Awa Diba went into labour 24 hours before Senegal's health workers walked out on strike. She spent a full day in a cracked-ceiling ward with four other women, intermittent electricity, a broken fan, and staff who told frightened mothers to be quiet. She entered as a trainee nurse and left as a mother — carrying a healthy daughter and a clear-eyed assessment that the system she chose to serve is itself unwell. The numbers frame the paradox. Senegal's economy grew 6.7 percent in 2025 according to the IMF, buoyed by new oil and gas production. But total public-sector debt stood at an estimated 132 percent of GDP at end-2024. Government audits after President Bassirou Diomaye Faye took office revealed previously undisclosed borrowing that revised central government debt from 74.4 percent to 111 percent of GDP at end-2023. The country is producing more wealth while finding itself with less room to spend it. The health system absorbs this contradiction directly. Just 5,236 doctors were registered with the National Medical Council at end-2024, of whom 4,407 work in the public sector. On September 16 and 17, doctors, pharmacists and dental surgeons struck for the second time in two weeks, demanding recruitment, better career and pension conditions, and investment in hospitals and equipment outside Dakar. The medical union SAMES says these demands date to 2023. Dr Marc Manga in Ziguinchor frames the core question: "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?" External shocks compound the fiscal squeeze. US aid cuts have hit programmes covering HIV, malaria and reproductive health. President Faye has sought breathing room in Washington with the IMF and World Bank, then in Abu Dhabi with investors, while calling the global debt architecture "inadequate" and "inequitable." At the UN, he is expected to press for wider debt relief for African countries. At a June 2026 conference in Accra, Senegal committed to advancing reparatory justice claims over the transatlantic slave trade. The extraction runs in layers. Debt service drains fiscal capacity that could fund hospitals. Concentration of medical infrastructure in Dakar forces patients in regions like Casamance to travel hundreds of kilometres. Public healthcare is not free — consultations, tests, medicines and treatment all cost money. So patients wait until illness reaches its final stage before seeking hospital care. Youth unemployment at 28.4 percent among 15-to-34-year-olds in Q1 2026 narrows the pipeline of trained professionals who might otherwise staff the system. Diba plans to specialise in haematology — cancer, leukaemia, sickle-cell disease. She sees fear as the dominant patient experience: people entering hospitals convinced they will not leave alive. That fear is rational in a system where equipment is missing, staff are striking, electricity is intermittent, and the fiscal headroom to fix any of it is consumed by debt obligations on borrowing that was hidden from public view until a new government opened the books. She named her daughter Myriam. The name carries the weight she intends: a child born on the eve of a medical strike, into a health system her mother has chosen to serve despite everything she saw from the inside. "I don't want my daughter to experience this." Whether Myriam does depends on choices being made now — in Dakar, Washington, Abu Dhabi, and Accra — about who bears the cost of Senegal's debt and who funds the hospitals that debt has hollowed out.
