The conflict in Borno State started in 2009 when Boko Haram launched attacks in Bauchi, Borno, Yobe and Kano. By 2014, Boko Haram controlled large swathes of territory in Borno State.
In 2015, Nigeria elected a new President who vowed to take back control of territory from Boko Haram and also stamp out corruption in the country. Since then the Nigerian army has been engaged in fighting with Boko Haram, including by launching airstrikes that began in 2016, in areas under Boko Haram control. The army has now taken back many cities and villages and is securing them.
The nature of the conflict between the Nigerian army and Boko Haram has changed to include military assistance from the neighbouring countries of Chad, Cameroon and Niger.
Boko Haram, also known as Islamic State West Africa Province (ISWAP), has carried out and continues to carry out attacks, suicide bombings and incursions in Borno State and also in neighbouring countries. As a result of the conflict, 2.7 million people are displaced across the four countries (Nigeria, Cameroon, Chad and Niger) according to Office for the Coordination of Humanitarian Affairs (OCHA).
MSF has been working in Maiduguri on a permanent basis since April 2014 and had previously intervened on several occasions to help control cholera epidemics. Today, more than 1.2 million internally displaced people (IDPs) are living in Maiduguri, most of them with the host community and others in camps (informal camps and 11 official camps).
In Maimusari and Bolori health centres, MSF runs an outpatient department (OPD; 400 consultations per day in Maimusari and 300 in Bolori), an Ambulatory Therapeutic Feeding Centre (ATFC; where people seen on an outpatient basis) and a maternity ward assisting simple deliveries.
In Maimusari, the government has just handed a new building over to MSF, which which allow us to evolve from a basic health care centre to a comprehensive healthcare facility with hospitalisation capacity. MSF has recently moved its outpatient activities (OPD and ATFC) inside this new building and next week will open an inpatient department with 50 beds for paediatrics and 10 beds for referrals from camps outside Maiduguri.
In Gwange, a Maiduguri district, MSF now has an 100-bed Inpatient Therapeutic Feeding Centre (ITFC) that has received people referred from Bama (18) and Dikwa (27) on 20 July. The ITFC is under tents, in the compound of health centre run by the Ministry of Health.
Epidemiological surveillance continues in the 11 official camps and in Mouna camp, an informal settlement with around 15,000 people. People arriving in Maiduguri go first to a camp where there are security screened by the army, then go either to Mouna camp, a camp close by set up on a private land, or to Custom camp made of unfinished buildings hosting between 2,000 and 3,000 people.
The disease surveillance system is now being strengthened to react rapidly to emergencies popping up in Maiduguri and on its outskirts. Since last week, cases of measles have been reported inside Maiduguri in the so-called “Arabic teaching college” camp and outside Maiduguri in Konduga, the last big town on the road to Bama that is for now accessible without escort. MSF teams are undertaking containment and case management at these sites.
Between 13 and 15 June, Nigerian authorities and a local NGO organised the evacuation of 1,192 people requiring medical care from the Bama area to the city of Maiduguri, capital of Borno State. This group of mostly women and children was placed in the “Nursing Village” camp for internally displaced people. Out of the 466 children screened by MSF in the camp, 66 per cent were emaciated, and 39 per cent had a severe form of malnutrition. Upon assessment, 78 children had to be immediately hospitalised in the MSF feeding centre, which has an inpatient capacity of 86 beds.
A team visited Bama with a military escort for the first time on 21 June and found people in a catastrophic situation. Out of the 800 children screened, 19 per cent were suffering from severe acute malnutrition (SAM). Estimates of mortality at that time were very high. Medical data from the health centre reported 188 deaths between 23 May and 21 June, mainly from diarrhea and malnutrition; counting of the graves in the cemetery behind the camp showed more than 1,200 graves had been dug since the internally displaced had gathered in the hospital compound. Five children died whilst the assessment was being undertaken.
MSF returned to Bama mid-July. Today, Bama is a ghost town held by the army. People live in a camp inside the hospital compound. Despite 1,500 people being evacuated by the authorities and some food distribution, the estimated malnutrition rates remain high (severe acute malnutrition is estimated at 15 per cent). An estimated 10,000 to 12,000 internally displaced (official figures 27,000) are living in terrible conditions in shelters made of rusty corrugated iron sheeting and cannot leave the camp. There are hardly any men or boys older than 12. We don’t know what has happened to them.
Another MSF team arrived on 19 July to provide medical and nutritional support: Ambulatory Therapeutic Feeding Centre, consultations, set up seven beds for observation and stabilisation, and improve water quality through chlorination. A referral system to Maiduguri has been organised with SEMA (State Emergency Management Agency) via ambulances and school buses.
An estimated 150,000 people, including 65,000 internally displaced, are living in Monguno. They have had almost no access to health care since January 2015.
A team visited Monguno last week and will return again soon. The UNICEF clinic and the ALIMA clinic are currently overwhelmed. MSF are planning to restart activities in the hospital, which has not been operational for several months. First an inpatient department will be set up under tents in the hospital compound. There will be 50 beds for general cases and 50 beds for malnutrition cases.
Dikwa is located in an enclaved area on the frontline. An MSF team undertook a two-day assessment this week. The estimated population in the camp for internally displaced is around 55,000, with new arrivals still streaming in from the new open areas. The majority of Dikwa's inhabitants (40,000) left for Maiduguri in 2014, and around 12,000 stayed and moved into the camp. Other people have arrived from the surrounding villages. Water is a big concern in the camp, both the quantity and the quality.
Dikwa was largely deserted until the governor allowed people to visit the town and to farm the surrounding land. On 20 July, the Dikwa population were allowed to visit their houses which are being repaired by government construction workers.
UNICEF and the International Committee of the Red Cross (ICRC) have been running a clinic in the camp for several months, and the ICRC distributes food every day. A rapid screening by MSF showed that 12.5 per cent of children were suffering from severe acute malnutrition. We are considering opening an Inpatient Therapeutic Feeding Centre and an Ambulatory Therapeutic Feeding Centre in the general hospital, which is currently empty.
Damboa, in southern Borno, has been greatly affected by the current conflict in northeast Nigeria. Currently the population is estimated at between 50,000 and 60,000, with many being displaced people from the surrounding area who are living in the town as well as in three camps. Malnutrition rates are very high, with an average of 12 per cent of children suffering from severe acute malnutrition. An MSF team has been on the ground treating patients in Damboa since 17 July, and the majority of patients seen have presented with malnutrition, malaria, diarrhea and/or skin infections.
The ICRC has started food distribution in Damboa but access to food remains a major challenge. Water and santitation is also a big issue, as there is limited access to clean water and there are an inadequate number of latrines in the camps.