In 2021, the health facilities that Doctors Without Borders/Médecins Sans Frontières (MSF) assists in Niger cared for exceptionally high numbers of malnourished children. In response to the crisis, MSF opened emergency medical-nutritional programs in several districts in the Maradi region and across the border in Katsina State, Nigeria, where many of the young patients came from.
“When I first arrived, admissions were already very high for the time of year,” said Dr. Many Mashako, who worked as a pediatrician for MSF in Madarounfa from February to December 2021. During the annual seasonal malnutrition and malaria peak—from June to October—the provision of medical-nutritional treatment from Niger’s Ministry of Health and MSF teams increase two-fold. In 2021, this included an increase in the number of beds to 260 in the Madarounfa district hospital. But even with this greatly expanded capacity, medical teams often had as many as 450 hospitalized children to care for at one time in the district.
Expanding medical activities
“For the entire time I was in Niger, the number of children admitted to the nutrition department didn’t follow the same trend as previous years,” said Dr. Mashako. “The intakes consistently exceeded our forecast. One of our first challenges was to train staff who’d been taken on and organize reinforcements. Given the scale of the peak, additional emergency medical and nutritional activities were rolled out in hospitals and health centers in Aguié and Guidam Roumdji to support the Ministry of Health. We also assisted the general hospital in Maradi.”
In 2021, nearly 30,000 children were admitted to the four hospitals MSF supported across the Maradi region. A total of 29,469 people were admitted in various hospitals and health centers: 15,071 at the Madarounfa district hospital from July to November, 2,470 at the malaria unit of the Dan Issa health center from August to November, 632 at the malaria unit of the Madarounfa health center from August to October, 4,973 at the Maradi regional hospital center from August to November, 1,128 at the Aguié hospital from August to October, and 5,194 at the Guidam Roumjdi hospital from July to November. “There were days when we’d have over 70 children in the intensive care wards in Madarounfa hospital. I’ve almost never seen anything like it. I really want to commend all the health workers who stepped in to help with the emergency,” Dr. Mashako said.
More than 115,000 consultations were also given in health centers and outpatient nutrition units in the Madarounfa district.
Responding to a crisis on both sides of the border
Behind these exceptionally high figures lies a particularly severe nutritional crisis in Nigeria’s Katsina State. Because of cultural and trading exchanges, Nigerian families frequently come to the Maradi region, and it’s not rare to see some arriving with a sick child. But, in 2021, the number of severely malnourished Nigerian children treated in the five health centers MSF assists in Madarounfa jumped 58 percent compared to the previous year. Children from Nigeria also accounted for 61 percent of young patients with severe acute malnutrition and complications at Madarounfa hospital's emergency room.
“The condition of most patients arriving from northwest Nigeria was particularly critical,” Dr. Mashako recalled. “Some Nigerian families who come a long way face major security issues, and then there’s the distance from the health centers on the border and the town of Madarounfa. This partly explains why children suffering from the numerous complications associated with severe acute malnutrition frequently arrived exhausted and in a state of advanced septicemia at the hospital.”
Reduced funding and food insecurity
In partnership with Nigeria’s health authorities, MSF manages a 60-bed inpatient nutritional hospital in Katsina town and five nutritional centers in Jibyia on the border with Niger. Northwest Nigeria is experiencing a wave of violence that is impacting the food security of families, along with the capacity of the health care system and partner organizations.
The effects of the emergency situation in Katsina are also visible across the border in Niger, where donor funding dedicated to nutritional programs has dwindled in recent years. According to Niger’s government, security and climate shocks in 2021 resulted in a mediocre agricultural season, leaving an estimated production deficit of 50 percent. This has prompted the authorities to launch an emergency program to support the sector. The situation is showing no signs of improvement in northwestern Nigeria, where the extent of the nutrition crisis may even now be underestimated.
“None of the factors that contributed to the exceptional situation we saw in Madarounfa hospital in 2021 have gone away and will likely play a similar role during next year’s peak,” said Dr. Mashako.