...
- 05/08/14--11:52: _Mali: Mali Bulletin...
- 05/08/14--12:51: _Niger: Unconditiona...
- 05/08/14--13:38: _Mali: Le Commandant...
- 05/09/14--02:56: _Niger: L’UNHAS: un ...
- 05/09/14--03:48: _Burkina Faso: Bleak...
- 05/09/14--05:12: _Niger: UNHCR Operat...
- 05/09/14--05:57: _Mali: Sahel Crisis ...
- 05/09/14--08:47: _Niger: Niger: Bulle...
- 05/09/14--12:00: _Mali: Mali Price Bu...
- 05/09/14--12:26: _Mali: Mali: Tableau...
- 05/09/14--13:33: _Mali: Les transfert...
- 05/09/14--14:25: _Mali: Mali: Evoluti...
- 05/07/14--21:24: Cameroon: CAR Neighbors Need Funds to Cope with Refugees
- Les résultats du forum PRESAO indiquent de fortes probabilités pour que les précipitations attendues pour 2014 soient inférieures à celles de 2013 dans la région, en particulier à l’ouest du Sahel
- L’indice FAO des prix des produits alimentaires enregistre une forte augmentation pour le deuxième mois consécutif
- Les prix des céréales sèches (mil, sorgho) restent toujours élevés et supérieurs à la moyenne quinquennale
- De fortes hausses des taux d’insécurité alimentaire sont notées dans les zones ayant enregistré des déficits de production au Tchad et en Mauritanie
- 05/08/14--11:12: Malawi: Purchase for Progress - P4P Malawi
- 05/08/14--11:19: Burkina Faso: Purchase for Progress - P4P Burkina Faso
- 05/08/14--11:38: Mali: Purchase for Progress - P4P Mali
- 05/08/14--11:48: Mali: Mali : Aperçu humanitaire (au 30 avril 2014)
- 05/08/14--11:52: Mali: Mali Bulletin humanitaire, avril 2014
Les ressources mobilisées par les acteurs humanitaires pour la campagne agricole qui démarre en mai restent limitées.
Le rapatriement spontané de plus de 1 600 réfugiés maliens du Niger confirme la tendance au retour.
OCHA a formé plus de 1 500 personnes sur la coordination civilo-militaire depuis le début de l’année.
Le Fonds Central d’Intervention d’Urgence (CERF) a alloué 11,4 millions de dollars au Mali pour soutenir les projets sous financés du Plan de Réponse Stratégique.
- 05/09/14--03:48: Burkina Faso: Bleak choices for Mali refugees in Burkina
- 05/09/14--05:12: Niger: UNHCR Operation in Niger - April 2014 Fact Sheet
- 05/09/14--05:57: Mali: Sahel Crisis 2014: Funding Status as of 09 May 2014
- 05/09/14--08:47: Niger: Niger: Bulletin humanitaire mensuel numéro 04 | Avril 2014
Afflux continu à Diffa de réfugiés, déplacés/ retournés en provenance du Nigéria.
De nombreuses femmes de la région de Zinder empruntent les routes migratoires pour se rendre en Algérie
- 05/09/14--12:00: Mali: Mali Price Bulletin April 2014
- 05/09/14--12:26: Mali: Mali: Tableau de bord humanitaire (au 08 mai 2014)
Le visage de la pauvreté au Sahel a changé depuis plusieurs décennies : les inégalités en milieu rural vont croissantes et les ménages les plus pauvres sont aujourd’hui exclus des circuits productifs. Démographie galopante, changements climatiques, conflits sociaux et réduction des ressources naturelles disponibles en sont les principales causes. Les ménages pauvres ne sont plus en mesure de protéger leur faible capital et d’investir pour l’avenir. Bon an mal an, par manque de moyens financiers principalement, environ la moitié de la population rurale est touchée par l’insécurité alimentaire et la malnutrition structurelle et est exclue de l’accès à la santé.
De nouvelles stratégies d’intervention sont requises afin d’atteindre les Objectifs du Millénaire pour le Développement et de renforcer l’équité. Les éléments clés du succès sont :
- 05/09/14--14:25: Mali: Mali: Evolution des mouvements de population (au 9 mai 2014)
73 extensionists graduated from Counterpart International’s Certificate Rural Extension Program in April, the first class since the closing of the Ministry of Agriculture (MAGA) extension system and university programs in 1990.
