The Maldives are a coral-reef archipelago of which the territorial configuration reflects a logic of disintegration: numerous islands, the majority of which have a surface area of less than 1km2 and which are dissipated between 19 atolls distributed in an oval shape of 800 km in length and 300 km in width. Therefore, the population groups and their residencies are themselves quite dispersed, that which also serves to reduce the cost of development.  When in actuality, the Maldives is a country relatively poor (less than $5000/capita/year with a human development index of .751 and 11% poverty).  Profound and deep-seated constraints weigh therefore heavily on the health care system, which in spite of undeniable progress over the past three decades, is still proof of significant insufficiencies today.  Even more so, certain further limitations have been imposed by external and relatively unforeseeable events such as the tsunami of December 26, 2004.  Above and beyond the description of these elements, this article aims to demonstrate that the explanations of such a situation are largely to be sought out in the territorial configuration, which brings us to approach the more general question of constraints due to isolation and micro-insulation in the improvement of access to care.