Nigeria: Responding to a Malnutrition Crisis in Borno State

In the past three months, Doctors Without Borders/Médecins Sans Frontières (MSF) has distributed 810 metric tons of food in Maiduguri, northeastern Nigeria, enough to feed 26,000 families for two weeks. “As a medical organization, it’s not usually MSF’s role to provide people with food,” explains MSF head of mission Phillippe Le Vaillant. “But there are people in desperate need. Other organizations were not stepping in up until now, so MSF was obliged to fill this gap.”

Around one million people who fled violence and insecurity related to the ongoing conflict between armed groups and the Nigerian armed forces in Borno State are now living in Maiduguri, the largest city in northeastern Nigeria. Despite an increase in humanitarian assistance in recent months, thousands of people in the city are still in need of food, water, and medical care.

Forgotten Camps 

Many of the most vulnerable are the thousands of people who live in informal camps that are not recognized by the authorities. As a result they receive little to no assistance. “Many people came to Maiduguri with nothing but the clothes on their backs,” says Le Vaillant. “They have almost no way to make money, the cost of food has more than doubled in 12 months, and years of violence and insecurity have pushed their ability to cope to the limit.”

In addition to running two large health facilities and two inpatient therapeutic feeding centers (ITFCs) for severely malnourished children, MSF trucks 80,000 to 100,000 liters of water into Maiduguri every day. This is an emergency measure to give people water to drink before a longer-term solution can be put in place. MSF teams are also constructing new latrines, maintaining existing latrines, and rehabilitating water boreholes in camps in the center of Maiduguri town.


“It was a Monday morning when our village in Gambaru, Ngala, was attacked. People came and started shooting everywhere. We woke to the sound of gunfire. --------------------------- We hid in our houses. At night, when the place was quiet and the people with the guns were sleeping, we fled. I could not find two of my children so we had to leave without them. We were so scared. --------------------------- We trekked for four days to get to Maiduguri. We didn’t think that we would make it here alive. When I met one of my children on the road, I was so happy. I thought I’d never see them again." - Mallaam Haruna. Her daughter, Fatima, is 13. She waits in line to collect food. Mallaam's family has been living in a camp for two years after fleeing their village. Photo: Malik Samuel. @doctorswithoutborders #forcedfromhome #nigeria #maiduguri #msf #aid #food #health

A photo posted by @forcedfromhome on

“A Lethal Interplay”

The need for food assistance will likely increase even further in March, which marks the start of the annual lean season when stores from this year’s low-yielding harvest run out. But starvation is not the only threat posed by dwindling food supplies—inadequate nutrition also weakens peoples’ ability to fight infections like malaria and diarrhea, which will both become more prevalent when the rainy season begins in June. 

“There is a lethal interplay between the lean and rainy seasons,” says MSF’s Dr. Javed Ali. “Just as people’s immunity falls as nutrients in their diet decrease, the number of infections rises. This is particularly difficult for children and can leave them very vulnerable to developing severe malnutrition with complications.”

From June to October 2016, this vicious cycle had deadly consequences for hundreds of MSF’s patients in Maiduguri alone. In August, 75 out of 369 children admitted to MSF’s ITFC died. In November, as the rainy season subsided and patients’ medical conditions became less complicated, 21 out of 250 children admitted to the ITFC died.

“During the summer, we were overwhelmed by the number of malnourished children with severe complications who needed treatment,” says Dr. Ali. “Even though seasonal factors have now brought some respite, it does not mean that the emergency is over. Without a significant scale-up from national and international aid organizations, the situation could be even worse next year, as millions remain displaced by the conflict.”

Across Borno State, MSF runs 11 permanent health facilities, while its medical teams make regular visits to five more. MSF is deeply concerned for the hundreds of thousands of people who could be living in areas of the state where aid agencies have not been granted access, who may be going without adequate food, water, or medical care.

Learn More: Adapting Strategy to Treat Undernutrition in Borno State, Nigeria