Story - MSF surgeons operate on 6-year old Zayyanu Murtala to reconstruct a hole in his jaw and damage to his eye, caused by Noma. In August 2015, MSF held a surgical intervention for 19 Noma patients at the Children's hospital in Sokoto State, in northwest Nigeria. Noma begins as an ulcer inside the mouth extending from within outwards, rapidly destroying the soft tissues and the bone. The disease is caused by poor oral hygiene which is exacerbated by severe malnutrition commonly associated with extreme poverty.