Between May 2013 and November 2014, the Nigerian government declared a state of emergency in three of its north-east States in a bid to combat militant Islamist movement Boko Haram. MSF has been working in Borno State since August 2014.

Isabelle Mouniaman-Nara, MSF’s programme manager in Nigeria, tells us what MSF has achieved in the country and the organisation’s plans for 2015.

MSF: What is the situation in northeast Nigeria, and more particularly in Borno State?

Isabelle: “Over the past four years or so, the situation has steadily worsened in north-east Nigeria. The radicalisation of Boko Haram and its change of strategy (seizing control of villages and towns, mass kidnappings, setting up of a caliphate, etc.) may result in yet more population displacements, public health issues­—notably epidemics—and problems with the provision of medical care in the region. There are now between 800,000 and 1.5 million displaced people in Nigeria and most are in the north-east of the country.

Maiduguri, Borno State’s principal town, was subjected to five terrorist bomb attacks in 2014 that left many people dead or wounded. Boko Haram has attacked Maiduguri twice and all but one of the roads leading in and out of the town are closed. These restrictions—including on people’s movements—are hindering trade and damaging the local economy. Other attacks are to be expected and the presidential elections in February 2015 may well lead to renewed tensions and violence.

Active in Nigeria since 2004, MSF set up operations in Borno in May 2013 but had to pull out because of the security situation. In August 2014 we returned to Maiduguri on a permanent basis. There is very little healthcare provision for people in Maiduguri—inhabitants and displaced alike—and in Borno in general, as there are only two doctors in the whole of the north of the State.

What does MSF do in Borno? What is planned for the future?

From September to December 2014, we assisted with the cholera epidemic in Maiduguri and treated 6,833 patients. Around 40% of them were living in displaced persons camps.

Estimates put the total number of displaced people in the Maiduguri area at 500,000. 400,000 are in the town itself, with 90% living in the community and the remaining 10% hosted in ten camps set up since last July. People in the camps are for the most part villagers who have fled from Boko Haram attacks.
MSF has been supporting static and mobile medical clinics in the town’s two biggest displaced persons camps (NYSC and WTC) since August 2014. We now want to ramp up our assistance to the displaced, so we plan to set up operations in a third camp.

These displaced people principally need food, shelters and, of course, access to medical care. There have also been reports of violence against women and children. So far, the Nigerian government and the community have been supporting the displaced and responding to their needs, at least partially. But if, as we expect, their numbers increase still further over the next weeks and months, they are going to require even more help.

MSF has conducted evaluations in health centres in eight of Maiduguri’s camps as well as in Biu. An average of 850 consultations are provided every week, mainly for patients with malaria, diarrhoea and respiratory infections. 4 to 6% of children who are screened are diagnosed with severe malnutrition and there are often dozens of victims of trauma/violence also requiring treatment.

As part of our plan of support to health centres, we will set up static clinics in three camps that will be open seven days a week, deliver weekly outpatient services (treatment of malnutrition and antenatal consultations) and implement a system for referring patients requiring emergency care to hospital.

We have also conducted evaluations in several of Borno State’s hospitals and health centres. We plan to launch activities at the clinic in Maimussari, one of Maiduguri’s districts, as patient numbers have increased with the influx of displaced people (up from 25,000 in 2001 to 127,000 in 2014). We will also provide antenatal and general medical consultations, set up 12 in-patient beds, assist with deliveries 24/7, treat malnutrition and set up a system for referring critically-ill patients to hospital.

In mid-January, we will provide mass casualty management training to hospital staff in Maiduguri and from the hospital in Mongono (a remote area with 300,000 inhabitants in the north of Borno where we may start working at a later date). Lastly, we have set up health surveillance systems and epidemic response strategies—mainly in the displaced persons camps—and are ready to implement vaccination campaigns if and when they prove necessary”.