Nigeria

People looking for treatment for their malnourished children arrive at the MSF outpatient feeding programme in Riko village, Katsina state, Nigeria, June 2022.

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Our activities in 2023

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Millions of people in Nigeria are living through escalating conflict, extreme weather events, and financial insecurity, while their access to healthcare is decreasing.

People’s lives have been disrupted by violence and crime, while regular disease outbreaks and malnutrition continue to endanger the lives of thousands of children. Over 3 million people have been driven from their homes in Nigeria’s northwest, northeast, and north central regions.

MSF has been responding to disease outbreaks and emergency health needs in Nigeria since 1996, focusing on maternal and paediatric healthcare throughout the country. Our nutritional activities in the northwest and northeast continue to grow as we see more patients for a large, and largely ignored, malnutrition crisis that is pushing people to their limits.

The MSF health promotion team conducts a session with caregivers at the Kofar Suari inpatient therapeutic feeding centre in Katsina state. At these sessions, parents learn how to prepare nutritious food from what is locally available. Nigeria, October 2024.

Spiralling violence and severe poverty, exacerbated by increased competition over depleting resources – which is a result of climate change – have left many people vulnerable to chronic cycles of acute malnutrition. In 2024, our teams continued to focus on nutrition activities, working in 33 outpatient and 10 inpatient therapeutic feeding centres across five states in northwest Nigeria; Zamfara, Sokoto, Katsina, Kano and Kebbi. In Zamfara state we treated 65,000 children for malnutrition in 2024. We also increased our response in the northeast, tripling our bed capacity in Maiduguri following a surge in cases, and doubling it in Kafin Madaki hospital, Bauchi state.

As the number of malnutrition cases continued to rise at an alarming rate, we continue to speak out and advocate for more to be done, calling on the government and other non-governmental organisations to increase their assistance to affected people, particularly in the northwest, where the crisis remains largely unrecognised.

A mental health session with displaced children at a camp in Zurmi, Zamfara state, Nigeria, May 2024.

In Nigeria’s northeast, thousands of people have been killed in fighting between armed opposition groups and the Nigerian army. People are unable to farm or sell their goods and mass displacement has resulted in catastrophic living conditions. Access to healthcare is limited, and many people may not to seek healthcare as they risk death and injury on their way to facilities. The Northwest has seen a significant increase in violence and insecurity, with hundreds of people being killed and kidnapped.

Our support for displaced people and host communities includes maternal and paediatric care, mental health support, treatment of malnutrition, support for survivors of sexual violence, and provision of water and sanitation, essential items and shelter.

A pregnant woman in the triage area of the comprehensive emergency obstetric and newborn care’ facility that MSF built at the Nilefa Keji hospital in Maiduguri, Borno state. This hospital is being run in collaboration with the state's Ministry of Health. Nigeria, 26 October 2024.

Nigeria has one of the worst maternal death rates in the world, only following behind South Sudan and Chad. According the latest UN data, which is from 2020, there are over 1,000 deaths for every 100,000 live births.

In 2024 we opened a referral hospital in Maiduguri, Borno state, for complicated deliveries and neonatal care. In a collaborative effort, staff from both MSF and the Ministry of Health are supporting pregnant women who are suffering from a range of complications such as pre-eclampsia, malaria and anaemia. We also conduct obstetric and neonatal activities, including surgery for conditions such as obstetric fistula, at Jahun General hospital in Jigawa state.

In Kano state, our teams support two general healthcare centres and a clinic for maternal and child health, while in Cross River, we provide emergency obstetric and neonatal care. In Sokoto and Zamfara, where communities face high levels of insecurity and violence-related injuries, our teams support survivors of sexual violence.

MSF vaccinators are set up in the community ready to vaccinate children with the penta-5 vaccine during a pilot mass vaccination campaign in Sokoto state, Nigeria, November 2024.

In 2024 we saw a number of cholera outbreaks across Nigeria and our teams responded in Borno, Sokoto and Bauchi states by setting up cholera treatment centres and units.

We see a number of recurring diseases every year in Nigeria, including measles, malaria, diphtheria and Lassa fever. In addition to responding to outbreaks, we conduct preventive activities. For malaria this means conducting indoor residual spraying, a type of chemical treatment that targets mosquitoes inside people’s homes. In Sokoto and Zamfara states we ran vaccination campaigns in 2024 and are now calling for these campaigns to be carried out across the country to curb the spread of preventable diseases.

Dr Kefas and Dr Dave examine a young girl with noma who underwent life-changing reconstructive surgery. Nigeria, October 2023.

Since 2014, we have supported the Noma Children’s hospital in Sokoto, in northwest Nigeria, by providing reconstructive surgery, nutrition and mental health support, as well as conducting community outreach activities, with a focus on early detection. Most patients who contract noma ─ a disfiguring and deadly infection if not treated on time ─ are children under six years old, whose immune systems have been weakened by malnutrition.

MSF supported the government in the drafting of the National Noma Control Plan, which aims to raise awareness about the disease. In 2023, after long-term advocacy efforts by our teams, noma was included in the World Health Organization’s Neglected Tropical Diseases list. The inclusion of noma is a significant milestone, as it will amplify global awareness, stimulate research and funding, and boost efforts to control the disease.

Website

Noma, a neglected disease

msf.org

Website

Noma, a neglected disease

msf.org

Our activities in 2023 in Nigeria

Data and information from the International Activity Report 2023.

