Nigeria: Borno State "Still Very Dangerous"


In northeast Nigeria's Borno State, the fight between the Nigerian government and the Islamic State’s West-African Province (ISWAP), formerly known as Boko-Haram, is having drastic consequences for public health, causing widespread displacement and limiting access to medical care.

Doctors Without/Médecins Sans Frontièrs (MSF) has been working in Borno since August 2014. MSF program manager Isabelle Mouniaman-Nara recently returned from a visit to Borno. Here, she provides an update on the situation, MSF's response, and the challenges ahead for people displaced for many years by the ongoing insecurity.

This crisis in Borno State has been going on for nearly two years. What does the future hold for those displaced by the fighting?

The situation hasn’t changed much. There are still around 1.6 million displaced people in northeast Nigeria, with the vast majority in Maiduguri, the capital of Borno State. While 90 percent of them live in the community, 100,000 of them are spread among ten or so camps in the town.

There was talk of sending the displaced back to where they come from, but due to the persistent lack of security in those areas, it looks as if that’s no longer in the cards. The authorities in Borno want to close down several of Maiduguri’s camps and assemble all the displaced in just six locations (all in the capital), possibly to return schools and universities to their original purpose, as they’ve been used up until now to accommodate the displaced, and also to better control security and the aid deployed in the camps.

What is MSF doing?

MSF is providing health and epidemiological monitoring in all of Maiduguri’s displaced persons camps, hygiene and sanitation in seven of them, and medical care in two.

Our teams are also working in the host community in former Boko Haram stronghold [of] Maimusari. Maimusari is a deprived district of Maiduguri and its inhabitants, residents and the displaced alike, are extremely vulnerable and their most basic needs are largely unmet.

We have opened a clinic where we give outpatient consultations and deliver maternal health and nutrition services. In addition, MSF runs a health center in Bolori II district (another former Boko Haram stronghold), where we also give outpatient consultations and provide maternal health and nutrition services.

We provide assistance (nutrition center, emergency treatment, and pediatrics) to the Infectious Diseases Hospital in Maiduguri and the emergency room in Umaru Shehu hospital. We are planning to set up a surgery program solely for the displaced. Working in partnership with the teams at the hospital, we will provide surgical treatment—from simple trauma to care for victims of attacks referred to us by, for example, the International Committee of the Red Cross, who also work in a Ministry of Health facility (surgery).

We may offer burn trauma care too, because during the cold season many people, especially children, living in insalubrious conditions are burned in domestic accidents often caused by unsafe makeshift heating appliances.

What are MSF's plans for the months to come?

Once the total number of camps drops to six, we will continue to ensure comprehensive health monitoring as well as medical, hygiene, and sanitation activities, but only at two of the sites. It is essential that we stay in the camps because it’s the only effective way to keep track of what is actually happening to the displaced.

We will continue our work in Maimusari and Bolori II and at Umaru Shehu hospital. We will transfer activities currently run at the Infectious Diseases Hospital to the health center in Maimusari as soon as its refurbishment is completed.

MSF will manage hygiene and sanitation at the sites and facilities where we’ll be working, but we would like to hand over at least part of this to other agencies.

Our assistance has so far focused exclusively on the town of Maiduguri. Our last attempt to venture further was in February 2015, when we went to Monguno to evaluate a hospital and determine whether we could set up operations. The following day, former Boko Haram fighters attacked Baga and the whole town fled to Maiduguri. Monguno suffered a similar fate and was also emptied of its inhabitants.

The authorities would like people living in rural areas to move into towns such as Bama, Baga, and Monguno, and to stay put while the Nigerian army takes offensive action in the vicinity. Those who don’t manage to get to these urban centers in time will be automatically considered as sympathizers or possibly even members of Boko Haram.

We’re also concerned because nothing seems to have been done in the towns to prepare for the influx of all these people in terms of health care, food, shelters, etc. We need to keep a close eye on the situation. But, northeast Nigeria is still very dangerous, so our priority is ensuring that our teams can get around and do their work in safety.

MSF set up operations in Borno in May 2013 but had to pull out because of the security situation. In August 2014, MSF returned to Maiduguri on a permanent basis. The security situation in Borno continues to be extremely volatile with regular reports of clashes between the military and insurgents, particularly in rural areas. The government is planning the return of IDPs to their home communities by January 2016. But this plan encounters resistance from IDPs as the security situation in the surrounding areas remains tense. Since 28 September 2015, an MSF team has been working in the 11-bed emergency room at Umaru Shehu hospital in Maiduguri. MSF continues its sanitarian and health surveillance/monitoring in 15 IDP camps. MSF also continues its medical activities in 2 camps – ATC and Teachers Village camps – where we provide primary healthcare and antenatal consultations. MSF also carries out water & sanitation activities in 9 of the 15 IDP camps. In late September 2015 MSF transferred secondary healthcare activities from Maimusari clinic to the Infectious Diseases Hospital. MSF continues to run two clinics in urban districts in Maimusari and Bolori to provide primary healthcare.