Alarming surge of severe malnutrition in northern Nigeria

Humanitarian assistance must be urgently scaled up as the malnutrition crisis unfolds.

The legs of a malnourished child on a hospital bed in Nigeria.

Nigeria 2023 © Ehab Zawati/MSF

Abuja, June 4, 2024 — In recent weeks, Doctors Without Borders/Médecins Sans Frontières (MSF) inpatient facilities in northern Nigeria have recorded an extraordinary increase in admissions of severely malnourished children with life-threatening complications, with twice as many admissions than last year in some locations. This horrifying influx of malnourished patients is occurring before the usual peak season for malnutrition in July and August. 

"We are resorting to treating patients on mattresses on the floor because our facilities are full,” said Dr. Simba Tirima, MSF country representative in Nigeria. “Children are dying. If immediate action is not taken, more lives hang in the balance. Everyone needs to step in to save lives and allow the children of northern Nigeria to grow free from malnutrition and its disastrous long-term—if not fatal—consequences.”

Humanitarian assistance must be urgently scaled up. MSF calls upon the Nigerian authorities, international organizations, and donors to take immediate action to diagnose and treat malnourished children to prevent associated complications and deaths, as well as engage in sustained, long-term initiatives to mitigate the underlying causes of this urgent malnutrition crisis. 

The rising plight of Malnourished Children in the Northwest of Nigeria
A mother and child undergoing treatment at Gummi General Hospital's inpatient therapeutic feeding center. Nigeria 2023 © Ehab Zawati/MSF

An overwhelming increase in malnutrition in 2024

"We've been warning about the worsening malnutrition crisis for the last two years,” added Dr. Tirima. “2022 and 2023 were already critical, but an even grimmer picture is unfolding in 2024. We can't keep repeating these catastrophic scenarios year after year. What will it take to make everyone take notice and act?"

In April 2024, our medical team in Maiduguri, northeast Nigeria, admitted 1,250 severely malnourished children with complications to the inpatient therapeutic feeding center—twice as many as in April 2023. The center has been forced to urgently scale up its capacity, and by the end of May, it had 350 patients, far surpassing the 200 beds initially designated for the peak malnutrition season in July and August.

We are resorting to treating patients on mattresses on the floor because our facilities are full. Children are dying. If immediate action is not taken, more lives hang in the balance.

Dr. Simba Tirima, MSF country representative in Nigeria

Also in the northeast, the MSF-operated facility in Bauchi state's Kafin Madaki Hospital recorded a significant 188 percent increase in admissions of severely malnourished children during the first three months of 2024 compared to the same period in 2023.

In the northwest part of the region, in Zamfara state, the inpatient centers in Shinkafi and Zurmi have received up to 30 percent more admissions in April compared to March. Talata Mafara’s facility saw an increase of about 20 percent during the same period. Similarly, in April, MSF inpatient facilities in major cities like Kano and Sokoto reported alarming surges, with a 75 and 100 percent increase respectively. The therapeutic feeding center in Kebbi state also documented a rise by more than 20 percent in inpatient admissions from March to April 2024.

Despite the alarming situation, the overall humanitarian response remains inadequate. Other nonprofit organizations active in the north are also overwhelmed. The United Nations and Nigerian authorities issued an urgent appeal in May for $306.4 million to address the pressing nutritional needs in Borno, Adamawa, and Yobe states. Yet this will be insufficient because it ignores other parts of northern Nigeria where needs also outweigh the current capacity of the organizations to respond adequately.

Mothers and children in Maiduguri, Nigeria.
Mothers are struggling to find food for their children and maintain a balanced diet, which is important to prevent malnutrition and delays in the child's growth. Nigeria 2023 © Ehab Zawati/MSF

Roots of the malnutrition crisis in Nigeria

Migratory herders in Nigeria have been moving southward in recent years as environmental degradation and the impacts of climate change have reduced the available fertile land. Violence and insecurity in traditional grazing areas in the north are also forcing herders into the north-central region of the country, leading to clashes with sedentary farmer communities.

In addition, armed groups regularly raid towns and loot property, and the instability is preventing people from accessing farmland. "People don’t have access to their lands anymore, which means they have less food," said Froukje Pelsma, MSF's former head of mission in Nigeria. At the same time, government food distributions are sporadic and unreliable.

According to the Nigerian Bureau of Statistics, an estimated 78 percent of people in northwest Nigeria live below the poverty line. Health care is often unaffordable or hard to access, and many children have never been vaccinated against common childhood diseases. A very limited amount of international aid reaches the region. All these factors have contributed to the growing numbers of malnourished children in urgent need of treatment.

Government food distributions are sporadic and unreliable, and access to farms is insecure and risky. In the summer of 2023, MSF discovered that many residents of Ortese camp in Benue state had resorted to eating cassava peel due to the lack of food, resulting in upper gastrointestinal disorders.

Dr. Saleh Muhammad Auwal examining a child at the ITFC in Sokoto Specialist Hospital.
Dr. Saleh Muhammad Auwal examines a child at the inpatient therapeutic feeding center at Sokoto Specialist Hospital, where MSF supports the 40-bed capacity wards where children with severe acute malnutrition are being treated. Nigeria 2023 © Ehab Zawati/MSF

Immediate action is needed

The catastrophic nutritional situation seen in recent years in northern Nigeria calls for a larger response. Reductions in the already-limited funding available for the northwest have also dangerously affected the provision of crucial therapeutic and supplementary food. These supplies were completely unavailable in Zamfara state during the first four months of this year and are now only available in limited quantities. This reduction has meant that it is only possible to provide treatment for more severe malnutrition cases, compromising the response. An effective response would also address malnutrition earlier in its progression and avoid exposing children to a higher risk of mortality.

“We are alarmed by the reduction of aid at these critical times,” said Dr. Tirima. “Reducing nutritional support to only severely malnourished children is akin to waiting for a child to become gravely ill before providing care. We urge donors and authorities to increase support urgently for both curative and preventive approaches, ensuring that all malnourished children receive the care they desperately need.”

We are alarmed by the reduction of aid at these critical times. Reducing nutritional support to only severely malnourished children is akin to waiting for a child to become gravely ill before providing care.

Dr. Simba Tirima, MSF country representative in Nigeria

The persistent malnutrition crisis in northern Nigeria stems from a variety of factors such as inflation, food insecurity, insufficient health care infrastructure, ongoing security issues, and disease outbreaks worsened by low vaccine coverage.

Tackling acute malnutrition in northern Nigeria requires preventive and curative steps. There is immediate need to stabilize and strengthen health care facilities and programs capable of diagnosing and treating malnutrition effectively. Other key steps include reinforcing vaccine programs that can help stave off vaccine-preventable diseases, enhancing access to nutritious food through agricultural initiatives and food distribution programs, improving the water and sanitation situation, and raising awareness.