The extensionists are now certified to work in their communities for the MAGA throughout the Huehuetenango district, providing best farming practices and techniques to improve the overall agriculture productivity.The certification is a part of the USDA-funded Food for Progress program.
The National Extension System in Guatemala disappeared 24 years ago leaving many rural farmers and communities desperate for guidance and support. The new administration in Guatemala has made an effort to re-establish the extension system.
Counterpart is improving the capacity of MAGA’s formal extension agents and certified non-governmental agricultural advisers to provide technical support to agricultural producers for increased productivity and household and market outcomes.
Through the establishment of Rural Development Learning Centers (CADERS in Spanish), Counterpart provided farmer-to-farmer training to the graduated extensionists, one third of which were women.
Counterpart has 10 CADERS in Huehuetenango where training activities took place on soil conservation, water management, horticulture production, food security and nutrition for community members, agricultural promoters, and MAGA extensionists.
The CADERS facilitate a teaching and learning process and provide a place for farmers and teachers to converse on best practices and technology, food and nutritional security, and rural development solutions. After trainings, each farmer is then able to share and replicate what they learned to their community members.
“The transfer of knowledge and skills to farmers and their families is an important extension activity and the extension agent must prepare himself thoroughly,” Country Director Maria Esther Bucaro said. “They must find out which skills or areas of knowledge are lacking among the farmers in his/her area, and then arrange suitable teaching and learning experiences through which the farmers can acquire them and solve their problems. Extension also provides advice and information to assist farmers in making decisions and generally enable them to take action.”
Moki Edwin Kindzeka
YAOUNDE, CAMEROON — A European Union official says countries that share borders with the troubled Central African Republic urgently need millions of dollars to cope with an increasing number of refugees. One of those countries is Cameroon, where nearly 80,000 C.A.R. residents have fled since December.
The past year of violence in the C.A.R. has forced nearly a million people to flee their homes, including an estimated 160,000 in Bangui, the capital.
Since December, more than 100,000, mostly Muslims, have fled to neighboring countries.
The EU commissioner for international cooperation, humanitarian aid and crisis response, Kristalina Ivanova Georgieva, says the living conditions of the refugees and host communities is getting worse.
"Desperate refugees are fleeing for their lives from the Central African Republic, small communities are receiving big numbers of refugees and that makes live difficult," she said. "We have made a decision to double humanitarian aid from three to six million euros [$4-$8 million] so there could be more assistance for shelter, food, medical care for the refugees that cross."
Speaking during a visit Tuesday to Yaounde, Georgieva said efforts to stabilize the C.A.R. and stop the flow of refugees will require taking away guns and machetes from the militias.
EU foreign ministers recently approved a new military mission to the C.A.R. and deployed 850 troops to support the French and African Union forces already in the country.
Also, the United Nations Security Council has authorized an expansion of the African force under U.N. command.
Georgieva says the increased troop strength is needed because the country is descending into total chaos.
"We are working very hard with the United Nations to make it possible for a significant reinforcement of up to 12 000 [troops] to arrive as quickly as possible because stabilizing the Central African Republic is the only way to reduce the flow of refugees into neighboring countries," she said. "The Central African Republic has been forgotten for far too long and we, the international community has a debt to pay. It is a very deep and serious crisis."
The crisis is having a significant impact on Cameroon, which is hosting more than 180,000 refugees from the C.A.R. Host communities have complained of higher food prices in areas where the refugees are lodged, and an increase in disease.
P4P in Malawi
In Malawi, P4P works directly with smallholder farmers’ organizations (FOs) to develop their capacity, and engages with key stakeholders to build smallholder-friendly agricultural markets, which the country relies on for sustained economic development. In order to facilitate the development of these markets, P4P links smallholders with the Agricultural Commodity Exchange for Africa (ACE), enabling FOs to use the online, public commodity exchange as a marketing platform. Through training exercises, WFP and local partners help smallholder farmers develop business and harvesting skills to meet WFP’s high quality standards. After acquiring these skills, smallholder farmers are able to sell their crops to WFP as well as other buyers, and, most importantly, become competitive players in formal markets to increase their incomes and improve their lives.
