Why are we there?
- Armed Conflict
- Endemic/epidemic disease
- Health care exclusion
Nigeria: Latest MSF Updates
- Disastrous Living Conditions More Deadly Than Violence
- Crisis in Nigeria State: "We Fled to Survive"
- Reaching Those Most in Need of Care
- NPR: Tens of Thousands Displaced by Boko Haram in Nigeria
Crisis in Borno State
The conflict in Borno State started in 2009 when Boko Haram launched attacks in Bauchi, Borno, Yobe, and Kano. By 2014, the group controlled large swathes of territory in Borno State, including Maiduguri, the state capital.
In 2015, Nigeria elected a new president who vowed to take back control of territory from Boko Haram and stamp out corruption in the country. Since then the Nigerian army has been engaged in fighting with Boko Haram, including launching airstrikes at the beginning of 2016 in areas under the group's control. The army has since taken back many cities and villages.
The nature of the conflict between the Nigerian army and Boko Haram later changed to include military assistance from neighboring countries Chad, Cameroon, and Niger.
Boko Haram, also known as the Islamic State's West Africa Province (ISWAP), continues to carry out attacks, suicide bombings, and incursions in Borno but also in surrounding countries. As a result of the conflict, 2.7 million people are displaced in the region (Nigeria, Cameroon, Chad, and Niger) according to the UN Office for the Coordination of Humanitarian Affairs.
MSF Projects in Borno State
MSF has been working in Maiduguri on a permanent basis since April 2014 and previously controlled cholera epidemics on several occasions. Today more than 1.2 million internally displaced people (IDPs) live in Maiduguri, most of them within the host community and others in camps (both informal camps and 11 official camps).
In Maimusari and Bolori health centers, MSF runs outpatient departments (OPDs) (400 consultations per day in Maimusari and 300 in Bolori), an ambulatory therapeutic feeding center (ATFC), and maternity services (for simple deliveries).
In Maimusari, the government recently handed over a new building to MSF, which will allow for a more comprehensive health care facility including hospitalization. MSF recently moved inside this new building to provide outpatient services (OPD/ATFC) and will open an inpatient department with 50 beds for pediatrics and 10 beds for referrals from camps outside of Maiduguri.
In Gwange, a Maiduguri district, MSF now runs an inpatient therapeutic feeding center (ITFC) with a 100 bed capacity that received cases referred from Bama (18) and Dikwa (27) on July 20.
Epidemiological surveillance continues in the 11 official camps and in Muna Camp, an informal settlement with around 15,000 people. The surveillance system is now being strengthened to react rapidly to potential emergencies in Maiduguri and its outskirts. Since last week, cases of measles have been reported inside Maiduguri in the so-called "Arabic Teaching College" camp and outside Maiduguri in Konduga, the last big town on the road to Bama accessible without escort. MSF teams are doing containment and case management on site.
A cholera treatment center will be opened in Maiduguri in the coming days, as the cholera season approaches.
Between June 13 and 15, Nigerian authorities and a local nongovernmental organization facilitated the evacuation of 1,192 people requiring medical care from the Bama area to the city of Maiduguri, capital of Borno State. This group of mostly women and children was placed in the "Nursing Village" IDP camp. Of the 466 children screened by MSF in the camp, 66 percent were emaciated, and 39 percent of these had a severe form of malnutrition. Upon assessment, 78 children had to be immediately hospitalized in the MSF feeding center, which has an inpatient capacity of 86 beds.
A team visited Bama with a military escort for the first time on June 21 and found a population in a catastrophic situation. Out of the 800 screened children, 19 percent suffered from severe acute malnutrition (SAM). Estimation of mortality at that time was very high. Medical data from the health center reported 188 deaths from May 23 to June 21, mainly from diarrhea and malnutrition; counting of the graves in the cemetery behind the camp showed more than 1,200 dug since the IDPs gathered in the hospital compound. Five children died during the assessment.
