In Nigeria's Borno State insecurity and suicide attacks by insurgents have displaced nearly 3 million people in recent years increasing the need for medical and humanitarian aid.
The population continues to pay the price of a merciless conflict, between Boko Haram and Nigeran military which too often disregards the safety of civilians. Rural communities have been devastated and in many instances cut off from the outside world. By mid-2016 the distressing extent of the health catastrophy was becoming clearer as toll of a mounting nutrition crisis was becoming clearer.
The population of Maiduguri, capital of Borno state, has more than doubled with the influx of internally displaced people, which has overwhelmed basic services in the city. Despite a significant military presence, insecurity remains high, with Maiduguri targeted in repeated suicide bomb attacks, and people are afraid to return home.
The humanitarian crisis in Borno state, northeastern Nigeria
People remain trapped in a daily cycle of violence between Boko Haram and the Nigerian military and are continually displaced from their homes. In the towns of Pulka, Dikwa, Rann and Banki, large numbers of people continue to arrive from the rural areas, fleeing violence or in search of aid.
In addition, MSF teams have witnessed Nigerian refugees forcibly pushed back into Nigeria from Cameroon since last December.
Displaced people's camp bombing
At least 120 people were wounded and 90 killed following a bombing in an internally displaced person's camp in Rann, Nigeria, on 17 January 2017. The bombing was carried out by the Nigerian Army.
“This large-scale attack on vulnerable people who have already fled from extreme violence is shocking and unacceptable,” says Dr Jean-Clément Cabrol, MSF Director of Operations.
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- Nigeria attack: “I can’t find the words to describe what I saw in Rann”
- Nigeria: MSF strongly condemns the aerial bombing of a displaced camp in Rann
Health Disaster in Borno State
An extremely critical health situation is unfolding in Borno State. At least 500,000 people are either displaced or cut off in enclaves outside the state capital of Maiduguri and are in urgent need of food, medical care, drinking water and shelter.
Assessments by MSF, UN agencies and the Nigerian authorities have shown an extremely serious situation. In Bama, mortality rates exceed the emergency threshold and 15 percent of children are suffering from severe acute malnutrition.
Efforts are being mobilised but a massive relief operation is required to respond to this crisis, particularly for those who are in remote or cut-off areas.
The crisis as it happened...
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- Nigeria: Cholera spreads in displaced persons camps in Borno State
Key Figures in 2016
OVERVIEW OF MSF ACTIVITIES
MSF has been providing healthcare to people displaced by violence, as well host communities, in northeastern Nigeria since mid-2014. The organisation is currently managing 12 medical facilities in eight towns in Borno (Maiduguri, Dikwa, Monguno, Damboa, Gwoza, Pulka, Ngala and Benisheikh) and regularly provides care in an additional four locations. Elsewhere in the country, in places like Zamfara, Port Harcourt and Jahun, MSF continues to run extensive projects on child health and sexual and reproductive health, and also responds to medical emergencies such as meningitis and measles outbreaks.
In 2015, around 10,000 outpatient consultations were carried out across four sites (two in the camps, two in the community) each month. Nearly a quarter of the patients presented with respiratory tract infections.
In May, the team started offering maternal healthcare, and by the end of the year had seen more than 16,200 women for at least one antenatal consultation, and assisted 1,330 deliveries. More than 5,900 children attended the nutrition programme, and from June, an inpatient paediatric unit admitted around 100 children each month. MSF started providing emergency services at Maiduguri’s Umaru Sheu hospital in October, and emergency surgery by the end of the year.
In Kukerita camp, Yobe state, an MSF team undertook 2000 outpatient consultations, referred complicated cases for further care, and provided six million litres of clean drinking water to displaced people towards the end of 2015. Antenatal care was also provided. In addition, MSF worked to rehabilitate the local healthcare centre in Kukerita and supplied them with a generator to ensure power around the clock.
MSF has been working in Zamfara state since 2010 following an outbreak of lead poisoning in children. This year, the team continued to monitor lead levels and fewer than 10 per cent tested needed chelation treatment to remove it from their bodies.
The Zamfara project has now evolved to provide healthcare to children under the age of five in five villages, focusing on malaria, upper and lower respiratory tract infections, malnutrition and diarrhoea. Routine vaccinations are also administered, and inpatient care for children is available in a paediatric inpatient department run jointly by MSF and the Ministry of Health. Overall, more than 19,300 consultations were carried out and 3,200 children were admitted.
In June, a new programme began in Niger state to address lead exposure in children, which is typically caused by unsafe mining and ore processing. MSF trained Kagara hospital staff on lead protocols in August, and a health promotion team worked with residents in two villages, teaching them how to reduce lead exposure in their homes.
MSF advocacy efforts resulted in a government decision to remediate lead from the two villages. From October, MSF also supported the Ministry of Health at Magiru clinic to ensure children under five received good-quality care for common childhood diseases.
MSF launched a new programme In Kebbi state consisting of three mobile clinics and a health centre that offers inpatient and outpatient services for children under 15. A malaria clinic opened in August and over 4,000 patients had been treated for malaria by the end of the year. MSF expanded its outpatient services in October to include people of all ages, and had carried out 5,400 consultations by the end of the year. In December, the team were also able to expand their inpatient activities – this had been delayed by insecurity.
Reconstructive surgery for children
In August, a surgical team made its first visit to Sokoto to operate on 25 children suffering from noma (a facial gangrene infection that usually affects children under the age of six), cleft palate, cleft lip and other facial disfigurements. MSF ensured pre- and post-operative care, including nutritional and psychosocial support for families, which helped reassure parents about their children undergoing surgery and also enabled the children – who are often shunned because of the disease – gain social skills.
Around 450 individual and group mental health sessions were undertaken. Outreach and educational activities were launched in November to raise awareness of noma and the possibility of surgery. More surgical visits are planned for 2016. Referrals were also made for children needing continued nutritional care, and over 300 children were admitted to the therapeutic feeding centre.
Sexual and reproductive healthcare
A new programme for victims of sexual and gender-based violence started in June in Port Harcourt, and following an awareness campaign delivered in schools, health clinics and the media in September, monthly attendance at the clinic doubled from around 35 to 70 patients. The comprehensive package of care includes prophylaxis for HIV and sexually transmitted infections, vaccinations for tetanus and hepatitis B, wound care, emergency contraception and counselling.
The well-established Jahun emergency obstetrics programme at the government hospital in Jigawa state admitted an average of 900 patients per month, of whom around 100 needed intensive care. Staff cared for 116 babies in the neonatal unit each month. During the year, surgeons carried out approximately 2,400 interventions, including 300 for obstetric fistula. About 60 per cent of patients were aged between 15 and 19.
Responding to emergencies
An early warning surveillance system based in Sokoto facilitates rapid response to emergencies. In 2015, an outbreak of meningitis led to a mass vaccination campaign that reached 229,500 people, and over 6,300 people received treatment for the disease. In November, MSF supported a measles vaccination campaign run by the Ministry of Health in three states.
An Abuja-based emergency team ensured health facilities were prepared for possible post-election violence by training medical staff on mass casualty response and assessing facilities. The team also responded to an outbreak of cholera in Maiduguri, where more than 1,700 patients were treated.
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