For more than three years, ongoing conflict between Boko Haram and the armies in the Lake Chad region has taken a heavy toll on civilian populations. Many have fled their homes and left everything behind to find refuge in other villages and eventually across borders. Authorities report that there are now more than 240,000 displaced people in southeastern Niger’s Diffa region, bordered by Chad and Nigeria. The majority of them were driven from home by violence.
The Consequences of an Ongoing Conflict
Despite relative calm and no major displacements for the past few months, the situation in Diffa remains extremely volatile. Sporadic attacks by Boko Haram and military operations have kept people on the move, seeking safety and hoping for peace. Many have been displaced multiple times. “After I left my village in Cameroon, I moved about 15 times, first to Nigeria then to Niger,” says Garba, who works as a watchman for Doctors Without Borders/Médecins Sans Frontières (MSF) in Garin Wazam, a site for displaced people located 58 kilometers [about 36 miles] from Diffa Town. “I had to leave one place after the other due to repeated attacks.”
The pressure on host communities has also dramatically increased. An estimated 100,000 people in the region now live in a situation of extreme vulnerability, with insufficient food, water, and sanitation infrastructure.
Hepatitis E Outbreak Highlights Need for Better Water and Sanitation Conditions Among Displaced People
The conflict has also impacted agricultural and livestock activities around the Komadougou River, at the border with Nigeria, and on the shores of Lake Chad, cutting off access to important socioeconomic opportunities.
In Diffa, the security measures put in place by the authorities in response to the conflict have also wreaked havoc on commercial activities. Trading goods such as fish and some vegetables is still forbidden, as is traveling by motorcycle. Both activities are important to earning a living for many in the region.
Medical Care for the Most Vulnerable
Despite the presence of a large number of humanitarian actors in Diffa, a lack of management and coordination means many basic needs remain unmet. Families living in sites for displaced people struggle to access sufficient water, food, and sanitation infrastructure.
Long travel times and security measures make access to health care a daily challenge, and many people are also being charged for medical consultations, laboratory tests, and medicines. Highly vulnerable populations cannot afford to pay for these services.
In response, MSF is supporting primary, reproductive, and mental health care, along with vaccination and nutritional screening activities in eight health centers in the districts of Diffa, Bosso and Nguigmi. These services make an important difference for both displaced and local populations in the area. “Toumour is 80 kilometers [about 50 miles] from Diffa Town and has become isolated due to the conflict,” explains Audace Ntezukobagir, MSF emergency coordinator for Diffa. “As a result, people there lack food, water, and work. However, on average around 3,900 people per month benefit from medical consultations we are providing for free in the health center, together with the health authorities.”
Respiratory Infections and Hepatitis E
Acute respiratory infections account for a large number of outpatient medical consultations, especially during the first months of the year. They are particularly prevalent in women and children. “This is clearly linked to the arid climate of the region, especially during the dry season, and the poor living conditions of our patients,” says Ntezukobagir. “People also suffer from diarrhea, which is partially explained by the poor quantity and quality of the water available.”
Authorities and humanitarian actors in the region still have yet to provide access to adequate water and sanitation infrastructure to displaced populations. This need was recently highlighted again by a recent outbreak of hepatitis E.
Mental Health Support
The vast majority of displaced people in Diffa have experienced traumatic events linked to the conflict. MSF currently provides individual mental health consultations, psycho-education sessions, and support at the community level. Group sessions also began at the beginning of 2017. “Our group sessions are composed of displaced and refugee women, all victims of the conflict,” says Yacoubou Harouna, an MSF psychologist in Diffa. “The discussions aim at breaking isolation, sharing common experiences and finding solutions together. The main objective is to cope with the distress caused by similar traumatic events.”
Since the end of 2014, MSF has assisted people in Diffa who fled violence linked to the presence of Boko Haram group and military interventions in the area. MSF ensures free medical and psychological assistance in eight health centers of the region. The organization also supports the supply of drinking water, the installation of latrines, and the distribution of essential items in various areas where displaced people, refugees, and returnees have gathered.
MSF also supports the Nigerien Ministry of Health in Nguigmi Hospital and the main maternal and pediatric health center in Diffa Town. At both hospitals, MSF supports the reproductive and sexual health and pediatric units and provides mental health support. At Nguigmi Hospital, the team also treats children with severe acute malnutrition.