Authors: Abdoul Fatao Diabate, Diadje Tanapo, Sekou Thera, and Moussa Sangare

A growing challenge for health research

Conducting health research in insecure settings remain a major challenge. In many sub-Saharan African countries, including Mali, the security conditions have deteriorated significantly over the past decade, and areas affected by the presence of non-state armed groups pose significant operational, ethical, and logistical constraints for field research teams. Our own field experiences have shown that conducting research in these contexts requires constant adaptation, strong local engagement, and careful risk management.

Safety and contingency protocols

In this context, several principles guide the conduct of responsible research. The safety of participants and field teams is an absolute priority and must be built into the study design from the outset. Ongoing security monitoring, carried out in collaboration with local authorities, community partners, and humanitarian organizations operating in the region is essential. Contingency protocols including flexible schedules, alternative routes, and evacuation procedures  must be established to anticipate unexpected disruptions without compromising the scientific integrity of the study. In our experience, these measures are not simply precautionary but often determine whether field activities can continue safely and effectively. In situations where access is not possible for non-local staff, we propose two options: First, training local community members to carry out data collection where feasible and second, replacing the affected area with a site that has similar characteristics.

Institutional partnerships and the role of local stakeholders

In our experience, working in close collaboration with the Ministry of Health and community health centers has been a key enabler for reaching target populations while maintaining institutional legitimacy in the field. Engaging local field coordinators from within the communities being studied not only builds trust with participants but also reduces the risks associated with the presence of outside teams in sensitive areas. These local actors also provide critical contextual insights that help research teams navigate cultural sensitivities, rapidly changing security dynamics, and community perceptions.

Discretion and field conduct

On a practical level, we encourage field teams to carry official mission orders and check in with all local authorities before and during activities, in order to avoid any confusion about their identity and purpose. It is critical that research teams not be mistaken for law enforcement and that they avoid any police or military escort in certain areas, as this could make them targets for unidentified armed groups. Based on our field observations, maintaining a neutral and low-profile presence is often essential for both staff safety and community acceptance. Discretion in movement is essential, and destinations should not be shared openly with anyone.

Ethics and the necessity of research in conflict settings

Finally, we recommend that ethics committees must be informed of the security risks inherent in data collection in insecure settings, and informed consent processes must reflect these contextual realities. Research in conflict-affected areas, while complex, remains both possible and necessary to generate the evidence needed to serve the most vulnerable populations. Despite the operational difficulties, excluding populations living in insecure settings from research risks further marginalizing communities that are already underserved by health systems and humanitarian responses.