MSF returned mid-July to Bama with a military escort. Bama is now a ghost town held by the army where IDPs live in a camp inside the compound of the hospital. Despite the evacuation by the authorities of 1,500 people and some food distribution, the estimation of malnutrition rates remains high (SAM=15 percent). An estimated 10,000–12,000 IDPs (the official figure is 27,000) are living in shelters made of rusty corrugated iron sheeting and cannot move from that camp. There are nearly no men/boys older than 12. It's unclear what happened to them.
Another MSF team arrived on July 19 to provide medical and nutritional support: ATFC, consultations, setup of seven beds for observation and stabilization, and improvement of water quality by chlorination. A referral system to Maiduguri is organized with SEMA (State Emergency Management agency) ambulances and school buses.
An estimated 150,000 people, including 65,000 IDPs, live in Monguno. There was almost no access to health care since January 2015. An MSF team visited Monguno last week and will return soon. The UNICEF clinic and the ALIMA clinic in the area are overwhelmed. MSF plans to restart activities in the hospital, which has not been operational for several months. In the meantime, an IPD will be set up under tents in the hospital compound with 50 beds for general cases and 50 beds for malnutrition cases.
Dikwa is located in an enclave on the front line, with IDPs in a camp. An MSF team did a two-day assessment of the area. The current camp population is estimated at around 55,000, with new arrivals still streaming in from newly reopened areas. The majority of Dikwa's inhabitants (40,000) left for Maiduguri in 2014; around 12,000 stayed and moved to the camp. Other IDPs come from surrounding villages. The town was deserted until the governor allowed the IDPs to travel to the surroundings farm, and on July 20 allowed the Dikwa population to go back to their houses, which are being rehabilitated by government construction workers. UNICEF and ICRC run a clinic and ICRC distributes food every day. A rapid screening showed 12.5 percent SAM. Water is a big concern, both quantity and quality. MSF is considering opening an ITFC and ATFC in the general hospital.
This is an excerpt from MSF's 2015 International Activity Report:
Insecurity and suicide attacks by insurgents led to further displacement, increasing the need for medical and humanitarian aid in Nigeria in 2015.
Over two million Nigerians have been displaced across the northeast of the country, largely as a result of brutal violence linked to the Islamic State’s West Africa Province (ISWAP), also known as Boko Haram. Rural communities have been devastated. The population of Maiduguri, capital of Borno state, has more than doubled with the influx of internally displaced people, which has overwhelmed basic services in the city. Despite a significant military presence, insecurity remains high, with Maiduguri targeted in repeated suicide bomb attacks, and people are afraid to return home.
MSF has been providing healthcare to people displaced by violence, as well the host community in and around Maiduguri, since mid-2014. In 2015, around 10,000 outpatient consultations were carried out across four sites (two in the camps, two in the community) each month. Nearly a quarter of the patients presented with respiratory tract infections. In May, the team started offering maternal healthcare, and by the end of the year had seen more than 16,200 women for at least one antenatal consultation and assisted 1,330 deliveries. More than 5,900 children attended the nutrition program, and from June, an inpatient pediatric unit admitted around 100 children each month. MSF started providing emergency services at Maiduguri’s Umaru Sheu hospital in October, and emergency surgery by the end of the year.
Towards the end of 2015, in Kukerita camp, Yobe state, an MSF team undertook 2,000 outpatient consultations, referred complicated cases for further care, and provided six million litres of clean drinking water to displaced people. Antenatal care was also provided. In addition, MSF worked to rehabilitate the local healthcare center in Kukerita, which was supplied with a generator to ensure power around the clock.
