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 ۲۴ 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 ۲۰۲۶, Senegal’s unemployment rate among people aged ۱۵ to ۳۴ was ۲۸.۴ 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 ۲۰۲۴, ۵,۲۳۶ doctors were registered with Senegal’s National Medical Council, including ۴,۴۰۷ 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.
“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 ۱۶ and ۱۷, doctors, pharmacists and dental surgeons went on strike, following a ۴۸-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 ۲۰۲۳.
“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.
The cost of waiting
Senegal is now producing oil and gas, and its economy grew by ۶.۷ percent in ۲۰۲۵, 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 ۱۳۲ percent of gross domestic product (GDP) at the end of ۲۰۲۴.
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 ۷۴.۴ percent to ۱۱۱ percent of GDP at the end of ۲۰۲۳, 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.
Who owes whom?
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 ۲۰۲۶ 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.
So people wait.
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 ۲۴ 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.”