3,058

Staff in 2023 (full-time equivalent)

€74.4 M

74.4M

Expenditure in 2023

1996

Year MSF first worked in the country

MSF in Nigeria in 2023 In Nigeria, Médecins Sans Frontières (MSF) scaled up activities to address the neglected malnutrition crisis and assist people displaced by violence. We also ran programmes to improve maternal and child health.

Country map for the IAR 2023.

In recent years, conflict, extreme weather events and deteriorating economic conditions have plunged Nigeria’s North West, North East and North Central zones into a deepening humanitarian crisis. Millions of people are living in increasingly vulnerable circumstances as they face catastrophic levels of malnutrition and outbreaks of preventable diseases.

Widespread violence and unrest have driven over 3.3 million people from their homes.* They, and many others in these areas of Nigeria, have extremely limited access to medical services, due to the lack of functioning healthcare facilities, and the financial and security challenges involved in travelling to those that are still working.

Violence and displacement
Nigeria’s North West region has experienced a significant increase in violence and insecurity over the past few years. Hundreds of people have been killed and kidnapped, while more than 600,000 have been displaced.** In the North East zone, thousands of civilians have been killed in the fighting between armed opposition groups and the Nigerian armed forces. This ongoing violence prevents people in need of medical assistance from seeking care, as they fear being killed or kidnapped on their way to health facilities.

MSF teams support displaced and host communities affected by violence in the North West, North East and North Central zones, including Plateau state, where the situation deteriorated rapidly in 2023, resulting in hundreds of deaths and mass displacement.

In Borno state, we launched a new project in partnership with a local foundation to provide basic healthcare at community level in hard-to-reach areas outside Maiduguri city.

In Zamfara state, our teams were forced to withdraw support from an inpatient nutrition facility in the town of Anka in September because of the increased tensions in the area. We also had to temporarily evacuate some of our staff in Zurmi in December due to heavy fighting next to the hospital.

Disease outbreaks
In 2023, we responded to an unprecedented diphtheria outbreak, which started in Kano state and spread across the country. By the end of the year, more than 20,000 suspected cases and 600 deaths were reported. MSF teams treated patients in Kano, as well as Maiduguri and Bauchi.

Our teams also saw an alarming number of patients with measles, particularly in Maiduguri, and responded to outbreaks of other diseases, such as meningitis, cholera and Lassa fever in Ebonyi, Bauchi and Zamfara. In addition, we conducted preventive activities to annual incidences of malaria, and called for mass vaccination campaigns to be carried out across the country to curb the spread of preventable diseases.

Malnutrition
The spiralling violence and severe poverty, exacerbated by increased competition over depleting resources – which is a result of climate change – have left many people vulnerable to chronic cycles of acute malnutrition. In 2023, our teams continued to focus on nutrition activities, working in 32 outpatient and 10 inpatient therapeutic feeding centres across five states in North West region (Zamfara, Sokoto, Katsina, Kano and Kebbi). We also increased our response in North East region, tripling our bed capacity in Maiduguri following a surge in cases, and doubling it in Kafin Madaki hospital, Bauchi state.

As the number of malnutrition cases continued to rise, we stepped up our advocacy efforts, calling on the government and other NGOs to increase their assistance to affected people, particularly in North West region, where the crisis remains largely unrecognised.

Women’s health and sexual violence
Nigeria has one of the worst maternal death rates in the world; after South Sudan and Chad, it is the country with the highest number of deaths during childbirth, with more than 1,000 per 100,000 births.*** Underfunding, lack of access to health services, soaring inflation that makes it difficult to afford hospital fees or transportation, and cultural practices that hinder women from seeking care, are responsible for this shocking record, and for the high number of women developing obstetric complications.

In 2023, we opened a women’s health clinic for mothers of malnourished children admitted to the inpatient therapeutic feeding centre we support in Katsina. We also conduct obstetric and neonatal activities, including surgery for conditions such as obstetric fistula, at Jahun general hospital in Jigawa state.

In Kano state, our teams support two general healthcare centres and a clinic for maternal and child health, while in Cross River, we provide emergency obstetric and neonatal care. We also support four basic emergency obstetric and neonatal care centres in northeastern Nigeria.

In Benue, thousands of displaced people, who fled armed clashes between farmers and herders, are living in precarious living conditions. Our teams working in the displacement sites continue to witness extremely high rates of sexual and gender-based violence (SGBV).

In 2023, we offered a range of services in Benue, including sexual and reproductive healthcare, and comprehensive care for victims and survivors of SGBV, comprising treatment and mental health support, and health promotion. These services are also available in the towns of Shinkafi, Zurmi and Anka in Zamfara.

Noma
Since 2014, we have supported the Noma Children’s hospital in Sokoto, in northwest Nigeria, by providing reconstructive surgery, nutrition and mental health support, as well as conducting community outreach activities, with a focus on early detection. Most patients who contract noma ─ a disfiguring and deadly infection if not treated on time ─ are children under six years old, whose immune systems have been weakened by malnutrition.

MSF supported the government in the drafting of the National Noma Control Plan, which aims to raise awareness about the disease. In December, after long-term advocacy efforts by our teams, noma was included in the World Health Organization’s Neglected Tropical Diseases list. The inclusion of noma is a significant milestone, as it will amplify global awareness, stimulate research and funding, and boost efforts to control the disease.

*IDMC, https://www.internal-displacement.org/countries/nigeria/

**IOM (2023), ‘North-Central and North-West Zones Displacement Report December 2023

***Integrated African Health Observatory: “Maternal mortality: The urgency of a systemic and multisectoral approach in mitigating maternal deaths in Africa”