The growing insurgency in northeast Nigeria is negatively impacting the lives and health care of people in the region, especially mothers and their infants, who lack adequate care and face food shortages. their life in danger. The insurgency has also exacerbated health problems such as malaria and malnutrition and hampered access to clean water.
In a December 2020 report, UNICEF said more than 400,000 children in northeast Nigeria are currently at risk of severe acute malnutrition (SAM) and without treatment, and 75,000 are likely to die this year. UNICEF adds that an estimated 10.6 million people – including 6.2 million children and 1.2 million people living in inaccessible areas – are in need of humanitarian assistance in the northeast.
According to the World Health Organization (WHO), malnutrition is the greatest threat to global public health. A recent UNDP report assessing the impact of the conflict in northeastern Nigeria found that it had led to a food crisis and that, as a result, more than 288,000 children in Borno, Adamawa and Yobe were suffering from SAM.
In addition to the efforts of the state government, nonprofits and international relief organizations are providing humanitarian assistance and medical aid to people and communities displaced by conflict.
“The conflict in Borno State has worsened malnutrition because most people are displaced from their communities and have lost their sources of income,” said Ugochukwu Ugwu, head of nutrition at the Justice, Development and Peace Commission. (JDPC), an organization that visits communities. in the state to meet their nutritional needs. “When we meet those who are severely malnourished or moderately malnourished, we refer them to outpatient therapy centers where they can receive intensive treatment,” he said.
Doctors Without Borders / Doctors Without Borders [MSF] also responds to the nutritional challenges of residents despite security threats. Trained MSF teams managed mobile clinics to provide basic health care to malnourished children under 16 in rural communities outside Maiduguri. These include Dusuman, Musari and the Ahmed Grema camp for internally displaced persons in Shuwari. “Our medical teams provide emergency care, surgery, treatment of malnutrition, maternity and antenatal services, vaccinations, as well as the prevention and treatment of malaria and other diseases,” said Isa Ibrahim , head of the MSF mobile team.
MSF started working in Borno State in 2014 to meet the growing needs of people displaced by the insurgency. In 2019, MSF’s mobile team treated more than 10,000 malnourished patients, mostly children, in several mapped communities across the state. In 2020, the team provided a total of 6,881 consultations on malnutrition for children living in villages outside Maiduguri. Of these, 71 children were treated for SAM and 190 children for moderate acute malnutrition.
According to Ibrahim, some neighborhoods like Zabarmari are too insecure for the team to visit. It is therefore difficult to provide the inhabitants of the region with humanitarian aid and medical care. Zabarmari is the community outside of Maiduguri where more than 100 rice farmers were beheaded in November 2020 by Boko Haram terrorists, which has sparked global condemnation and outrage.
In situations like these, Ibrahim says MSF is using a simple but effective method to provide children with essential health care and treatment for malnutrition. The team goes to a community and asks community leaders to select three to five people who can read and write to work as focal persons for the organization. After selection, people are trained and learn basic patient care skills. They are also given tools to perform simple tests such as rapid diagnostic tests for malaria, screening for malnutrition, weighing, temperature and MUAC measurements for affected children in the community.
In addition, since March of this year, MSF has hired seven community mobilizers from host communities and three community health extension workers (CHEWs) – a clinician, a drug dispenser and a supervisor as auxiliary staff who work from Monday. through Friday each week and are incentives paid monthly. Mobilizers inform and educate mothers and caregivers about MSF’s activities and how they can benefit from them.
However, in difficult cases where a child’s condition is severe or difficult to determine, focal persons and auxiliary health workers call the MSF team for advice or refer to Gwange Pediatric Hospital, the organization’s central clinic in the city. Ibrahim says MSF provides local transport for guardians or caregivers of the children to bring them to the clinic for treatment and after being treated they are taken back to their communities.
This health intervention is producing positive results as the malnourished children have received treatment and their parents have received nutritional counseling and how to respond when cases arise, Ibrahim said. For example, more than 1,529 consultations on malnutrition have been carried out since April 2021, of which 160 cases have been referred to the clinic managed by MSF for appropriate treatment and support.
Ibrahim says that this way children living in hard-to-reach villages and rural communities have access to basic health care when they need it.
“If not using a focal person in affected communities, access to health will be difficult for them because not everyone will like to be there due to the (security) challenges,” said said Abdulkareem Yakubu, MSF field communications manager, about the success of the technique.
Ibrahim added that MSF’s use of focal persons and auxiliary staff to work in communities is new to the organization’s work and this was designed because of the increased security concerns in the region. But three times a week, MSF staff visit communities to deliver medicines, monitor their activities and assess progress.
Building sustainable interventions requires an end to conflicts
The peak of insurgency in the region is straining the work of the non-profit organization to gain access to communities. However, Ibrahim says that this challenge has been largely resolved thanks to the experience and skills acquired by the focal persons, community mobilizers and auxiliary health workers with whom they engage to work in these communities. “Most of them live in communities with their families, so it’s easier to engage with their people,” he said.
As MSF continues to respond to growing security challenges, the sustainability of their work is also a concern for residents and experts who say the government needs to do more to complement their efforts.
Dr Laz Ude Eze, a public health expert, said that while one-off NGO interventions are invaluable, at the same time they are not sustainable in the communities where they work. He adds that the only thing that is sustainable is achieving food security in the state and across the country. “It is better to prevent malnutrition in the first place through food security and that involves a lot of things because there is a high level of poverty and it also leads to malnutrition,” he said, adding: “Solve the problem of insecurity in the state will also help farmers achieve food security.
Eze, who is also a sustainable development consultant, says raising public health awareness, especially among mothers in rural areas, will help them know the combination of local foods and high nutritional value supplements to avoid malnutrition. “This should be driven by local and state governments, with deliberate and intentional actions,” he said, adding: “The federal government’s school feeding program, for example, was aimed at tackling malnutrition, but its implementation has been poor. “
Most of the inhabitants have lost their livelihoods and cannot go to the farm to produce what they eat because of the conflict, and as a result, most of them depend solely on NGO interventions, which does not is not enough.
In addition to developing models of sustainability that improve the continuity of the work of NGOs such as MSF and others operating in the region, the government must step in and allocate more funds to local organizations on the ground in order to reach the communities in need. most vulnerable in the state. .
Although sustainability issues remain, MSF’s adaptation to provide access to nutrition and health care to children in hard-to-reach areas by training selected community members is proof that even within the framework of of an ongoing conflict, those most in need of care can and should be reached.