This article first appeared in the Fall/Winter edition of Dispatches, the MSF Canada magazine.
In northeastern Nigeria, a humanitarian emergency is reaching catastrophic levels, and Doctors Without Borders/Médecins Sans Frontières (MSF) has called for a massive international relief effort to take place immediately. The desperate living conditions in Borno State show the devastating impact of the ongoing conflict between Boko Haram and the Nigerian military. In several locations, people have sought refuge in towns or camps controlled by the military, and are entirely reliant on outside aid that does not reach them.
“Although a nutrition emergency was declared months ago, there has been a serious failure to help the people of Borno,” said Hugues Robert, head of MSF’s emergency response.
The conflict in Borno State started in 2009 when Boko Haram launched attacks in Bauchi, Borno, Yobe and Kano. By 2014, Boko Haram controlled large swathes of territory in Borno State.
In 2015, Nigeria elected a new president who vowed to take back control of territory from Boko Haram and also stamp out corruption in the country. Since then, the Nigerian army has been engaged in fighting with Boko Haram, including by launching airstrikes that began in 2016, in areas under Boko Haram control. The army has now taken back many cities and villages and is securing them.
The nature of the conflict between the Nigerian army and Boko Haram has changed to include military assistance from the neighbouring countries of Chad, Cameroon and Niger.
Watch an MSF video update on the human impact of the crisis in northeastern Nigeria:
The MSF response
MSF has been present in Maiduguri on a permanent basis since April 2014 working on pediatric and maternal health and nutrition, and previously responded to cholera epidemics on several occasions.
Today more than 1.1 million internally displaced people (IDPs) are living in Maiduguri (according to the International Organization for Migration), most of them within the host community, while the others are accommodated in camps (two informal camps and 11 official camps).
The population in most camps remained stable over summer. However, there was an influx of IDPs in Muna Garage camp. In the meantime, IDPs returned back from Maiduguri with the army’s assistance on a voluntary basis, though many of them came back to Maiduguri because they did not find proper living conditions. In Maiduguri, MSF is conducting a health surveillance activity now covering all official camps and the two unofficial camps of Muna and Customs House, where high rates of mortality for children under five have been recorded.
In September, MSF launched an operation in Custom House Camp: 1,136 children were screened for malnutrition. The severe acute malnutrition rate and moderate acute malnutrition rate were 20.8 per cent and 37.3 per cent, respectively. The team distributed to 1,500 families food rations for one month and relief kits including mosquito nets, jerry cans, soap, mats and blankets. They also provided seasonal malaria chemoprophylaxis to 1,057 children and 109 medical consultations. In mid-September, MSF ran a similar operation in Muna Garage Camp. Food rations and relief kits were distributed to 2,500 families.
Watch an interview with Fatima, who arrived in Maiduguri in search of shelter and care for her family after they were forced to flee their home village:
Maimusari and Bolori health centres
In Maiduguri, MSF runs two heath centres, Maimusari and Bolori, where MSF runs outpatient departments providing more than 2,100 consultations per week in each location, with 45 per cent of consultations for children under five in Maimusari, and as much as 71 per cent in Bolori. The centres also include ambulatory therapeutic feeding centres (ATFC) that provided treatment for an average of 318 patients per week in the two sites. The screening of 4,918 children for malnutrition in Maimusari showed a severe acute malnutrition rate of 18.7 per cent and a moderate acute malnutrition rate of 41.2 per cent. In Bolori, the screening of 6,033 children showed a severe acute malnutrition rate of 8.9 per cent and a moderate acute malnutrition rate of 28.4 per cent.
MSF also provides maternity services in the health centres (simple deliveries, antenatal care and postnatal consultations); 6,393 consultations took place in Maimusari and Bolori combined over a one-month period, and an average of 100 deliveries per week were assisted in Maimusari. In Maimusari, MSF opened an inpatient department with 50 beds for pediatric patients and a pediatric intensive care unit. Over 150 patients were admitted in the pediatric IPD, with malaria being the most common illness treated.
Gwange inpatient therapeutic feeding centre
In Gwange, a district in Maiduguri, MSF runs an inpatient therapeutic feeding centre (ITFC) with a 110-bed capacity. The ITFC is under tents, in the compound of the Ministry of Health-run health centre. Over 380 patients were admitted last August, 21 of whom were children under the age of six months. To compensate for the lack of food, we started in late September to provide family food rations to each child admitted in the ITFC.
After Nigerian authorities and a local NGO organized the evacuation of 1,192 people requiring medical care from Bama area to Maiduguri last June, an MSF team visited Bama with a military escort and found a population in a catastrophic situation. Of the 800 children MSF screened, 19 per cent were suffering from severe acute malnutrition. Estimated mortality at that time was very high. Medical data from the health centre reported 188 deaths within a one-month period, mainly from diarrhea and malnutrition; counting the graves in the cemetery behind the camp showed more than 1,200 had been dug since the IDPs had first gathered in the hospital compound. Five children died during the assessment.
Bama is a ghost town held by the army, where the IDP camp is located inside the compound of the hospital, under military control. An estimated 15,000 people are living in the camp, mostly women and children under the age of five. They live in makeshift shelters made of iron sheeting taken from houses and are totally dependent on outside help for food.
A team returned to Bama on July to provide medical and nutritional support via ATFC and medical consultations, as well as water and sanitation improvements. A referral system to Maiduguri was organized with State Emergency Management Agency (SEMA) ambulances and school buses.
The team has returned twice more for four days at a time. The visits aimed at rapidly reducing morbidity and mortality among children under the age of five by providing therapeutic food to malnourished children (PlumpyNut) as well as food rations for one month (beans, oil and BP5: fortified biscuits) for 2,500 families. During the last visit, 153 children were diagnosed with severe acute malnutrition and 360 with moderate acute malnutrition. Complicated cases were referred to Maiduguri. To improve the very poor sanitary conditions, 40 latrines were built in the camp.