P4P in Burkina Faso
In Burkina Faso, P4P focuses on increasing the capacity of farmers’ organizations (FOs) to invest in crop production, and to aggregate and market commodities. Training in quality management, storage, logistics, transport, credit access and partnership development has helped smallholders access quality-oriented markets. With WFP providing an assured market and an incentive for farmers to produce and sell more, P4P has also been a catalyst for collaboration between partners along the value chain. In addition, P4P links FOs to the government’s National Food Reserve, SONAGESS, as well as other buyers, ensuring that farmers have a sustainable market beyond WFP. Participation among women has been particularly high in Burkina Faso.
P4P in Mali
In Mali, P4P aims to increase the income of small-scale farmers, especially women, by increasing their productivity and strengthening their organizational and marketing capacity. In order to achieve this, WFP purchases directly from farmers’ organizations (FOs), providing smallholders with a substantial assured market. Additionally, capacity development activities, including promoting access to improved seeds and other inputs, providing training in agricultural techniques, and linking farmers to processing units or other markets beyond WFP, allow farmers to produce higher quality products in larger quantities. A strong government focus on policies which enable agricultural and rural development has played a key role in the implementation of P4P.
Entre le 28 avril et le 4 mai, environ 1 600 réfugiés maliens rapatriés spontanément du Niger sont arrivés dans le cercle de Ménaka, région de Gao. Ce retour est le résultat d’une initiative coordonnée par les réfugiés eux-mêmes.
The humanitarian context
The food crisis in the Sahel region in 2012 affected the Nigerien population severely. Poor crop production, increased food prices as well as a significant number of Nigerien returnees fleeing the conflicts in Libya, Ivory Coast, Mali and Nigeria, made access to food and other basic items very difficult. According to the director of the agricultural development department of Tanout, seven out of ten people faced food insecurity in April 2012. In this context, approximately 501 households were displaced to the city of Agadez and 725 households to the city of Zinder, fleeing from escalating food insecurity in their villages of origin. Subsequently, these households were identified by the Regional Committees for the Prevention and Management of Disasters and Food Crises in Zinder and Agadez (CRPGCA).
Seasonal population outflow is a normal phenomenon in Niger, but the emigration of entire families at the end of a season – as was the case at the beginning of 2012 – is exceptional. Starting in June 2012, inter-regional missions were organised to evaluate the general situation in the villages of origin of displaced households and the places where they sought refuge. The host communities and authorities in the regions of origin were involved in this evaluation process. The results showed that the environmental conditions in the villages of origin of the returned refugees were favourable (in terms of security, stability, arrival of first rains) while the economic situation of households was getting worse. Renewed displacements were observed, with rural households taking refuge in urban centres either in their region of origin or in regions further away – data which was confirmed by the CRPGCA census.
The increase of precarious and unhealthy housing conditions in zones of high flooding risk was observed too. There was also a sudden rise in begging by women and children in the cities and the imminent arrival of the sowing season coupled with the general context of humanitarian crises in the country pushed the local authorities and the Government to make an appeal for emergency assistance to the international community of NGOs working in Niger, in order to repatriate internally displaced people (IDPs) as quickly as possible.
ASB has been working in the regions of Zinder and Agadez since 2005 and specialises in food crisis response as well as risk prevention management. It was therefore well placed to respond to this appeal.
After coordinating with other NGOs working in the region, ASB centered its action on internally displaced households. The results of a preliminary study and the census undertaken by the regional committees of Agadez and Zinder in April 2012 (nearly 501 and 725 households respectively) show that the majority of displaced households were classed as ‘very poor’ since they had difficulties covering their basic needs (food, shelter, hygiene, health etc.) and had adopted negative survival strategies (e.g. selling off productive assets before their departure).
Bamako, le 7 mai. Le Commandant de la Force de la MINUSMA, le Général Jean Bosco Kazura, et une partie de son état-major, se sont rendus à Kati, au nord-ouest de Bamako, pour y assister aux exercices pratiques de fin de formation des techniciens des équipes de neutralisation des explosifs et munitions.
