SCENESETTER FOR HHS SECRETARY MICHAEL O. LEAVITT'S

UNCLAS SECTION 01 OF 05 BAMAKO 000606 SENSITIVE SIPDIS DEPT PASS TO HHS/OGHA DEPT PASS TO USAID E.O. 12958: N/A TAGS: PREL EAID ML SUBJECT: SCENESETTER FOR HHS SECRETARY MICHAEL O. LEAVITT'S VISIT TO MALI BAMAKO 00000606 001.2 OF 005 1.(SBU) Summary: We warmly welcome Secretary Leavitt's upcoming visit to Mali. The Secretary's visit will provide an important opportunity to highlight U.S. support for a moderate, majority Muslim democracy that stands as an example for West Africa and beyond. Mali has made considerable progress since its 1991-1992 transition to democracy. Unfortunately, Mali's health, education and economic indicators remain among the lowest in the world. U.S. assistance plays a crucial role in helping Mali to address these challenges by ensuring that Mali's political successes translate into tangible improvements for Mali's estimated 13 million people. U.S. support for Mali and its people is particularly apparent in the health sector. USAID/Mali's budget for health related activities is approximately USD 32 million per year, with nearly half of this amount dedicated to malaria prevention under the President's Malaria Initiative. The Centers for Disease Control and Prevention (CDC) and National Institutes of Health (NIH) provided approximately USD 4.4. million for health related programs in FY07. Mali is one of the few countries in West Africa not currently facing a food shortage. Rising food prices have, however, affected consumption patterns and the Ministry of Economy has predicted eventual food shortages for some remote areas. Mali also faces serious security challenges. Renewed fighting between Tuareg rebel groups and the Malian military in the northern region of Kidal has endangered the implementation of a peace agreement, known as the Algiers Accords, that was signed by the Malian government and Tuareg rebels in July 2006. Northern Mali also serves as a safe-haven for the Islamic extremist group al Qaeda in the Islamic Maghreb (AQIM) which continues to hold two Austrian hostages. Mali is an important ally in the global war on terrorism and a key member of the Trans-Sahara Counter-Terrorism Partnership (TSCTP). Although security concerns are currently confined to specific areas of northern Mali, increased levels of instability in the north has forced us to begin scaling back some of our assistance efforts for Mali's northern regions and we are concerned that further unrest will have a profound impact on our development and security goals. End Summary. -------------- Malian Democracy and International Engagement -------------- 2.(U) As a moderate majority Muslim democracy with over 15 years of democratic experience, Mali serves as an example for west Africa and beyond. President Amadou Toumani Toure, who is known to Malians as "ATT," was re-elected to a second and final five year term as President in 2007 with more than 70 percent of the vote. His closest presidential challenger, former National Assembly president Ibrahim Boubacar Keita, finished second with less then 20 percent. 3.(U) Mali is a responsible and engaged international partner. It has a strong human rights record and is one of the few members of the Organization of the Islamic Conference to be rated as "free" by Freedom House. Mali is also a leader in sub-Saharan Africa in terms of press freedoms, although this record was tarnished somewhat by the 2007 arrest and conviction of several journalists for "offending" the Head of State. The journalists were given small fines and suspended sentences. In addition to serving as the 2007 Chair of the Community of Democracies, Mali is active in the United Nations and other international organizations and has participated in several international peacekeeping operations. 4.(SBU) Unfortunately, Mali's political progress has not been matched by improved social and economic indicators. Mali ranked 173 out of 177 countries on the United Nation's 2007 Human Development Index. Mali's poor ranking is due in large part to literacy rates, health indicators and a per capita GNP that rank among the lowest in the world. These factors, along with renewed Tuareg unrest and the continued presence of al Qaeda-aligned terrorist elements in the country's sparsely populated northern regions, constitute serious threats to Malian democracy and regional stability. The U.S. plays a significant role in helping Mali to meet these challenges and reinforce almost two decades of democratic progress. -------------- U.S. Assistance to Mali -------------- BAMAKO 00000606 002.2 OF 005 5.(U) The November 2006 signing of a Millennium Challenge Account compact with Mali made the U.S. the largest bilateral donor to Mali. It also cemented strong U.S.-Mali relations and better positioned Mali as a force for stability in a politically fragile region. The USD 461 million compact entered into force in September 2007 and includes a USD 234 million irrigation project north of Segou and a USD 183 million airport renovation project. USAID/Mali has an annual budget of approximately USD 55 million, which is divided between the health, education, governance and communications, and economic growth sectors. Mali is host to one of the largest Peace Corps programs in Africa, with on average more than 120 Peace Corps volunteers in country working on health, sanitation, water conservation and economic development. 6.(SBU) Mali is an important ally in the global war on terror and a key member of the Trans-Sahara Counter-Terrorism Partnership (TSCTP). TSCTP programming in Mali can be divided into programs focused on counter-terrorism and counter-extremism. Important counter-terrorism programs include bilateral training exercises like Joint Combined Exercise Training (JCET) events. Counter-extremism activities include a broad range of Department of Defense supported humanitarian assistance, USAID development programs and public diplomacy outreach. The Department of Defense's Humanitarian Assistance Program has contributed over USD 3 million to Mali since 1999 to build wells, construct schools and renovate health clinics. Mali is an active participant in the DOD's International Military Education and Training (IMET) program. We also provide resources to train three Malian units in peacekeeping operations through the African Contingency Operations Training and Assistance (ACOTA) program. 