Recent clashes in northern and central Mali are hampering the deployment of humanitarian assistance, leaving vulnerable populations with limited or no access to health care, food, water and shelter.
While non-governmental organizations, or NGOs, can access most areas, banditry and continued attacks on roads slow down operations while posing a threat to humanitarian staff, says Badjougue Dambele, humanitarian coordinator for Oxfam.
“The security situation remains extremely volatile,” he said. “Following the signing of the peace agreement last year, we were hoping for an improvement. Instead, we saw the situation deteriorate with clashes erupting not only in Kidal, but in other regions as well."
The conflict between the northern separatist and pro-government militias has fractured into inter-communal violence.
Last year, the number of hostile incidents targeting aid organizations increased threefold compared to the previous year, according to the U.N. humanitarian office OCHA.
Radical groups use improvised explosive devices, or IEDs, to mine roads, and while they are mainly targeting Malian and international troops, they limit access for NGOs as well.
FILE - A Malian woman looks at men carrying humanitarian food aid, Mopti, Mali, Feb. 4, 2013.
Food is also regularly stolen, mostly by bandits. Criminality is the biggest risk for humanitarian agencies operating in the region, says Muriel Tschopp, country director of the Norwegian Refugee Council.
"We are targeted very regularly for car theft and so on,” Tschopp said. “It's usually non-violent, but it makes operations difficult."
Since July 21 in the far northern town of Kidal, fighting between groups loyal to the Bamako government and separatists killed more than 30 people and injured 82 others.
A week earlier, violent protests in the northern city of Gao killed at least two civilians. The protests mirrored some of the population's disappointment with authorities over the lack of improvement since 2013, when the north was retaken from occupying Islamist militants.
These are also the regions with the most vulnerable populations, says Côme Niyongabo of Doctors Without Borders, or MSF.
Food insecurity is chronic. And as this lean season wraps up ahead of the next harvest, close to one-third of the population in northern Mali is struggling to have enough to eat.
"When the fighting broke out in Kidal, we had just started a malaria prophylaxsis campaign for children under five years,” Niyongabo said. “The violence forced us to stop our operations and focus on treating injured."
FILE - Members of an armed group sit in a vehicle in Kidal, Mali, July 13, 2016. Clashes have been reported in the restive northern city between pro-government and former rebel groups, both based there since February.
While MSF has resumed operations, NGOs working in the Kidal and Menaka regions that are largely controlled by armed groups say they are constantly forced to negotiate access to villages and vulnerable communities, slowing down operations.
"Imagine you have an injured person in a village that needs to be evacuated and you have to negotiate access before going into that village,” said Barthélémy Brou Saouré of the International Committee of the Red Cross. “In that case, the insecurity does not only affect us, but also the people we are here to help."
In urban centers, such as Gao and Timbuktu, the situation has improved.
However, continued insecurity outside the cities prevents NGOs from addressing poverty and other long-term issues, such as unemployment.
And funding for emergency response in Mali has continued to fall since 2013. Current funding covers only one-third of the activities in the humanitarian response plan for Mali in 2016, according to OCHA.