Ces contingents népalais et cambodgiens ont suivi pendant plusieurs semaines des enseignements pratiques et théoriques – organisés et offerts par le Service de lutte antimines des Nations Unies ou UNMAS - sur la détection, le déminage et la dépollution de sites. Leur formation terminée, ces techniciens seront déployés dans le nord du pays pour y accomplir leur mission au profit des troupes et de la population. La cérémonie de clôture de la formation et de remise des diplômes est prévue lundi prochain.
Le General Kazura a pu constater la qualité des formations dispensées grâce aux démonstrations statiques et dynamique du matériel. Sous la conduite de M. Charles Frisby, chef de l’UNMAS au Mali, et des différents instructeurs, les stagiaires ont pu faire montre de leurs connaissances et de leur technicité. Les invités ont pu ainsi découvrir le pilotage à distance d’un engin lourd de déminage pour la préparation du terrain, ou encore une méthode plus « fine » de dépollution par un technicien revêtu du scaphandre de protection individuel.
Le Général Kazura a remercié les instructeurs pour leur implication dans la formation et a félicité et salué les stagiaires pour la qualité de leurs performances, en leur rappelant l’importance du rôle qu’ils auront à jouer dans les régions où ils seront déployés, tant aux profits de leur collègues Casques bleus, que des autorités et des populations locales.
UNMAS est présent au Mali depuis janvier 2013 à la demande du Département des opérations de maintien de la paix des Nations Unies pour y mener une mission d’évaluation, suite aux conflits qui ont secoué le pays.
Depuis 2012, plus de 250 personnes (civils, membres des forces armées maliennes, de la MINUSMA et de Serval) ont été tuées ou blessées par des engins explosifs improvisés et des restes explosifs de guerre.
Outre ses actions de déminage sur l’ensemble du territoire malien, UNMAS dispense aussi des formations au profit des Forces armées maliennes et des éléments de la MINUSMA.
A la fin des années 80, le Programme Alimentaire Mondial (PAM) a mis en place un service aérien dont le rôle était d’acheminer de la nourriture en grandes quantités en Ethiopie, Somalie, Angola et Soudan. En 2003, le PAM a accepté d’étendre son mandat et de gérer l’ensemble du transport aérien (passagers et cargo) pour les activités humanitaires et les programmes de développement. Le United Nations Humanitarian Air Service (UNHAS) est né. Ce service est aujourd’hui présent dans une quinzaine de pays et est capable, en cas d’urgence, d’ouvrir une nouvelle ligne dans les 48h. Il a commencé à opérer au Niger en 2008.
Dans ce pays, pour la seule année 2013, l’avion de l’UNHAS comptabilise 1674 heures de vols, 17 259 passagers et plus de 40 tonnes de matériels. Chaque mois deux à quatre évacuations médicales sont réalisées. Au Niger, l’UNHAS est au service de plus de 89 ONG nationales et internationales, de 12 agences multilatérales, des organisations affiliées à la Croix-Rouge et au Croissant Rouge, de la communauté diplomatique et des donateurs.
L’UNHAS est bien plus qu’un simple soutien aux opérations, c’est un maillon essentiel de la chaîne humanitaire et de développement qui facilite considérablement le travail des acteurs de l’aide. Son service va peut-être même au-delà.
DJIBO, 9 May 2014 (IRIN) - More than a year after France’s military intervention drove out Islamist militias, northern Mali appears to have regained some stability. However, Malian refugees at the Mentao camp in neighbouring Burkina Faso are wary of going back, citing security problems and unresolved political issues.
At the same time they lament that deteriorating camp conditions and the poor quality of life are forcing some to return.
“When you talk about food, water and health, we are in a very bad situation,” said Almahi Ag Almouhak, who heads a committee of the southern sector of the Mentao camp near Burkina Faso’s northern town of Djibo.
The camp is home to around 12,000 Malian refugees. Djibo has been a sanctuary for Malian refugees since the early 1990s when insurgencies in northern Mali led to a long period of instability and violence. The same migration recurred in January 2012 as Mali tumbled into conflict once more. Mentao was rapidly refurbished and brought into service and took in its first wave of new arrivals in February 2012.
“In the past, if the poorest of us had run out of food, we would organize contributions to help out. But now everyone is in the same predicament. We have nothing to spare. In the past, you would see refugees heading into the market in Djibo to buy supplies. But now no one has got credit,” Almouhak said.