7.(SBU) Malians practice a predominately open and tolerant form of Islam and are therefore unreceptive to extremist messages. Our TSCTP counter-extremism programs are designed to promote moderate messages and ensure that Malians remain unreceptive to extremist ideologies. TSCTP programs administered jointly by the State Department, USAID and the Department of Defense are designed to ensure that this remains the case and counter the possible spread of extremist ideologies. USAID/Mali considers the northern region of Mali an important area and has undertaken activities there in a concerted effort since 1999. USAID/Mali implemented approximately $3.7 million worth of activities in the north during FY07, including support to 35 rural health centers, the construction and reinforcement of 17 community radio stations, the establishment of six community telecenters offering internet access, the conduct of conflict-mitigation activities, support to rice and horticultural commodities, the expansion of access to financial services, the provision of scholarships and mentoring to 6,500 girls under the Ambassador's Girls Scholarship Fund, and the creation of teacher training and radio-based instruction for children of nomadic populations. USAID/Mali received an additional $9.5 million in TSCTP funds and the majority of these resources have been earmarked for activities in the north that aim to expand economic opportunities for youth, construct additional community radio stations, build capacity for local government, and support madersas throughout the country. 8.(U) On the Public Affairs side, we have used cultural preservation grants to help Mali honor its Islamic heritage by protecting thousands of ancient Islamic manuscripts in Djenne and Timbuktu and helping to preserve an ancient mosque in Gao. We additionally recently celebrated the year anniversary of the only American Corner in Mali. Located in Gao, it has allowed us to quadruple our outreach to key contacts in the region and to further promote mutual understanding between Malians and Americans. -------------- U.S. Assistance to the Health Sector in Mali -------------- 9.(U) The majority of Mali's approximately 13 million people live in rural areas with limited access to essential health services. Although there has been a steady decline in maternal and child mortality, these indicators remain alarmingly high. Mali has one of the world's highest fertility rates, which increases health risks to mothers and contributes to poverty levels. The average number of births per Malian woman is 6.6. children. The current maternal mortality rate is 464 deaths per 100,000 live births. BAMAKO 00000606 003.2 OF 005 Under-five child mortality has decreased from 229 to 191 per 1000 live births since 2001. Infant mortality, which is at 96/1000 live births, accounts for more than half of under-five child mortality. Malnutrition among children remains a crucial problem as 2 out of 5 children are chronically malnourished. In addition, 81 percent of children from 6 to 59 months in age are anemic. Mali has seen a decline from 1.7 percent to 1.3 percent in the HIV/AIDS prevalence of the general population over the past 5 years. An estimated 85 percent of Malian women are victims of female genital cutting. 10.(U) USAID/Mali receives approximately USD 32 million per year for health related activities. Nearly half of this money is for malaria control via the President's Malaria Initiative (PMI). USAID/Mali is currently implementing the High Impact Health Services (HIHS) approach launched in 2003. The HIHS framework supports the Government of Mali's ten-year health and social development plan and covers six primary technical areas: maternal health and family planning; malaria control; HIV/AIDS and child health; nutrition; vaccinations; and control of diarrheal disease. HIHS is designed to increase levels of access, availability and quality of health services offered at local health facilities throughout the country. HIHS also encourages the use of high impact health behaviors at the household level. The key strategies behind HIHS aim to link and involve communities with health services, deliver key interventions within communities and promote and support essential health practices. 11.(U) CDC Mali operates from within the Ministry of Health's committee for coordinating efforts to fight the spread of HIV/AIDS. In Mali, CDC's Global AIDS Program (GAP) currently focuses on three areas of intervention: HIV prevention, surveillance and laboratory strengthening. In the area of prevention, CDC supports two local community-based organizations (ASDAP and Soutoura) that provide comprehensive prevention and community health services to at risk populations. Both groups operate voluntary counseling and testing centers as part of their comprehensive service package. The CDC also works with the Malian Government to implement two major epidemiological surveys which have identified important statistical trends and data among high risk groups. CDC's GAP program also provides technical assistance to the National Institute for Public Health Research (INRSP) laboratory on the development and use of laboratory testing algorithms, manuals and other guidelines as well as reinforcing national diagnostic capabilities to support surveillance efforts. 12.