Mayotte: France's Excluded Department - Doctors of the World

Mayotte: France’s Excluded Department



Mayotte is a French overseas department and region located in the Indian Ocean, between Mozambique and Madagascar. It is composed of two main islands, Grande-Terre and Petite-Terre, and several smaller ones. It has a population of about 310,000 people, most of whom are Muslims and speak Shimaore and Shibushi, two local languages, although French is the official language. 

As a French territory in Africa, Mayotte is struggling and facing a growing health crisis. It is currently the poorest and most densely populated department of France, with high unemployment rates and low level of education. It further struggles with social and political instability, as well as environmental degradation. Despite its many challenges, it has attracted a lot of migrants from neighboring countries, who seek better living conditions and security. 

In May this year, the French government launched an operation called Wuambushu, which translates to reconquest in Shimaore. The goal was to expel undocumented immigrants from Mayotte and demolish their slums, with little care for their wellbeing. Security forces backed by bulldozers raided several neighborhoods and arrested hundreds, with little regard to human rights. 

Mayotte and its inhabitants, both nationals and migrants, have suffered a lot under the regime, especially when it comes to health. Across the country, all the health indicators are in the red. The island nation struggles with undersized healthcare, issues with access to care and health insurance, and has an extreme shortage of healthcare staff. The results have led to much lower life expectancy than what could be found in mainland France. Infant and maternal mortality, as well as chronic, infectious and parasitic diseases all have high rates of prevalence. 


“There is no state medical aid since the social security code does not apply here,” says Rozenn Calvar, general coordinator of the Doctors of the World program on the island. “Even the affiliated people will have different rights from those of the metropolis. Access to free care does not exist.”

As a result, people suffering from chronic illnesses such as diabetes have to pay for their treatments. And too often, they have to do without. Mayotte is also the French department most exposed to poverty, with 77% of the population living below the poverty line. Four out of ten homes are made of sheet metal. The sanitation network is largely inadequate, and running water is rare.


Inform, advise, and guide people in order to connect them to healthcare 

It is in this context that Doctors of the World (DotW) intervenes in slums, with people excluded from healthcare and constantly threatened with deportation. “There are as many deportations to the border in Mayotte as in all the rest of French territory ”, explains Rozenn Calvar again. As a result, patients do not come to consultations because they fear being arrested and deported from Mayotte. 

Faced with this threat, Doctors of the World has responded with a different approach to provide care to those in need. “We go door to door with the beneficiaries, with teams made up of three members, including health professionals.“ says Fleur Meissonnier, a health supervisor for DotW.

Their objective: to inform people excluded from healthcare about their rights, to raise their awareness, to advise them, to guide them so that they can get through the doors of health structures in Mayotte. Follow-up is also offered to ensure that people are treated and that they are taking their treatment well. A whole range of support work also makes it possible to alert health professionals to what is really happening in the slums and to help them better understand the problems encountered by their inhabitants. 

With around 30 to 40 volunteers, Doctors of the World is able to carry out numerous types of health missions as stated above. However, the situation will continue to deteriorate unless Mayotte receives sufficient funds to grow its health infrastructure. To get a glimpse at the day-to-day activities of the DotW team in Mayotte, scroll down to see more photographs from Martin Straub, who accompanied our team in the field.




Malnutrition rates among children under 5 are very high, and more generally, malnutrition affects the entire population. 47% of the population declares itself to be food insecure.

With 3.5 times fewer doctors than in mainland France, Mayotte is a veritable medical desert.

As part of its visits, Doctors of the World works a lot with peer volunteers, people who are themselves in precarious social and administrative situations and who have a very detailed understanding of the situation of slum dwellers.