Row over food rations
The refugees raise other concerns: the quality of medical care, the sometimes-intrusive security presence, the lack of entertainment possibilities for the young. But mostly they complain about food rations, arguing that monthly allocations of rice, oil, corn-soya blend, salt and “top-up” cash payments are inadequate and poorly scheduled.
In January 2014, following consultations with the refugees, the UN Refugee Agency (UNHCR) and the World Food Programme (WFP) started combining food rations with cash distributions. Refugees were handed a monthly payment of 3,500 CFA francs (US$7) to buy much-requested items like milk, condiments and meat, supplementing the rice and other rations received from WFP.
But refugees in Mentao (and elsewhere) say the scheme has not worked, pointing out that the cash meant to compensate for halving the 12kg monthly rice rations is insufficient. “What we get is not nearly enough,” said Almouhak.
“When you hear about refugees going back to Mali, it is not because they feel secure enough to return, it is because of hunger,” said Mohamed Ag Mohamed Ibrahim, the deputy head of Mentao’s southern sector committee.
Worries over insecurity
Despite the 2013 elections that ended Mali’s post-coup transitional government and brought in a new president and parliament, Mentao residents are wary. There are still sporadic attacks and ambushes around key northern cities like Timbuktu, Gao and Kidal. The refugees also talk disparagingly about a seemingly grounded peace process, with no real dialogue between the government and the Tuareg- separatist National Movement for the Liberation of Azawad (MNLA).
“Nothing is on the right path,” said Daouad Ag Ghali, a Mentao resident. “None of the meetings between the different parties [government and rebel movements] has produced anything.”
But some internally displaced people and refugees have been going back and taking on the challenges of restarting their lives, with the backing of the Malian government. Others at Mentao say the camp will be deserted en masse within a month if conditions do not get better regardless of concerns about security back home.
“You find people organizing collections,” said Almouhak. “They will get enough money together, find themselves a truck and then go. Many simply want to find the animals they left with friends.”
“It has got to a stage where people here are selling off the mats they sleep on to get some extra money,” Ibrahim pointed out. “We are pastoralists but we don’t have our animals with us. This is poverty.”
UNHCR stresses that spontaneous return is a basic right for refugees and one that it does not oppose, but the agency is keen to keep track of returnees and know how they get on. Relief officials and refugees acknowledge that some Malians are clearly crossing over and coming back again.
Mass return is not for now
Whatever improvements there have been in northern Mali - fewer security incidents, an expanding UN presence, the gradual restoration of state administration - UNHCR has made it clear that mass return was never an option for 2014. “The situation in Mali will remain fragile and will not yet allow for large-scale returns,” the agency said.
According to UNHCR and the Burkinabe state-run National Commission for Refugees (CONAREF), refugee numbers have dropped significantly, from a peak of close to 50,000 in 2012 to just under 34,000 in February 2014. The UNHCR’s own projections suggest there will still be around 14,300 Malian refugees on Burkinabe territory by the end of 2015.
Angèle Djohossou, UNHCR’s deputy representative in Burkina Faso, said a tripartite agreement must be signed by the governments of Burkina Faso, Mali and UNHCR before any serious repatriation programme can be set in motion.
There is a grim acknowledgement from both the UNHCR and partners that the level of services at Mentao and other camps is under threat from shrinking budgets and a perceived lack of concern from donors, which is fuelling the refugees’ sense of abandonment.
Djohossou warns that “the situation of Mali has not received the level of funding that it merits,” referring to donors’ attention being diverted to other priorities elsewhere such as the Central African Republic, South Sudan and Syria.
UNHCR’s budget for refugee operations in Burkina Faso in 2014 is $25.7 million, down from $32.8 million in 2013 because of the projected return of 5,000 refugees. Djohossou says funding in 2013 for Mali was 50 percent below what it should have been, and the UNHCR is facing similar constraints in 2014.
The budget breaks down into 30 different sections, covering everything from water provision to donor mobilization.
Some areas, including child protection and education, are given priority in the allocation of funding; but there are other areas where shortfalls are anticipated. For example, Djohossou says funding constraints have compromised the agency’s attempts to monitor the 25 percent of refugees living outside the main, consolidated camps as effectively as it would like.
