MSF has been responding to disease outbreaks and emergency health needs in Nigeria for many years, focusing on maternal and paediatric healthcare throughout the country and scaling up our activities in the northeast as vast numbers of people caught up in the conflict depend on aid to survive.
In 2019, the intensification of violence and insecurity increased humanitarian needs in Nigeria. It has been 11 years since an insurgency began in northeast Nigeria, with armed opposition groups fighting the Nigerian army. Thousands have been killed in fighting and many more by malnutrition, measles and malaria. People are unable to farm or sell their goods and mass displacement has resulted in catastrophic living conditions. Watch our video explainer on the crisis in the northeast.
Twenty per cent of all global maternal deaths due to complications during pregnancy or childbirth happen in Nigeria, according to the World Health Organization. In 2019, the country’s mortality rate for under-fives was 76.8 per cent. We run the maternity and neonatal departments of Jahun general hospital, Jigawa state, and support basic obstetrics in health centres to reduce complications during pregnancy. In 2019, we assisted 13,400 births, 70 per cent of which were complicated cases.
We run mass vaccination campaigns across the country against diseases such as measles, meningitis and pneumococcal pneumonia. Our teams also provide seasonal malaria chemoprevention. In 2019, an outbreak of Lassa fever, an acute haemorrhagic illness, was declared a national emergency. In Ebonyi state, we assisted the state and federal ministries of health and the Nigerian Centre for Disease Control with technical support and staff training at a teaching hospital in Abakaliki.
We support the Noma Children’s Hospital in Sokoto with specialised surgical care for patients with noma and other conditions that require reconstructive surgery. Most patients with noma ─ a disfiguring and often deadly infection ─ are children under six, whose immune systems have been weakened by malnutrition. As well as surgery, we support pre- and post-operative medical and mental care, community outreach activities, and active case finding in the region. In 2019, our staff conducted 170 surgical interventions and 530 individual mental health consultations.
We run a programme for victims of sexual and gender-based violence in Port Harcourt, Rivers state. It includes preventive treatment for sexually transmitted infections, emergency contraception, counselling and psychosocial support. In 2019, we treated 1,424 new patients, 61 per cent of whom were under the age of 18.
We have been responding to lead poisoning in children in Zamfara state since the epidemic was discovered in 2010. Following a similar outbreak in Niger state in 2015, we have set up safer mining projects in both areas, working with miners to reduce their exposure to toxic lead and off-site contamination. In 2019, 938 patients in Zamfara state completed chelation therapy to remove lead from their blood.
Our activities in 2020 in Nigeria
Data and information from the International Activity Report 2020.
MSF continued to assist people affected by conflict and displacement across several states, while maintaining a range of general and specialist healthcare programmes.
Displacement and violence
In northeast Nigeria – particularly in Borno state – more than a decade of conflict between the Nigerian government and non-state armed groups has taken a severe toll. The United Nations estimates that more than 2.1 million people have already been displaced*, and the numbers continue to rise. More than a million have been completely cut off from aid for years. In 2020, as the situation deteriorated, a series of brutal mass murders and kidnappings took place, but only people living in government-controlled areas in Borno state were able to obtain assistance. In the areas we could access, we managed hospital emergency rooms, operating theatres, maternity units and paediatric wards, providing services such as treatment for malaria, tuberculosis, HIV and sexual violence, nutritional care, vaccinations and mental health support.
In Maiduguri, we manage a 72-bed therapeutic feeding centre treating severely malnourished children with medical complications. We also run a 65-bed paediatric hospital with a specialist intensive care unit, which is the only facility of its kind providing free healthcare in Borno. At these facilities, we treated thousands of children for malaria, measles, and malnutrition in 2020.
In addition, our teams provided treatment for malaria in displacement camps in Ngala and Banki, and delivered seasonal malaria prophylaxis in several locations across the state. We also offered specialist healthcare in Ngala to people in the town and in displacement camps. In Gwoza and Pulka, towns controlled by the Nigerian military, our teams supported emergency care in public hospitals. In both Pulka and Rann, we conducted thousands of outpatient consultations, mainly for acute diarrhoea related to a lack of clean water.
Increasing violence and banditry in the northwestern states have driven people from their homes, forcing them to lose livelihoods, food sources and access to basic services. Around 100,000 people sought safety in the Zamfaran towns of Anka, Zurmi and Shinkafi, following an upsurge in fighting in 2018. In these towns, our teams conducted medical consultations, provided treatment for malaria and admitted thousands of children to our therapeutic feeding centres.
In Zamfara, we also continue to screen and treat for lead poisoning, a result of unsafe mining practices that put people, especially children, at risk. In 2020, we admitted 1,500 children for monitoring and treatment.
MSF supported several isolation facilities opened by the Ministry of Health across the country by renovating facilities, training medical staff on infection prevention and control measures, and providing treatment to patients. We also reinforced infection prevention and control measures, and adapted the triage and patient flow systems in our facilities to ensure the continuity of activities.
In Kano state, where COVID-19 led to the closure of many health facilities, we conducted consultations in two general healthcare centres from June onwards. Nearly half were for malaria.
In Jahun general hospital in Jigawa state, we continued to offer comprehensive emergency obstetrics and neonatal care, as well as vesico-vaginal surgery for obstetric fistula. A total of 205 women underwent this procedure in 2020. MSF also gave logistical, technical and medical support to four centres providing basic emergency obstetric and neonatal care around Jahun.
Noma is an infectious but non-contagious disease that particularly affects young children, with the infection destroying the bone and tissue of the lower half of the face if left untreated. Those who survive are left with severe disfigurement, which can only be corrected with extensive reconstructive surgery. In 2020, although COVID-19 restrictions had an impact on our noma activities, we were still able to perform surgery on 73 patients. Our care package for noma patients includes physiotherapy and nutritional support, and mental healthcare for both them and their families. MSF and the Ministry of Health also conduct outreach activities with a focus on early detection and referrals for noma patients in northwest Nigeria.
Benue and Rivers states
In 2020, the number of people displaced by violent clashes over land between farmers and herdsmen continued to rise. By the end of 2020, an estimated 197,000 people had fled their homes. Around half of them live in official camps in and around the Benue state capital, Makurdi. In 2020, MSF supported the health authorities by running a range of services in the camps, including general, reproductive and mental healthcare, nutritional support, health education, treatment for victims of sexual and gender-based violence, and vaccinations.
We also assisted with the response to outbreaks of cholera and yellow fever and improved water and sanitation. When COVID-19 arrived in Benue, we triaged suspected patients and organised referrals to public facilities. In two clinics in Port Harcourt, Rivers state, we offered comprehensive healthcare to victims of sexual violence, including prophylaxis for HIV and other sexually transmitted infections, vaccinations for tetanus and hepatitis B, emergency contraception, and psychological and social support.
In Ebonyi state, Lassa fever ─ an acute haemorrhagic illness ─ is endemic. In response to an outbreak, we assisted the state and federal ministries of health and the Nigerian Centre for Disease Control by giving technical support, training staff and treating patients at a teaching hospital in Abakaliki. We also raised awareness within the community, conducted case tracing and decontaminated the homes of patients.
*UNHCR, Nigeria Emergency