Twenty-four hours before health workers across Senegal were due to walk out on strike, Awa Diba went into labour.
asserted
Diba → walk → labour
Her first child was coming into the world as hospitals prepared to limit services to emergency care.
asserted
hospitals → come → care
“There is a lot of shouting,” Diba says.
asserted
Diba → be → shouting
“I saw things inside the hospital that shocked me.”
asserted
that → see → me
Her labour lasted 24 hours.
asserted
labour → last → ?
She shared a room with four other women.
asserted
She → share → women
Cracks ran across the ceiling.
asserted
Cracks → run → ceiling
The fan did not work.
asserted
fan → work → ?
Some rooms had air conditioning; others did not.
asserted
others → have → conditioning
Women cried.
asserted
Women → cry → ?
Sometimes, she says, their cries were met with: “Be quiet.”
asserted
cries → say → ?
A system she never expected to enter
Diba entered the hospital as a trainee nurse and left as a mother, carrying a healthy daughter.
asserted
Diba → expect → daughter
The experience left her feeling that the system itself was unwell.
asserted
system → leave → her
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.
asserted
she → grow → that
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).
uncertain
rate → age → Statistics
Nursing felt different.
asserted
Nursing → feel → ?
“You can have paid internships, or clinics can take you on to do shifts.”
asserted
clinics → have → shifts
She moved to Dakar and retrained, completing placements at Hopital Principal de Dakar and the Albert Royer children’s hospital.
asserted
She → move → Dakar
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.
uncertain
doctors → register → 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 16 and 17, doctors, pharmacists and dental surgeons went on strike, following a 48-hour stoppage the previous week.
asserted
doctors → say → stoppage
Emergency care continued, while routine medical activities were disrupted.
asserted
activities → continue → ?
SAMES is calling for more recruitment, better career and pension conditions, and greater investment in hospitals and medical equipment, particularly outside Dakar.
asserted
SAMES → call → Dakar
The union says its demands date back to 2023.
asserted
demands → say → 2023
“We waited, we hoped and we followed up,” says Dr Diabel Drame, the union’s secretary-general.
asserted
Drame → wait → ?
“Unfortunately, no plausible response was given to us.”
asserted
response → give → us
Waiting is something Senegal’s health system knows well.
asserted
system → know → ?
Patients wait for doctors.
asserted
Patients → wait → doctors
Doctors wait for equipment.
asserted
Doctors → wait → equipment
Unions wait for promises to be honoured.
asserted
promises → wait → ?
And the government waits for financial breathing space.
asserted
government → wait → space
The cost of waiting
Senegal is now producing oil and gas, and its economy grew by 6.7 percent in 2025, according to the International Monetary Fund (IMF).
uncertain
economy → wait → Fund
But the country is also carrying a heavy debt burden.
asserted
country → carry → burden
The IMF estimated total public-sector debt at 132 percent of gross domestic product (GDP) at the end of 2024.
asserted
IMF → estimate → 2024
Government audits after President Bassirou Diomaye Faye took office uncovered previously undisclosed borrowing and led to major revisions of Senegal’s debt figures.
asserted
Faye → take → 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.
asserted
exercise → say → liabilities
The paradox is that Senegal is producing more wealth while finding itself with less room to spend it.
asserted
Senegal → produce → it
Foreign aid has also long supported healthcare.
asserted
aid → support → 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.
uncertain
Cuts → affect → 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.
asserted
Faye → go → investors
Faye has described the global debt architecture as “inadequate” and “inequitable”, arguing that it hinders access to essential public services, including healthcare and education.
asserted
it → describe → healthcare
…and 27 more, not listed.
The Aporia
