Instead of hospital beds, hammocks serve as resting places for patients treated at the Auaris health centre in the Yanomami Indigenous Territory (YIT), in the Brazilian Amazon. Anyone walking around the site - which was renovated and expanded through a partnership between Médecins Sans Frontières (MSF) and the indigenous health authorities working in the territory - will also notice that the signs are written in the Sänoma and Ye’kwana languages, in addition to Portuguese.

At this centre, respect for the culture and habits of indigenous people is demonstrated not only in the physical structure, but also in the medical practices adopted: instead of just handing out a prescription, healthcare providers take the opportunity to listen and learn.

“Now healthcare is integrated, Sanöma and serenapi [non-indigenous] people working together. Shaman and doctor, together,” says Miro Sanöma, a resident of the Kululu community in the Auaris region. “If a person becomes very ill, first they perform xapori [healing ritual], then take them to the health centre.”

YIT is the largest indigenous territory in Brazil, with a population of just over 30,000 people spread across an area larger than Portugal. The Auaris health centre is located in its most densely populated region, which is mostly home to the Sanöma and Ye’kwana peoples. The renovated health units is one of the legacies left by MSF as we wrap up our activities for indigenous health in the region, after nearly three years of work.

Today’s situation contrasts with the very difficult scenario we encountered when we began working in the region in May 2023, just a few months after the government declared a health emergency.

Throughout this project, MSF teams provided general healthcare, focussing on malaria diagnosis and treatment, as well as mental health care, and implementing environmental health solutions and infrastructure improvements. Although many challenges remain, local care capacity has been strengthened, which is expected to help communities continue to receive higher-quality assistance.

“I have been here for two years now, and when I arrived there was an average of one severely-ill patient per day, due to severe malnutrition, advanced-stage malaria, dehydration, or snakebite accidents,” says Carlos Camacho, an MSF doctor who has worked in YIT since early 2024. “As prevention efforts improved, mainly due to health promotion activities in the communities, we noticed a decrease in severe cases. Today, I hardly ever see severe patients here in Auaris.”

Dr Camacho’s observation aligns with official numbers released by the Ministry of Health in the latest report on the Yanomami emergency. ¹  Comparing detected malaria cases, there was a 20.7 per cent drop in the first half of 2025 compared to the same period in 2024, from 17,952 to 14,233.

The data indicates that transmission remains high in the YIT, but there has been a marked improvement in diagnoses and a significant reduction in severe cases and deaths. Between January and June 2023, there were ten deaths, with a slight drop to nine in 2024, and then down to three in the first six months of this year.

MSF also provided support at the Yanomami and Ye’Kwana Indigenous Health Support Centre (CASAI–YY) in Boa Vista, where patients needing care not available in the territory are taken. Services at the CASAI–YY included medical and mental health care, health promotion activities, and improvements to sanitation infrastructure.

The health promotion team was responsible for monitoring health in the malocas [large communal dwellings] of each ethnicity, while also offering educational sessions on waste management, nutrition, and malaria.

A key feature of MSF’s work with indigenous peoples has been the adaptation of medical approaches that value and respect the traditional knowledge of those who protect Brazil’s forests and biodiversity. To ensure smooth interactions within the YIT, we sought support from anthropologists and intercultural mediators.

This openness was key to developing awareness activities and providing clear information, allowing the community to understand malaria treatment and prevention. Once they were more aware, people began seeking care at the early stages of illness, which resulted in a reduction in mortality.

In addition to malaria, the mental health of young people has become a growing concern in indigenous communities, partly because breaking with traditions often causes silent suffering. Faced with this scenario, MSF teams listened, welcomed, and worked side by side with communities, offering psychosocial support and building culturally sensitive responses.

Over nearly three years of activities, the mental health work included group and individual psychoeducation, community awareness and mobilisation, psychological first aid, psychosocial activities, and support groups which reached 5,582 participants.

The work in YIT and CASAI-YY was the most recent chapter in MSF’s long history of supporting indigenous health in the Amazon. Our first project in Brazil was in response to a cholera outbreak in the early 1990s. A few years later, MSF worked in the state of Roraima (where YIT is located) during a malaria outbreak and, more recently, supported indigenous communities during the COVID-19 pandemic. This engagement reflects our historic commitment to expanding healthcare access for indigenous peoples in Brazil.

As MSF’s activities in YIT ended, we focussed on ensuring a responsible and sustainable transition. MSF provided training for health professionals and community members to support a smooth handover of medical and operational responsibilities.

“The transition process is an opportunity to ensure that the progress of recent years can continue to benefit indigenous communities here in the future,” says Damaris Giuliana, MSF’s project coordinator in YIT. “We arrived with knowledge about diseases and treatments in non-indigenous contexts and learned about spiritual illnesses and the cures performed by shamans.”

“We remain committed to sharing the knowledge gained in YIT so that future initiatives - within and outside MSF - can build on this experience,” says Giuliana.