In northeast Nigeria’s Borno State, ongoing conflict between Boko Haram and the Nigerian army and recurring attacks on civilians have forced thousands of people to flee their homes in search of safety. There are currently more than 1.5 million displaced people in the area, according to the United Nations High Commissioner for Refugees (UNHCR). While most are internally displaced within Nigeria, some 157,000 more have fled to neighboring Niger, Chad, and Cameroon since January 2015.
These countries are no safer, however, as they also face the threat of cross-border attacks and military offensives on their territories, in addition to the resulting waves of internal displacement. On Wednesday, June, 17, an attack in two villages in southeast Niger killed dozens; two days before, on June 15, two bombings allegedly linked to Boko Haram took place in the Chadian capital of N’djamena.
The Nigerian crisis is exacerbating an already precarious situation, affecting an extremely vulnerable population. Moreover, the continuing insecurity presents an enormous challenge to humanitarian groups as they endeavor to evaluate the needs in the region. Doctors Without Borders/Médecins Sans Frontières (MSF) is currently one of very few organizations in the region providing support to national authorities of the four affected countries around Lake Chad. Below is an outline of MSF activities in the area:
The security situation in Borno State remains extremely volatile and tense. There are more than one million internally displaced people (IDPs) in Borno, and around 400,000 of them currently live in Maiduguri, the main town of the region. Many are being helped by local communities, while 77,758 are gathered in 13 IDP camps in the city.
MSF is running medical activities in four of these camps, covering the primary health needs for more than 34,300 people. Every week, MSF teams carry out hundreds of consultations, mostly for children under five. In addition to medical care, MSF is also providing water supplies (more than two million liters each month), and has established a health surveillance system in five camps.
As the situation in the camps stabilizes, MSF’s priority is to guarantee support to all displaced people hosted by local communities, as well as to the host community itself. MSF has set up a clinic at the Maimusari health center in Jere district, a slum of Maiduguri town, to provide health services to 120,0000 people, displaced and host community alike. The facility includes a 12-bed maternity unit and 60 beds for pediatrics, nutrition, and intensive care.
According to Office for the Coordination of Humanitarian Affairs (OCHA), there are 175,000 displaced people in southeast Niger’s Diffa region. Many arrived recently, after authorities urged the population settled on the Lake Chad islands in Niger to leave the area following a deadly attack carried out by Boko Haram. Around 25,000 people are now settled in two camps, one in Bosso and another one in Nguigmi, two towns located near the lake.
MSF has deployed mobile clinics in these two camps to provide basic health services to this displaced and isolated population, and refers cases to Diffa hospital if needed. MSF is also running the regional mother and child health reference center, which includes a maternity ward, a pediatric ward, and a laboratory in Diffa town. On the outskirts of town, MSF supports three health centers in Geskerou, Ngaroua, and Nguigmi, where more than 16,000 medical consultations have been performed so far in 2015, 65 percent of which were for children under five.
The potential for a cholera outbreak is a concern as the rainy season starts and sanitation conditions in the camps deteriorate. Additionally, a peak of malnutrition and malaria cases is expected during the approaching hunger gap period. “The main needs are shelter, water, sanitation, health, and protection,” says Aissami Abdou, MSF field coordinator in Diffa. “However, there are still a few organizations working in the area.”
Some miles east, in Cameroon, the security situation along the border with Nigeria remains volatile, with regular incursions from Boko Haram. Refugees continue to arrive on a daily basis in the camps established by national authorities in the Extreme North region.
“I have just arrived in Gawar with my husband and four of my children,” says Emmanuelle, one of the 40,000 refugees settled in the two camps of Minawao and Gawar, where MSF collaborates with national authorities and other humanitarian agencies to provide health care and water and sanitation services. “Boko Haram’s fighters kidnapped our three daughters. We don’t know anything about them, we can only pray for them.” Today, 60 percent of the water in the camps is provided by MSF, and the organization carries out more than 500 medical consultations each month.
“The increase in the population caused by this frequent displacement poses a real risk to the food insecurity in the area,” says Hassan Maiyaki, MSF head of mission in Cameroon. “Today we are reinforcing our support to the intensive therapeutic feeding center in Mokolo District Hospital, where we offer pediatric and nutritional care to refugees, IDPs, and the local population in need of hospitalization.” MSF is also present in the city of Kousseri, at the border with Chad, where around 30,000 IDPs are scattered around the city. MSF teams are providing surgical support to the city's hospital, where 36 cases were treated in May.
MSF began its response to the displacement caused by Boko Haram in the Lake Chad region at the end of February. According to the UNHCR, 18,000 refugees from Nigeria fled insecurity in their country. They arrived in Lake Chad, one of the poorest regions in the country, which has low vaccination coverage and a high risk of epidemics.
Boko Haram represents a threat to Chad, and is active around Lake Chad, resulting in a deteriorating security situation. In February, the group carried out an attack in Ngouboua, causing thousands of residents and refugees to flee for safety. Most recently, on June 15, two bombings allegedly linked to Boko Haram took place in the capital, N'djamena, killing 27 people and wounding 101.
MSF supported key Ministry of Health hospitals by providing surgical and medical kits for the influx of patients. Recently, MSF also organized a training and simulation on mass casualty management in the General Hospital.
MSF is currently running mobile clinics in Forkouloum, carrying out around 850 medical consultations per week, mainly for diarrhea and respiratory infections. Many of the patients are Chadian residents who were displaced by violence. Psychological support has been a key part of MSF’s response. Teams are providing mental health care through individual and group sessions in Dar es Salaam refugee camp. Medical care and mental health support is also provided to victims of sexual violence. To date, MSF has carried out 223 mental health consultations.
In collaboration with local authorities, MSF also supplied around 6,000 people in Ngouboua, Bagasola, and nearby Forkouloum with hygiene and shelter kits, which included blankets, plastic sheeting, and mosquito nets to protect against malaria.