“Donors need to get the message,” a senior NGO official in Mentao told IRIN on condition of anonymity. “We get a lot of missions coming here, which is encouraging for us and for the refugees, but donors need to realize that nothing here has changed. If the funding is not there, what will a refugee eat?”
“If a refugee has to pay for hospital treatment, what money will that person use? If they want water, where will they get their supplies from?”
The crisis in northern Mali since 2012 has forced some 50,000 Malians into exile into Niger. It has also led to the return of 6,000 Niger nationals previously living in Mali. Most refugees live in the three camps established in Tillaberi region in 2012, namely: Abala, Mangaize and Tabareybarey.
In 2013, in an attempt to adapt to the specific needs of nomadic refugees, two “refugee hosting areas” were established in Intikane and Tazalit in Tahoua region. These are vast areas where nomadic Malian refugees can settle freely with their livestock enabling them to live according to their traditional and pastoral way of life with grazing land for their animals.
Following the presidential elections in July-August 2013 and a gradual improvement of the security situation in northern Mali, a back-and-forth movement between Niger and the areas of origin in Mali has been observed. Some refugees have also requested UNHCR for return assistance. Even though the situation in northern Mali does not yet call for the promotion of organized massive returns, UNHCR has offered individual assistance and since November 2013 has assisted some 6,000 refugees to return to Mali.
In May 2014, a Tripartite Agreement between Mali, Niger and UNHCR was signed for the voluntary repatriation of refugees to supervise the process.
Millet, rice, and sorghum constitute the basic staple foods for the majority of the Malian population. Millet has traditionally been the most widely consumed, but since 2005 rice has become a popular substitute in urban households. Sorghum is generally more important for rural than urban households. Markets included are indicative of local conditions within their respective regions. Ségou is one of the most important markets for both the country and region because it is located in a very large grain production area. Bamako, the capital and largest urban center in the country, functions as an assembly market. It receives cereals from Koulikoro, Ségou, and Sikasso for consumption and also acts as an assembly market for trade with the northern regions of the country (Kayes and Koulikoro) and Mauritania. Markets in the deficit areas of the country (Timbuktu and Gao) receive their supplies of millet and rice from Mopti, Ségou and Sikasso.
Aperçu de la situation
Le conflit armé affectant le nord du Mali depuis 2012 a subi une escalade en janvier 2013. Ce conflit a provoqué le déplacement de 278 370 personnes dont 137 096 Personnes Déplacées Internes (PDIs) dans les différentes régions du pays et 141 274 réfugiés (Avril 2014) en Mauritanie, au Burkina Faso, au Niger et dans d'autres pays. Sur le plan de la sécurité alimentaire, 1 500 000 personnes ont besoin d’une assistance alimentaire immédiate et d’ici la fin de l’année 2 100 000 personnes seront sous pression, 496 000 enfants de moins de 6 à 59 mois souffriront de malnutrition aigüe, dont 136 000 de malnutrition aiguë sévère (MAS) et 360 000 enfants seront à risque de malnutrition aigüe modérée (MAM).
a. L’existence d’une stratégie d’intervention de long terme, portée par les Etats et soutenue par les bailleurs de fonds sur la durée, en appui aux processus nationaux d’ores et déjà engagés en la matière – cet engagement sur la durée devra renforcer la résilience des populations les plus pauvres et permettre ainsi une croissance équitable et soutenue dans les pays sahéliens ;
b. La flexibilité des programmes pour intégrer la réponse aux crises qui deviennent de plus en plus récurrentes au Sahel – la programmation et les programmes doivent être dynamiques et pouvoir être ajustés en période de crise en augmentant l’assiette et la couverture sur la base d’informations récentes et objectives ;
c. La qualité du ciblage, les ménages pauvres devant être les premiers bénéficiaires, et au sein de ces ménages, les individus les plus vulnérables à la malnutrition (femmes enceintes et allaitantes et enfants de moins de 5 ans) ;
d. Des systèmes intégrés et multisectoriels de transferts sociaux avec différents outils, tels que les transferts monétaires saisonniers destinés aux ménages pauvres et l’exemption de paiement des frais de santé pour les individus pauvres ou vulnérables.