Nigeria: Outbreak of cholera in Borno State

An epidemic of cholera broke out in Borno State in the northeast of Nigeria at the end of September. Already operating in this remote state that is difficult to get to and where the provision of healthcare is extremely limited, MSF is now responding to this latest epidemic. There have been 4,500 cases and 70 deaths from cholera in barely a month in Borno State’s capital and principal town Maiduguri and the number of cases continues to rise.

MSF provided assistance during a previous cholera outbreak in Maiduguri in 2010 and set up a 120-bed cholera treatment centre (CTC) in the town’s hospital. In view of this latest epidemic, MSF has decided to re-open the CTC and increase the number of beds to 150. Eight MSF staff members working in cooperation with Ministry of Health personnel are providing care for the most serious cases and 1,912 people have already received treatment. MSF has also set up in several of the town’s districts five preventive oral rehydration points. Easy to install, these give people access to oral rehydration solutions. Action Contre la Faim (ACF) is looking into assisting with water, hygiene and sanitation activities.  

Cholera epidemics are frequent in Nigeria and in January this year an outbreak occurred in Bauchi State, also in the northeast of the country,. MSF teams provided treatment in a CTC to 8,500 of the 15,500 people who contracted the disease.

3 to 5 million of the world’s population fall victim to cholera every year. An acute infection of the intestine, cholera is highly contagious and is transmitted by ingesting food and water contaminated by the bacterium or faeces. The disease kills 100,000 to 120,000 people every year. Cholera often occurs in over-crowed places where clean water, refuse collection and lavatories are lacking or are in short supply. Young children and the elderly are particularly at risk. Principal symptoms are watery diarrhoea and vomiting, which can rapidly lead to severe dehydration and sometimes death. However, if it is treated promptly, cholera is easy to cure. Treatment consists in replacing lost fluids and salts to prevent dehydration—rehydration salts are administered orally. Very seriously ill patients must be admitted to hospital and some may require up to 8 to 12 litres of intravenous fluids a day. Sometimes they also need antibiotics. In spite of the speed at which the symptoms appear and their severity, recovery is quite spectacular as, after only a few days of treatment, the bacteria disappear and patients return to good health.

In May 2013, the government declared a state of emergency in Borno, Yobe and Adamawa States after the radicalisation of Islamist movement Boko Haram, particularly active in the northeast of Nigeria. MSF initiated a first intervention in Borno State after an attack on the town of Baga in May 2013 but was quickly forced to close down its activities because of the mounting insecurity. Some time later, an exploratory mission was carried out in Chibok in the south of the State and 3,760 people were treated. Over half were children under the age of 5 and many were suffering from malnutrition. After working in the area for ten weeks, in October 2013 operations had to be suspended yet again for security reasons.

MSF returned to Maiduguri again in May 2014 and is providing support to fixed and mobile medical clinics alike in two of the town’s three displaced persons camps. These camps host refugees who have fled from Boko Haram attacks in the surrounding region. There are now 58,000 people living in the three camps and the National Emergency Management Agency (NEMA) estimates that the total number of displaced people is 350,000. 
MSF is able to continue its work combatting the cholera epidemic in the town as it has not been subjected to attack for some time and the situation is calm. Yobe, Borno and Adamawa States are extremely remote and the restrictions on people getting in and out are taking their toll on trade and the local economy. In Borno State, access to healthcare for displaced people, Maiduguri’s vulnerable inhabitants and the population in general is wholly inadequate.