People’s lives in Nigeria have been disrupted by violence and crime, while regular disease outbreaks continue to endanger the lives of thousands of children.
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. Since mid-2021, we have scaled up our nutritional activities in the Northwest, as a growing yet largely ignored malnutrition crisis is pushing people to the limits.
In recent years, violence and insecurity have increased humanitarian needs in Nigeria. It has been 13 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.
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, provision of water and sanitation, non-food items and shelter. In providing healthcare access for refugees coming from Cameroon, we are also supporting healthcare services in Cross River state since March 2022.
Nigeria currently accounts for 10 per cent of global maternal deaths, the fourth-highest number worldwide, according to UNICEF*. Each year, approximately 262,000 babies die at birth, the world’s second highest number.
Our teams run the maternity and neonatal departments of Jahun general hospital, in Jigawa state, and support basic obstetrics in health centres to reduce complications during pregnancy. In 2021, we assisted 17,500 births. We also support maternal and child healthcare in Kano where we assisted 1,436 deliveries in the first six months of 2022.
In collaboration with Nigeria’s Ministry of Health, our teams support mass vaccination campaigns carried out across the country against diseases such as measles, meningitis and pneumococcal pneumonia. We also provide seasonal malaria chemoprevention. In Ebonyi state, we support health authorities to treat Lassa fever patients through technical support and staff training at a teaching hospital in Abakaliki.
We support the Noma Children’s Hospital in Sokoto with acute medical care and reconstructive surgery for patients with noma. Most patients with noma ─ a disfiguring and often deadly infection ─ are children under six, whose immune systems have been weakened by malnutrition. In addition to surgery, our team provides physiotherapy, nutritional and mental health support, and conducts outreach activities to improve early detection. In 2021, our staff conducted 105 surgical interventions.
We run programmes for victims of sexual and gender-based violence in our projects in Benue and Zamfara. This include preventive treatment for sexually transmitted infections, emergency contraception, counselling and psychosocial support.
A large proportion of people in Nigeria’s Northeast and Northwest regions are chronically vulnerable to food and nutrition insecurity. A combination of factors including escalating violence and the disruption of access to farming, widespread displacement, soaring food prices, and epidemics, is driving a growing health and nutrition crisis.
MSF runs a 120-bed nutritional centre in Maiduguri in Borno state. In addition, we collaborate closely with the Ministry of Health by supporting services in 21 outpatient and eight inpatient nutrition facilities across five states in the Northwest – Zamfara, Sokoto, Katsina, Kano and Kebbi.
Our activities in 2022 in Nigeria
Data and information from the International Activity Report 2022.
In Nigeria’s Northeast and Northwest regions, a combination of factors, including escalating violence, displacement, high food prices, climate change, and epidemics, have contributed to a severe health and malnutrition crisis.
In 2022, in response to this alarming situation, Médecins Sans Frontières (MSF) expanded activities, working in 32 outpatient therapeutic feeding centres and 10 inpatient therapeutic feeding centres across Kano, Katsina, Kebbi, Sokoto and Zamfara states in Northwest region.
In Northeast region, during the summer (April – October), the number of children with malnutrition registered at our project in Maiduguri, Borno state, was much higher than we had anticipated, forcing us to triple our bed capacity and adjust our intervention to cater for a full-scale emergency.
We also responded to malnutrition in other states, such as Bauchi, launching an emergency intervention in Toro.
Violence and displacement
In northeast Nigeria, particularly in Borno state, people have endured more than a decade of armed conflict between the government and non-state armed groups. Around one million people remain displaced across the state. In 2022, the authorities continued to close displacement camps in the state’s capital, Maiduguri, with only three remaining in and around the city by the end of the year. Most displaced people now live in host communities and in informal settlements.
Our teams continued to provide lifesaving specialist healthcare to children under 15 years old in Gwange paediatric hospital, the only facility offering paediatric inpatient services free of charge in the area.
MSF suspended activities in Gamboru/Ngala and Rann in May, and in December took the difficult decision to close the project due to the unacceptably high risks faced by our teams.
The levels of violence against people in Nigeria’s Northwest region significantly increased during 2022, with armed groups frequently killing, looting and kidnapping for ransom, and causing more than a million people to flee their homes. Due to the insecurity, in Anka, Zamfara, we had to scale down our 130-bed hospital to 40 beds. Nevertheless, we continued to provide medical care in the town, for both local residents and displaced people. We also worked in two hospitals and 10 general health facilities in Shinkafi and Zurmi, responding to the consequences of this violence.
Intercommunal clashes between herders and farmers led to further waves of displacement in Benue state. In 2022, more than 443,000 people were living in dire conditions in informal camps,* with limited access to healthcare, food, water and sanitation. To address the immense needs, we supported victims of the violence at our general healthcare clinics in Mbawa and Ortese camps. In three other camps, we ran community-based general healthcare services.
Sexual and gender-based violence
Another alarming consequence of the violence in some parts of the country has been the increase in the number of victims of sexual violence, including in Ortese camp, Benue, where we escalated our response to assist the high number of women reaching our facilities. In Zamfara, we also offer outpatient consultations for victims of sexual and gender-based violence.
Our teams run the maternity and neonatal departments of Jahun general hospital, in Jigawa state, and a clinic dedicated to treating women affected by obstetric fistula, a condition caused by damage to the birth canal during prolonged or obstructed labour. We also support basic obstetrics in four health centres to reduce complications during pregnancy.
In Kano state, we continue to support two general healthcare centres and a clinic to cater for maternal and child health. Meanwhile, in our newly-opened project in Cross River, we started supporting two outpatient facilities, general healthcare services, basic emergency obstetric and neonatal care, and referral systems for emergency and lifesaving care. Training is a key element in our activities in this state. In 2022, we ran training courses for health staff on Lassa fever, nutrition, laboratory skills, and water and sanitation.
In Sokoto, we support treatment for noma, a neglected disease that mainly affects young children. It starts with an infection of the gums that goes on to destroy the bone and tissue of the cheek and nose. If left untreated, noma kills up to 90 per cent of those affected within weeks. Those who survive are left with severe disfigurement. Our team provides reconstructive surgery, physiotherapy, nutrition and mental health support, and conducts outreach activities for the early detection of cases. Our teams also run an international advocacy campaign, calling for noma to be included in the WHO Neglected Tropical Diseases list in 2023.
In 2022, MSF emergency teams worked alongside the Ministry of Health to bring the cholera outbreaks in Borno, Kano, Bauchi and Cross River states under control. Our support included treating infected people, supporting oral rehydration points, launching vaccination and health promotion campaigns, and improving water and sanitation services.
In Ebonyi state, Lassa fever – an acute haemorrhagic illness – is endemic. In Abakaliki, at the Alex Ekwueme Federal Teaching Hospital, we reinforce medical capacity to tackle the disease through the training of medical workers (for early detection and referral of cases) and case management during the peak season. We also run community outreach activities to sensitise people on Lassa fever symptoms, transmission and mitigation of the risks, as well as to tackle the stigma surrounding the illness.
MSF remains prepared to respond to medical emergencies or disease outbreaks in Nigeria. In 2022, our emergency teams launched interventions in Zamfara, Katsina, Bauchi, Borno, Kano and Ebonyi states to respond to various urgent needs, including malnutrition, Lassa fever and cholera. In Kogi state, we provided safe drinking water, donations of medicines, and technical training on healthcare management and water purification for the medical staff.