The world is facing an unprecedented crisis related to the COVID-19 pandemic with many unknowns, which has led to much confusion and anxiety. Public health measures have for centuries been the cornerstone of the response to epidemics. Among them, physical distancing measures aim to reduce contact between infected and uninfected people. As part of the global COVID-19 response, they have been widely used to slow down the spread of the virus in several countries. Despite their overall acceptance, they have been poorly documented, particularly in Africa, and debates persist on their appropriateness and practicality in the context of low-income countries. This article describes the implementation of these measures in four West-African countries—Mali, Burkina Faso, Senegal and Guinea—and discusses people’s willingness to comply with them. We describe these measures and discuss the importance of considering the socio-cultural, economic and political context to choose the most appropriate and effective measures and propose ways to explore strategies that are potentially better adapted to the African context.