Three months after a violent attack by unknown assailants on its office in Maïné Soroa, in southeastern Niger’s Diffa region, Doctors Without Borders/Médecins Sans Frontières (MSF) has been forced to stop providing medical and humanitarian assistance to people in the area.
MSF had worked in Maïné Soroa since 2017, and in the Diffa region since 2015. Here, MSF head of mission in Niger Abdoul-Aziz O. Mohammed reflects on the project and explains the reasons behind the difficult decision to withdraw.
Why did MSF start working in Maïné Soroa?
Over the past five years, the conflict in northeastern Nigeria spread throughout the Lake Chad basin, hitting the Diffa region in southeastern Niger with full force.
Armed clashes were followed by violence against civilians, causing people to be displaced from their homes on a massive scale: more than 250,000 refugees, displaced people, and returnees are currently living in the Diffa region. And it’s not only the conflict: banditry, with criminal kidnapping and robbery, is also a growing problem.
By 2017, more than a quarter of a million uprooted people were living in makeshift shelters and camps or staying with local families. Local capacities were overwhelmed and couldn’t meet people’s needs for food, water, shelter, and medical care.
The health situation was particularly catastrophic in the district of Maïné Soroa, 60 kilometers [about 37 miles] south of Diffa city. Medical facilities were short of funds, medical supplies, and staff, and patients had to pay for consultations and treatment, which most of them couldn’t afford.
Meanwhile, across the border in Nigeria’s Yobe state, it was a health desert. Thousands of people, including doctors and nurses, had fled the area, so health facilities were no longer functioning. No humanitarian organizations had stepped in to provide care to the people still living there.
That’s why we decided to extend our work in the Diffa region with a new cross-border project based in Maïné Soroa, which started in July 2017. Our aim was to meet the medical needs of people living on both sides of the border, in Niger and in Nigeria, with a particular focus on child and maternal mortality—a chronic problem in the region, made worse by the current insecurity.
What medical services did MSF provide in Maïné Soroa?
Over the past two years, we provided medical activities on several levels.
At Maïné Soroa district hospital, we worked alongside Niger’s Ministry of Public Health to support the emergency room, the pediatric ward, and internal medicine services, as well as treating children with severe acute malnutrition and complications. Altogether our teams cared for over 10,200 patients, and more than 3,000 were hospitalized.
Gradually, we expanded our work to 12 health areas in Niger and Nigeria, providing basic and maternal health care through mobile clinics and referring patients in need of specialized care to the hospital in Maïné Soroa. Furthermore, we ran mobile clinics in the villages of Tam, Boudoum, Maalam Boulamari, Chiri, Ambouramali, Mguelbéli, and Foulatari in Niger, and Dekwa, Deguel Toura, Boultwa, and Marari on the Nigerian side of the border. Altogether, our teams carried out 134,601 general medical consultations and 1,571 antenatal consultations, and assisted 126 births.
At the same time, our teams provided weekly medical consultations and care for nomadic communities as they moved around the region, grazing their livestock or selling their goods, because we had noticed that these communities rarely visited medical facilities and we wanted to prevent them from waiting until a member of their community was seriously ill before seeking care, when it is often too late to save them.
A large part of our efforts were focused on preventing and managing diseases at the community level, with the help of about 30 community health workers in Niger and about 15 in Nigeria. We trained them in the management of simple diseases such as malaria and diarrhea and gave them medications about twice a month. They reported back to us weekly on the number of patients they had managed and any challenges they faced, so that we could offer them the right support.
Why is MSF leaving Maïné Soroa?
On April 26, 2019, unidentified armed men attacked our office in Maïné Soroa. One staff member was slightly injured, four vehicles were set on fire, and the premises were damaged. We temporarily suspended some of our activities while we analyzed the situation.
We haven’t been able to clearly determine who was behind this attack, nor how to prevent it from happening again, with the risk of even more critical consequences for our teams. We have concluded that conditions are not in place for MSF to be able to continue working in the area.
In the months since the attack, the security situation has gotten worse. On June 15, an aid worker from the International Rescue Committee (IRC) and the driver of their rental car were killed in the village of Tcholori, about 15 kilometers [about nine miles] from Maïné Soroa.
Our decision to close our project in Maïné Soroa was not an easy one to take. We know that it will have an impact on people who have no other access to free health care, and that it comes at a particularly critical time for children, as the seasonal malaria peak begins. Unfortunately, we have no choice. We cannot put the lives of our team members at risk.
We’ve given medical supplies to the Ministry of Public Health, and MSF will continue to provide free health care in other areas of the Diffa region. Our teams are still working in the cities of Diffa and Nguigmi, supporting two district hospitals and several health centers, and they are also running mobile clinics and distributions of essential relief items including kitchen utensils, mosquito nets, and blankets in the surrounding areas.
MSF first worked in Niger in 1985, and currently runs medical and humanitarian projects in six regions of the country in support of the Ministry of Public Health. MSF’s focus is on reducing child and maternal mortality; assisting refugees, internally displaced people, returnees, host communities and migrants; and responding to epidemics of diseases such as cholera, measles, and meningitis.