Due to the conflict between Boko Haram and the Nigerian army and recurrent insurgency attacks on civilians living in Borno State, north-east Nigeria, thousands of people are regularly fleeing their homes in search of safety.

According to the UNHCR, there are today more than 1.5 million displaced people in the area. Most of them are internally displaced in Nigeria, particularly in the northeastern part, while around 157,000 of them have fled since January 2015 towards the neighbouring countries of Niger, Chad and Cameroon. These countries are also facing the threat of sporadic cross-border attacks and military offensives on their territories, attacks that have caused dozens of victims and waves of internal displacements inside the countries.

Just this week, on Wednesday night, an attack in two villages in southeast Niger killed dozens of people; two days before, on Monday 15 June, two  bomb attacks allegedly linked to Boko Haram took place in the Chadian capital of N’djamena.

The Nigerian crisis is exacerbating a precarious situation, affecting an already extremely vulnerable population.  Moreover, as the insecurity continues, humanitarian organizations are facing enormous difficulties to get a clear picture of the needs in the region. MSF is today one of the few organizations present in the region providing support to national authorities of the four affected countries around Lake Chad to alleviate the suffering of this population.

NIGERIA

The security situation in Borno State continues to be extremely volatile and tense.  

There are over a million of internally displaced people in Borno and around 400.000 of them live today in Maidaguri, the main town of the region. Many of them are helped by local communities, while 77 758 are gathered in 13 IDPs camps in the city. MSF has medical activities in four of these camps, covering the primary health needs for more than 34 300 people.

Every week, teams carry out hundreds of consultations, mostly for children under five, in the medical dispensatory of each camp.  MSF is also providing water supplies (more than 2 million liters each month) and has put in place a health surveillance system in five camps.  

As the situation in the camps is stabilized, MSF’s priority today is to guarantee support to all displaced people hosted by local communities, as well as to the host community itself. MSF has set up a clinic at the Maimusari health center in Jere district, a slum of Maiduguri town, to provide health services to 120,0000 people, both the displaced and host community. The facility includes a 12-bed maternity and 60 beds for paediatrics, nutrition and intensive care.

NIGER

According to OCHA, there are 175,000 displaced people in the Diffa region in the southeast of Niger. Many of them arrived just recently, after authorities urged all the population settled on the Lake Chad islands in Niger to leave the area following a deadly attack of Boko Haram. Around 25,000 people are now settled in two camps, one in Bosso and another one in Nguigmi, two towns located near the lake.

MSF has deployed mobile clinics in these two camps providing basic health services to this displaced and isolated population and referring to Diffa hospital if needed. MSF is also running the regional mother and child health reference center including the maternity, the pediatric ward and the laboratory, in Diffa town. On the outskirts, MSF is supporting three health centres in Geskerou, Ngaroua and Nguigmi, where more than 16,000 medical consultations have been performed so far in 2015, 65 percent of which were for children aged under five.

The situation could deteriorate in the coming weeks as the raining season is starting and the sanitation conditions in the camps are bad; cholera outbreak could easily appear. Besides, a peak of malnutrition and malaria cases is expected during the near hunger gap period. “The main needs are shelter, water, sanitation, health and protection. However, there are still a few organisations working in the area,” says Aissami Abdou, MSF field coordinator in Diffa.

CAMEROON

Some kilometers east, in Cameroon, the security situation along the border with Nigeria remains volatile, with regular incursions from Boko Haram. Refugees continue to arrive on a daily basis in the camps established by national authorities in the Extreme North region.  

“I have just arrived in Gawar with my husband and four of my children. Boko Haram’s fighters kidnapped our three daughters. We don’t know anything about them, we can only pray for them,” says Emmanuelle, one of the 40,000 refugees settled in the two camps of Minawao and Gawar where MSF collaborates with national authorities and other humanitarian agencies to provide primary health care and water and sanitation: today, 60% of the water of the camps is provided by MSF and more than 500 medical consultations are carried out monthly.

“The increase in the population caused by this frequent displacement poses a real risk to the food insecurity in the area,” says Hassan Maiyaki, MSF Head of Mission in Cameroon. “Today we are reinforcing our support to the intensive therapeutic feeding centre in Mokolo District Hospital where we offer pediatric and nutritional care to refugees, IDPs and the local population in need of hospitalization.”  MSF is also present in the city of Kousseri, at the border with Chad, where around 30.000 IDPs are scattered around the city. MSF’s teams are providing surgical support to the Hospital of the city, where 36 cases have been treated in the month of May.

CHAD

MSF began responding to the displacement in the Lake Chad region caused by Boko Haram at the end of February. According to the UNHCR, there are currently 18,000 refugees from Nigeria who have escaped the insecurity in their country. They have arrived to Lake Chad, one of the poorest regions in the country, with a low vaccination coverage and a high risk of epidemics.

Boko Haram represents a threat to Chad, and is active around Lake Chad. Security in the country continues to deteriorate. Back in February, an attack was carried out in Ngouboua, causing thousands of residents and refugees to flee for safety. Most recently on 15 June, two bomb attacks allegedly linked to Boko Haram took place in the capital, Ndjamena, killing 27 people and wounding 101. MSF supported key Ministry of Health hospitals by providing surgical and medical kits for the influx of patients. Recently, MSF also organized a training and simulation on mass casualty management in the General Hospital.

MSF is currently running mobile clinics in Forkouloum, carrying out around 850 medical consultations per week mainly for diarrhea and respiratory infections. Many of the patients are Chadian residents who have been displaced as a result of the violence. Psychological support has been a key part of MSF’s response. Teams are providing mental health care through individual and group sessions in Dar as Salam refugee camp. Medical care and mental health support is also provided to victims of sexual violence. To date, MSF has carried out 223 mental health consultations.

 In collaboration with local authorities, MSF also supplied around 6,000 people in Ngouboua, Bagasola, and nearby Forkouloum with hygiene and shelter kits, which included blankets and plastic sheeting as well as mosquito nets to protect against malaria.