(U) NIH is a founding partner of Mali's Malaria Research and Training Center (MRTC),which was created in 1989. The MRTC is a unique and truly African operation whose work is planned, directed and executed by Malian staff. The MRTC was presented as a model for development efforts at the Second International Meeting of the Multilateral Initiative on Malaria in South Africa in 2000. NIH has designated the MRTC as a recipient of one of NIH's highly competitive and coveted Tropical Medicine Research Center grants. In FY07, NIH funding for the MRTC exceeded USD 2.7 million. These funds provide vital training opportunities for Malian medical students and researchers, and support important vaccine research. -------------- Food Security -------------- 13.(U) According to the World Bank and Mali's Commissioner for Food Security, Mali is one of the few countries in the region that does not currently face a food crisis. The World Bank and other donors have, in fact, criticized Mali for exacerbating the regional food crisis by blocking the export of cereals. Mali currently has enough course grains to carry over until the October harvests. However, many Malians have already begun replacing staple goods with alternative, cheaper commodities due to rising food prices. The Minister of Economy predicted eventual food shortages in certain remote areas and has signaled his intention to request assistance from the international community. Higher prices will hit Mali's northern regions harder because these areas produce less and import more agricultural products, making them more susceptible to exogenous shocks. BAMAKO 00000606 004.2 OF 005 14.(U) USAID provides almost $1 million in annual support to Mali's rice sector, including in the areas of irrigation, access to arable land, wells, financing, and support for the commercial sales of rice. This is in addition to the USD 6 million spent annually by USAID, in collaboration with American universities, to help introduce new technology into the cultivation of sorghum and millet, fisheries, and other crops to provide broader food security. The MCC's USD 234 million project in Alatona is focused on modernizing the irrigation system and developing 14,000 hectares of additional irrigable land. -------------- Security Challenges -------------- 15.(SBU) Security concerns in northern Mali constitute a significant challenge for the Malian government. Mali has weathered two Tuareg rebellions (one in 1963 and a second during the 1990s) since independence. In May 2006 Tuareg rebels attacked two Malian military outposts in northern Mali and rekindled fears of another prolonged rebellion. President Toure resisted calls from some Malian political leaders to force a military confrontation with the rebels and instead opted for dialogue mediated by Mali's northern neighbor, Algeria. In July 2006 Mali and the Tuareg rebels signed a peace agreement, known as the Algiers Accords, which pledged to provide increased development and infrastructure support to Mali's three northern regions. In 2007 a dissident group of Tuareg rebels led by Ibrahim Bahanga resumed attacks against Malian military posts and convoys. Bahanga held several dozen Malian soldiers hostage for nearly six months until Libya helped negotiate their release in March 2008. Less than two weeks later Bahanga seized another group of Malian soldiers. He and another rebel group, the Alliance for Democracy and Change (ADC),are now holding approximately 80 Malian soldiers as "prisoners of war." 16.(SBU) Although Tuareg unrest is generally confined to the region of Kidal, rebels have orchestrated early morning attacks against military outposts in the regions of Gao and Segou. Algerian-brokered discussions aimed at uniting disparate Tuareg rebel factions and facilitating a return to the Algiers Accords framework are currently on-going. President Toure remains committed to a negotiated settlement with Tuareg rebel leaders. Key aspects of the Algiers Accords not yet implemented include the creation of special military units composed of northern and southern Malians, and the reduction of Malian forces in the north to pre-2006 troop levels. Neither of these components can be implemented without a cease-fire that is respected by all Tuareg rebel groups. Tuareg rebels are also demanding a credible investigation into the April 10 executions of two Tuareg rebels who had been re-integrated into the Malian army in the northern city of Kidal. In addition to supporting Malian efforts to respect the Algiers Accords, we have urged the Malian government to investigate these killings and have noted that credible allegations of human rights abuses perpetrated by members of the Malian military could adversely affect our ability to provide military training to Malian units in the future. 17.(SBU) In addition to the unfolding Tuareg crisis, Mali's sparsely populated and vast northern regions also serve as a haven for smugglers, bandits and terrorist elements. The Malian government is unable to fully secure these zones due to their size and remote nature. Algerian Islamic extremists formerly known as the Salafist Group for Preaching and Combat (GSPC) but now called al Qaeda in the Lands of the Islamic Mahgreb (AQIM) continue to use northern Mali as a safe haven and are currently holding two Austrian hostages on Malian territory. -------------- Comment: U.S. Support for Mali -------------- 18.(SBU) Mali's status as a leader in democracy, human rights and tolerance make U.S. engagement with Mali, and support for Mali's development in crucial areas like the health sector, even more critical. The number and variety of U.S. government agencies involved in health care in Mali, as well as the presence of award winning institutions like Mali's Malaria Research and Training Center, are a testament to U.S. commitment in this regard. Your visit to Mali will BAMAKO 00000606 005.2 OF 005 serve as a further demonstration of U.S. Government support for Mali and its people at a time when Mali is confronted with serious development and security challenges. Your visit will also afford an important opportunity for us to engage with Malian officials and members of civil society on important issues like malaria prevention and the fight against HIV/AIDS. MCCULLEY