Mali, one of the world’s poorest nations, is greatly affected by poverty, malnutrition, epidemics, and inadequate hygiene and sanitation. Mali's health and development indicators rank among the worst in the world, with little improvement over the last 20 years. Progress is impeded by Mali's poverty and by a lack of physicians. The 2012 conflict in northern Mali exacerbated difficulties in delivering health services to refugees living in the north.