MSF has been working in Zamfara state since 2010 following an outbreak of lead poisoning in children. This year, the team continued to monitor lead levels and fewer than 10 per cent of children tested needed chelation treatment to remove it from their bodies. The Zamfara project has now evolved to provide healthcare to children under the age of five in five villages, focusing on malaria, upper and lower respiratory tract infections, malnutrition and diarrhea. Routine vaccinations are also administered, and inpatient care for children is available in a pediatric inpatient department run jointly by MSF and the Ministry of Health. Overall, more than 19,300 consultations were carried out and 3,200 children were admitted.
In June, a new program began in Niger state to address lead exposure in children, which is typically caused by unsafe mining and ore processing. MSF trained Kagara hospital staff on lead protocols in August, and a health promotion team worked with residents in two villages, teaching them how to reduce lead exposure in their homes. MSF advocacy efforts resulted in a government decision to remediate lead from the two villages. From October, MSF also supported the Ministry of Health at Magiru clinic to ensure children under five received good-quality care for common childhood diseases.
MSF launched a new program In Kebbi state consisting of three mobile clinics and a health center that offers inpatient and outpatient services for children under the age of 15. A malaria clinic opened in August and over 4,000 patients had been treated for malaria by the end of the year. MSF expanded its outpatient services in October to include people of all ages, and had carried out 5,400 consultations by the end of the year. In December, the team were also able to expand their inpatient activities – this had been delayed by insecurity.
Reconstructive Surgery for Children
In August, a surgical team made its first visit to Sokoto to operate on 25 children suffering from noma (a facial gangrene infection that usually affects children under the age of six), cleft palate, cleft lip and other facial disfigurements. MSF ensured pre- and post-operative care, including nutritional and psychosocial support for families, which helped reassure parents about their children undergoing surgery and also enabled the children – who are often shunned because of their appearance – gain social skills. Around 450 individual and group mental health sessions were undertaken. Outreach and educational activities were launched in November to raise awareness of noma and the possibility of surgery. More surgical visits are planned for 2016. Referrals were also made for children needing continued nutritional care, and over 300 children were admitted to the therapeutic feeding center.
Sexual and Reproductive Healthcare
A new program for victims of sexual and gender-based violence started in June in Port Harcourt, and following an awareness campaign delivered through schools, health clinics and the media in September, monthly attendance at the clinic doubled from around 35 to 70 patients. The comprehensive package of care includes prophylaxis for HIV and sexually transmitted infections, vaccinations for tetanus and hepatitis B, wound care, emergency contraception and counselling.
The well-established Jahun emergency obstetrics program at the government hospital in Jigawa state admitted an average of 900 patients per month, of whom around 100 needed intensive care. Staff cared for 116 babies in the neonatal unit each month. During the year, surgeons carried out approximately 2,400 interventions, including 300 for obstetric fistula. About 60 per cent of patients were aged between 15 and 19.
Responding to Emergencies
An early warning surveillance system based in Sokoto facilitates rapid response to emergencies. In 2015, an outbreak of meningitis led to a mass vaccination campaign that reached 229,500 people, and over 6,300 people received treatment for the disease. In November, MSF supported a measles vaccination campaign run by the Ministry of Health in three states.
An Abuja-based emergency team ensured health facilities were prepared for possible post-election violence by training medical staff on mass casualty response and assessing facilities. The team also responded to an outbreak of cholera in Maiduguri, where more than 1,700 patients were treated.
At the end of 2015, MSF had 655 staff in Nigeria. MSF first worked in the country in 1971.
Rabi, 17 years old, celebrates her discharge from the Jahun Hospital fistula repair program:
"And what of that sick woman who arrived here many days ago? What of her that suffered many days with labor pains, only to see a stillborn baby, and after her wrapper cloth always wet?
What of the way that her husband turned from her, repulsed by the leaking urine, what of her family who would no longer touch the food that she cooked? What of that chair, the one everyone avoided, the one she alone would sit on?
That chair is no longer for me, because that woman is no longer me. I am now cured from my injury. With dry cloth around my hips, I am ready to return to my family. I sing because I am happy, I sing because I am free."