“I arrived in Maiduguri, the capital of Borno state, in April 2014. First, we went as an explo team to evaluate the needs, because about a third of the state was affected by the insurgent activities of Boko Haram. In June we received the first influx of internally displaced people (IDPs) in Maiduguri and we were the first international organization to support them, in collaboration with the Nigerian Ministry of Health (MoH). They had come from Konduga and Damboa, which are local government areas inside Borno State. The situation before that was really very catastrophic, as the people fled their villages. The MoH was exhausted trying to support them with basic needs, so we collaborated with them to provide services. MSF provided water, shelter and logistics support in addition to medical consultations, nutritional support and perinatal care for displaced people in Maiduguri, mostly women and children.

In September we found there was a huge cholera outbreak among the IDPs. We treated about 7,000 cases in centers that we established in Maiduguri.

At that time, we were still in the process of identifying needs. We made a lot of visits to hospitals outside of the capital, traveling to areas that were very affected by the insurgency, such as Baga, Monguno, Damboa, Konduga and Biu. Some hospitals were bombed or burnt down and looted. We started to support them with medications and set up referrals of patients. About 90 percent of the areas we visited were affected by insurgent activities, and we received about one million IDPs inside Maiduguri. The majority of them are squatting within the host community.

In March 2015, about 10,000 people who had been abducted in August 2014 by Boko Haram were freed – mainly women and children. They were put in a big fenced area in Maiduguri. There were no houses, no shelters, no lavatories. In less than 24 hours our team was there to identify the needs, which were very urgent. We set up water tanks with a total capacity of 15,000 liters, provided shelters and sanitation, and started a clinic.

There are about one million IDPs now living in Maiduguri. There are 14 camps but most of the IDPs – about 90 percent – are living in the communities of the city. They may be staying with extended family members, or five or six IDP families stay together in one household. We are now running clinics for the IDPs living in the host communities as well as in the camps. We provide primary health care and maternal and pediatric care, as well as an outpatient department and a nutrition program.

Our team is working all the time, because IDPs arrive every week. There have also been Boko Haram activities inside Maiduguri – in February, there was a big attack on the town – so we have given the three main hospitals training on how to deal with mass casualties. Whenever there is an explosion or an attack in Maiduguri, we give the Ministry of Health support in triage and management of the emergency.

Despite this violence, Maiduguri is one of the safest areas in Borno State, which is why most of the IDPs have gathered there. The other place with a significant number of IDPs is the city of Biu.

A month or two ago, some IDPs in Maiduguri started going back to their homes to farm and fish in Lake Chad. But, unfortunately, the roads and the villages are still not safe. Some people are now coming back after being attacked by Boko Haram again.

There are some people who are still missing in the bush, and their condition is catastrophic – even worse than the IDPs we see. The main problem now is movement to those areas. The team is working to assess the security and the challenges they might face there.

None of the hospitals outside of Maiduguri and Biu are currently functioning. And most of them were completely destroyed with bombs. Those that weren’t destroyed were looted. This is now the first stage of the crisis in Borno state, but the gaps will be huge when people start going back to their homes. They will need emergency support for some time. They are going back to zero – there is no means for people to make a living in the area”.