Niger is a vast, arid state on the edge of the Sahara. It is rated by the UN as one of the world's least developed nations, with one of the highest rates of population growth.
Already vulnerable to drought and food shortages, especially during the 'hunger gap' between harvests in May and September, people in Niger continue to suffer the consequences of violent clashes between armed opposition groups and military forces in the region.
The conflict has led to more than 247,000 displaced people sheltering in sites along the border between Niger and Nigeria, where overcrowded and unsanitary conditions in the sites provide an ideal environment for the spread of diseases such as hepatitis E. The pressure on the host communities has also dramatically increased as many lack food, water, proper sanitation infrastructure, and access to natural resources.
Together with the Ministry of Health, we provide primary and secondary healthcare, reproductive health services and mental healthcare for the local community and displaced people.
In June 2017, we started running mobile clinics in order to better reach nomadic communities and people displaced by the violence.
We are also developing community-based healthcare and health promotion activities in the region, targeting malaria, diarrhoea, respiratory infections and screening for malnutrition.
Our teams have set up ‘listening spaces’ in the villages of Assaga and Chetimari to offer advice and medical assistance to women on sexual and reproductive health.
Maternal health is a major challenge in Niger.
“The average number of children per woman in Niger is 7.3 according to the national statistics from 2015. This means that Niger has the highest fertility rate in the world," explains Ann Mumina, MSF’s medical coordinator in Niger in May 2018. "In addition, almost 30 per cent of births still take place at home, without medical assistance. This understandably has an impact on the maternal mortality rate, which is also very high.”
We have been supporting the maternity ward and assisting with obstetric emergencies at Madaoua hospital, in Tahoua region, since early 2016, and have helped build a new maternity unit in Sabon-Guida health centre.
Our teams in Diffa region work in the main maternal and paediatric regional hospital in Diffa town, the district hospitals of Nguigmi and Mainé-Soroa town, and several health centres and health posts in the districts of Diffa, Nguigmi and Bosso.
Niger has made remarkable progress in cutting under-five mortality over the past decade, but malnutrition and malaria remain a challenge.
Following the 2012 malaria peak, several measures to combat the disease were adopted by the health authorities, with the support of MSF. Thanks to these measures, in 2014 the number of people with malaria dropped by more than 70 per cent. However, cases started to reappear little by little until they had more than doubled in 2016 during the same period.
We support community health workers in over 40 villages in Maradi region alone during the peak malaria season, to ensure early detection and treatment of simple malaria and screening for malnutrition. This ramping up of our health promotion and community-based healthcare activities has resulted in a 25 per cent reduction in admissions for severe complicated malaria in the facilities we support.
We have teams working with the Ministry of Health in hospitals and health centres in the regions of Diffa, Maradi, Tahoua and Zinder to improve access to free, quality healthcare for under fives. We provide equipment and medication, train local health workers and boost the capacity of public facilities when they face peaks in malnutrition and malaria.
A hepatitis E epidemic was declared in Diffa region in April 2017. Working at 224 sites, our teams chlorinated water and distributed clean jerry cans, as well as community and personal hygiene kits that included soap, gloves and utensils. More than 200,000 people attended awareness-raising sessions about preventing the disease and recognising its symptoms.
We supported the treatment of hepatitis E in hospitals and health centres, and set up an intensive care unit in the mother and child clinic in Diffa to treat pregnant women suffering from complications as a result of the disease.
In 2018, for another year running, Niger faced several outbreaks of meningitis C and measles, two life-threatening and highly contagious diseases. And in the second half of 2018, the country battled its worst cholera outbreak in years. As the epidemic subsided, we and the local health authorities again shifted our focus to preventing future outbreaks in the area along the Niger-Nigeria border, a known cholera hotspot.