In recent years, conflict, extreme weather events and deteriorating economic conditions have plunged Nigeria’s North West, North East and North Central zones into a deepening humanitarian crisis. Millions of people are living in increasingly vulnerable circumstances as they face catastrophic levels of malnutrition and outbreaks of preventable diseases.

Widespread violence and unrest have driven over 3.3 million people from their homes.* They, and many others in these areas of Nigeria, have extremely limited access to medical services, due to the lack of functioning healthcare facilities, and the financial and security challenges involved in travelling to those that are still working.

Violence and displacement
Nigeria’s North West region has experienced a significant increase in violence and insecurity over the past few years. Hundreds of people have been killed and kidnapped, while more than 600,000 have been displaced.** In the North East zone, thousands of civilians have been killed in the fighting between armed opposition groups and the Nigerian armed forces. This ongoing violence prevents people in need of medical assistance from seeking care, as they fear being killed or kidnapped on their way to health facilities.

MSF teams support displaced and host communities affected by violence in the North West, North East and North Central zones, including Plateau state, where the situation deteriorated rapidly in 2023, resulting in hundreds of deaths and mass displacement.

In Borno state, we launched a new project in partnership with a local foundation to provide basic healthcare at community level in hard-to-reach areas outside Maiduguri city.

In Zamfara state, our teams were forced to withdraw support from an inpatient nutrition facility in the town of Anka in September because of the increased tensions in the area. We also had to temporarily evacuate some of our staff in Zurmi in December due to heavy fighting next to the hospital.

Disease outbreaks
In 2023, we responded to an unprecedented diphtheria outbreak, which started in Kano state and spread across the country. By the end of the year, more than 20,000 suspected cases and 600 deaths were reported. MSF teams treated patients in Kano, as well as Maiduguri and Bauchi.

Our teams also saw an alarming number of patients with measles, particularly in Maiduguri, and responded to outbreaks of other diseases, such as meningitis, cholera and Lassa fever in Ebonyi, Bauchi and Zamfara. In addition, we conducted preventive activities to annual incidences of malaria, and called for mass vaccination campaigns to be carried out across the country to curb the spread of preventable diseases.

Malnutrition
The spiralling violence and severe poverty, exacerbated by increased competition over depleting resources – which is a result of climate change – have left many people vulnerable to chronic cycles of acute malnutrition. In 2023, our teams continued to focus on nutrition activities, working in 32 outpatient and 10 inpatient therapeutic feeding centres across five states in North West region (Zamfara, Sokoto, Katsina, Kano and Kebbi). We also increased our response in North East region, tripling our bed capacity in Maiduguri following a surge in cases, and doubling it in Kafin Madaki hospital, Bauchi state.

As the number of malnutrition cases continued to rise, we stepped up our advocacy efforts, calling on the government and other NGOs to increase their assistance to affected people, particularly in North West region, where the crisis remains largely unrecognised.

Women’s health and sexual violence
Nigeria has one of the worst maternal death rates in the world; after South Sudan and Chad, it is the country with the highest number of deaths during childbirth, with more than 1,000 per 100,000 births.***  Underfunding, lack of access to health services, soaring inflation that makes it difficult to afford hospital fees or transportation, and cultural practices that hinder women from seeking care, are responsible for this shocking record, and for the high number of women developing obstetric complications.

In 2023, we opened a women’s health clinic for mothers of malnourished children admitted to the inpatient therapeutic feeding centre we support in Katsina. We also conduct obstetric and neonatal activities, including surgery for conditions such as obstetric fistula, at Jahun general hospital in Jigawa state.

In Kano state, our teams support two general healthcare centres and a clinic for maternal and child health, while in Cross River, we provide emergency obstetric and neonatal care. We also support four basic emergency obstetric and neonatal care centres in northeastern Nigeria.

In Benue, thousands of displaced people, who fled armed clashes between farmers and herders, are living in precarious living conditions. Our teams working in the displacement sites continue to witness extremely high rates of sexual and gender-based violence (SGBV).

In 2023, we offered a range of services in Benue, including sexual and reproductive healthcare, and comprehensive care for victims and survivors of SGBV, comprising treatment and mental health support, and health promotion. These services are also available in the towns of Shinkafi, Zurmi and Anka in Zamfara.

Noma
Since 2014, we have supported the Noma Children’s hospital in Sokoto, in northwest Nigeria, by providing reconstructive surgery, nutrition and mental health support, as well as conducting community outreach activities, with a focus on early detection. Most patients who contract noma ─ a disfiguring and deadly infection if not treated on time ─ are children under six years old, whose immune systems have been weakened by malnutrition.

MSF supported the government in the drafting of the National Noma Control Plan, which aims to raise awareness about the disease. In December, after long-term advocacy efforts by our teams, noma was included in the World Health Organization’s Neglected Tropical Diseases list. The inclusion of noma is a significant milestone, as it will amplify global awareness, stimulate research and funding, and boost efforts to control the disease.

*IDMC, https://www.internal-displacement.org/countries/nigeria/

**IOM (2023), ‘North-Central and North-West Zones Displacement Report December 2023

***Integrated African Health Observatory: “Maternal mortality: The urgency of a systemic and multisectoral approach in mitigating maternal deaths in Africa”