Insecurity and suicide attacks by insurgents led to further displacement, increasing the need for medical and humanitarian aid in Nigeria in 2015.
Over two million Nigerians have been displaced across the northeast of the country, largely as a result of brutal violence linked to the Islamic State’s West Africa Province (ISWAP), also known as Boko Haram. Rural communities have been devastated. 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.
MSF has been providing healthcare to people displaced by violence, as well the host community in and around Maiduguri, since mid-2014. 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.
Towards the end of 2015, in Kukerita camp, Yobe state, an MSF team undertook 2,000 outpatient consultations, referred complicated cases for further care, and provided six million litres of clean drinking water to displaced people. Antenatal care was also provided. In addition, MSF worked to rehabilitate the local healthcare centre in Kukerita, which was supplied 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 of children 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 the age of 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 their appearance – 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 through 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.
No. staff in 2015: 655 | Expenditure: €17.2 million | Year MSF first worked in the country: 1971 | msf.org/nigeria