Since May 2013, a violent insurgency by Boko Haram has led to widespread displacement and an escalating humanitarian crisis in the Lake Chad region. According to UNHCR, nearly 1.4 million people have been internally displaced in northeast Nigeria alone, and approximately 170,000 people have fled to neighboring Cameroon (56,000), Chad (14,000), and Niger (100,000). At least 1,300 people have died due to the violence so far this year.
Many of the casualties include children, and numerous cases of abduction and sexual abuse of women and girls have also been reported. Internally displaced persons (IDPs) have been seeking refuge and basic services among local communities, which already had scarce resources.
MSF has deployed medical teams to assist the displaced and local populations in the four affected countries. Insecurity remains the main obstacle to safe operation, while the rainy season is creating additional logistical challenges.
Borno State remains the epicentre of the current conflict and the situation continues to be extremely volatile and tense. Random attacks are common, mostly targeting civilians.
“Boko Haram attacked our village at night, around 10 p.m.,” recalls Fatima, 45 years old. “Armed men entered the houses and burnt them down. Many people were killed. My sister was kidnapped, and I haven’t heard from her since. We fled into the forest and walked for 24 hours until we found a road and transport to Maiduguri.”
Hundreds of thousands of displaced people currently live in Maiduguri, Borno State’s capital. Many of them are supported by local communities, while approximately 100,000 are gathered in 22 camps around the city. “There are twelve of us living in a tent, with no other choice,” says Aisha, a 55-year-old displaced woman living at the Federal Training Center (FTC) camp. “The canvas is torn and inside it is full of dust and insects. Everything gets wet when it rains.”
MSF has opened three primary health care clinics that serve a catchment area of around 35,000 people. MSF also runs a 72-bed hospital in Maimusari, which includes a 12-bed maternity unit and 60 beds for pediatrics, nutrition, and intensive care. MSF also makes regular donations to local hospitals in order for them to deal with mass casualties following bomb attacks.
In Cameroon, the security situation along the border with Nigeria remains volatile, with regular incursions and attacks by Boko Haram. Refugees continue to arrive on a daily basis in the camp established by national authorities in the Extreme North region. Two suicide bombings occurred in the city of Maroua on July 22 and 25, resulting in a large number of casualties. MSF provided support to local health authorities to treat the wounded.
“Boko Haram fighters attacked our village in the middle of the night,” says Esther, 24, from Nigeria. “They killed several people including my father and one of my sisters. We tried to flee, but they attacked us again while we were on the road. My mother and my sister had to stay behind. I hope I will find them one day. I arrived in Cameroon with my nine-month-old daughter and my 14-year-old sister after walking for two days.”
Some 45,000 refugees currently live in Minawao camp, where MSF collaborates with national authorities and other humanitarian agencies to provide primary health care, water, and treatment for malnutrition. MSF provides 55 percent of the water in the camp and is carrying out more than 2,300 medical consultations monthly.
“We are seeing increasing numbers of admissions to our malnutrition treatment program,” says Hassan Maiyaki, MSF head of mission in Cameroon. “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.”
MSF is also present in Kousseri, at the border with Chad, where tens of thousands of IDPs are scattered around the city. To respond to their needs, MSF teams are providing surgical support to the hospital and starting pediatric care to treat malnutrition and malaria.
There was a marked increase in insecurity in Chad’s Lake region in July. Attacks by Boko Haram became more frequent and, in response, the Chadian military has expanded its presence in the area. An estimated 40,000 people have been displaced in the last two weeks alone, and many are gathering in various makeshift sites in Baga Sola and Bol districts.
“The other day I heard some shots being fired in the nearby village and I fled with my wife and my eight children,” recounts Mahamad, 57. “Many of us had our houses burned down, and I am lucky no one I know was killed. But we only have enough food to eat once per day.”
MSF has been working in the region since March 2015 and is running mobile clinics near Baga Sola while supporting the Chadian Ministry of Health in Tchoukoutalia. Teams are also providing mental health care in the Dar Es Salam refugee camp in Baga Sola, home to around 7,000 refugees from Nigeria and Niger, according to official figures. In response to the latest wave of displacement, MSF commenced a mobile clinic in Yakoua and will soon begin one in Koulkimé.
“Women and children are particularly vulnerable in this situation, and medical needs in general are high,” says Federica Alberti, MSF head of mission in Chad. “Some pregnant women have walked several kilometers in searing heat to seek medical attention. People are living without proper shelter, and do not have access to food or clean drinking water. Due to the harsh living conditions and the rainy season, we are already treating patients with diarrhea, malaria, and respiratory infections, as well as malnourished children.”
In the capital, N'djamena, MSF supported Ministry of Health hospitals following suicide bomb attacks that took place on June 15 and July 11. Since April, MSF has been training Ministry of Health staff on management of mass casualties, in order to help increase the national capacity to respond to emergency scenarios.
In southeast Niger, the already fragile humanitarian situation has been aggravated by the escalation of the ongoing conflict and the consequent waves of people fleeing the violence.
The living conditions of this displaced and refugee population—who have little access to health care, safe water, or sanitation facilities—are dire. The situation could deteriorate further during the “hunger gap” period, when community food stocks are drastically reduced between harvests.
This year, the violence and restrictive measures are affecting normal trade and making food even scarcer. Moreover, the rainy season is now causing an increase in water-borne diseases such as malaria and diarrhea, which, combined with malnutrition, are particularly dangerous for young children.
To improve access to health care, MSF is supporting the main maternal and pediatric medical center in Diffa city, as well as six health centers in the districts of Diffa, Nguigmi, and Bosso. In parallel, MSF is running mobile clinics inside two IDP camps in the Diffa region, carrying out water and sanitation activities and distributing 25,000 mosquito nets.
Around Diffa, MSF teams are now assisting approximately 28,000 refugees recently arrived from Nigeria in Chetimari, Gagamari, and Assaga. Local health facilities are overwhelmed and access to water and sanitation is often insufficient. Since beginning its activities, MSF has carried out more than 30,000 consultations, including around 20,000 for children under five.