Kerri Ann Kelly is the head of mission for Doctors Without Borders (MSF) in Nigeria. She explains how the complex humanitarian situation in Borno State, in the northeast of the country, will only get worse with the onset of the rainy season.

Seventy-year-old Musa Kime arrived in Rann, a town in Borno State, a few weeks ago. Along with other people from his village, Kime walked 21 kilometres on foot through the night to reach the relative safety of this small town in northeast Nigeria.  ‘I just want some food and a place to stay, I have not much hope,’ says Kime.

Others like Kime continue to arrive in towns across the region every day, fleeing the long-running conflict between the Nigerian military and armed groups. According to the United Nations, 1.7 million people have been displaced in northeast Nigeria; 78 percent of them in Borno State.

MSF, Doctors Without Borders, Nigeria, Malaria
A team of community health workers (CHWs) prepare to deliver a preventive malaria solution to a child in the community in Rann. Photo: MSF/Nitin George

Mohammed Jabu also just arrived in Rann and he sits under a communal shelter, waiting to receive humanitarian assistance. He expresses anxiety about the future. “We came here with little or no clothes and belongings, there is not a lot of food here either.” For the displaced people in Rann, the lack of food and shelter supplies will only get worse during the rainy season.

Rann is home to more than 40,000 people, including the host community and internally displaced people from surrounding villages. Heavy rains from July to September transform the town into an island, leaving residents cut-off from the outside world. It has become increasingly difficult for humanitarian organisations to reach people with much-needed shelter, food supplies and lifesaving medical care. Food insecurity is also a big problem with the season between harvests – when farmers are unable to sow their fields – fast approaching.

The risk of water-borne disease is also concerning. Heavy rains lead to numerous pools of stagnant water which are easy breeding grounds for mosquitoes. Open defecation and overflowing pit latrines increase the risk of outbreaks, which can spread unchecked throughout towns. At a time when people are coping with reduced food supplies, falling sick with malaria or diseases like hepatitis E can prove deadly. Pregnant women and children under the age of five are the most vulnerable.

In response, a preventative malaria treatment programme for children under five was launched by the Borno State government in collaboration with several humanitarian organisations, including MSF. In Rann, MSF trained 47 teams of community health workers and provided malaria treatment for 14,725 children in three days.

There is also no access to inpatient hospital care in Rann. During the dry season some residents risk the insecure roads to access a hospital in a town 25 kilometres away, but in the rainy season this is simply not possible. The general hospital in the town was destroyed in 2014 during the conflict and it is only now being renovated by the local authorities.

Many of the new arrivals in our health facility in Rann report that continued insecurity and lack of adequate food forces them to leave their villages to escape the ongoing conflict. As people continue to arrive in Rann and other towns across northeast Nigeria, the need for better medical facilities, shelters and sanitation facilities is becoming urgent.

MSF, Doctors Without Borders, Nigeria, Malaria
A community health worker (CHWs) prepares a dose of malaria prophylaxis in Rann in north-east Nigeria. Photo: MSF/Nitin George

Rann has also not managed to escape the violence. On 17 January 2017, the town was bombed by a Nigerian military plane, killing 90 people and injuring at least 150 others. Following the bombing, MSF provided medical care through mobile clinic teams who regularly visited the town. Since September 2017, MSF has had a permanent presence in Rann.

In March 2018, MSF was forced to temporarily suspend activities in Rann following an attack on a military base. Three humanitarian aid workers from other organisations were killed in the attack. Insecurity means that humanitarian organisations can only reach the town by helicopters. Today, there is a lack of health and sanitation services in Rann; and aid organisations who are present do not have permanent teams with experienced, senior staff, and this hampers the effectiveness of the humanitarian response.  

The need for more humanitarian assistance across northeast Nigeria could not be more urgent. Humanitarian aid in the form of food, medical care and sanitation services has to be ensured so communities in Rann can live in safety, security and with dignity. The sheer number of people dependent on humanitarian assistance across northeast Nigeria goes to show that the humanitarian crisis here is far from over.


In Rann, MSF provides outpatient care including a therapeutic nutrition programme. In northeast Nigeria MSF is providing primary and secondary healthcare in eight locations across Borno State and in the capital of Yobe State, Damaturu. Through permanent teams or during regular mobile clinics, teams run nutrition programmes for malnourished children, provide mental health support, respond to disease outbreaks and provide emergency paediatric care among other services.