Cablegate: Scenesetter for Hhs Secretary Michael O. Leavitt's

DE RUEHBP #0606/01 1821652
R 301652Z JUN 08




E.O. 12958: N/A

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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

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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)

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.

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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

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

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.

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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

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

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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.

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