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Nigeria: Hunger washes in with the rains
Photojournalist Sylvain Cherkaoui documents the food crisis in northeast Nigeria as the rainy season approaches
“I recognised the body of a mother who had been at the MSF distribution that morning. Her twins had been given packets of therapeutic food paste as they were suffering from malnutrition. Now I saw them crying, pressing themselves against her inert body. I can’t find the words.”
So spoke MSF project coordinator Alfred Davies following the bombing of a camp in Rann, northeast Nigeria. The attack took place in January, killing more than 100 people and injuring a further 150.
Today, Rann is facing a different threat. As the rainy season intensifies, isolated areas in Nigeria’s insecure Borno State are becoming cut off.
With hundreds of thousands of people almost entirely dependent on aid for their survival, a rupture in this provision of lifesaving help could have deadly consequences.
With the conflict between Boko Haram – a militant group with ties to the so-called Islamic State – and the Nigerian military still raging, towns in the area are tightly controlled by the military and people have very limited, or even no freedom to leave.
There is already a hepatitis E outbreak and a high risk of cholera. The rainy season also brings the annual malaria peak from August to October, which causes high mortality rates in children under five and contributes to malnutrition.
This month, photojournalist Sylvain Cherkaoui visited MSF projects across Borno State to document the food crisis. All words by MSF.
As the rainy season progresses, towns like Rann will soon be cut off by road. We will be sending out mobile teams to deliver medical and humanitarian support in Rann, as well as towns such as Banki and Damasak over the coming months.
The teams will carry out health consultations, give preventive treatment for malaria, distribute mosquito nets and soap, and work to improve water and sanitation. They will also screen and treat children for malnutrition.
Maiduguri is the capital of Borno State. It's home to around two million people, one million of whom are internally displaced having fled other parts of the northeastern state. The vast majority (around 90 percent) live with local people, with the remainder living in official and unofficial camps around the city.
Here, we are focusing on maternal and child health, including nutrition, and monitoring access to food, shelter, water and medical care. With the onset of the rainy season, we are also preparing for the possibility of a cholera outbreak within the city.
“We see a lot of cases of diarrhoea," says Dr Ebel Lorena Ortiz. "Many of our patients do not have access to safe water sources and toilets so hygiene is challenging.
"We’re really concerned that this will have more of an impact as the rainy season intensifies, which will also bring the added risk of outbreaks such as cholera, hepatitis E and malaria.
“One of the most rewarding parts of my job is when a child transfers out of what we call phase one; this means we’ve treated their underlying health problems and they are ready to receive treatment for malnutrition and start gaining weight.
"In phase one most children are fed through a tube, when it can be removed and they can eat by themselves, we know they are on the road to recovery.”
The 88-bed inpatient therapeutic feeding centre in Fori, a district in southern Maiduguri, opened in January. Here, we treat between 60 and 70 children every day for severe malnutrition.
We also run an ambulatory therapeutic feeding centre, which treats less severe cases as outpatients. There are currently around 1,400 children enrolled in this programme.
We are also carrying out a mass surveillance of the area surrounding the clinics in Fori and Dala. Community health workers cover around 6,000 households per week, monitoring access to food, water, shelter and sanitation.
The team screens children with a MUAC band, which measures the mid-upper-arm circumference, identifying the level of malnutrition. This child is measuring as acutely malnourished.
The team uses a smartphone to record the results to allow for easy analysis, and shares data with other organisations working on nutrition in the city.
Aisha Muhammad, 20, brought daughter Fatima Abubakr, three, to be checked by our medical team. She was concerned about the swelling in her daughter’s stomach and face.
Aisha has always lived in Maiduguri and has three other children. Fatima was checked by the doctors, but does not have malnutrition, so will be referred to a health structure nearby.
If initial measurements show that a child is malnourished, they then take an appetite test to see if they are capable of eating food.
According to their weight and height, a child has one hour to eat a set amount of peanut-based therapeutic food.
If a child cannot pass the test, they need to be admitted to the hospital so that underlying health problems that are affecting their appetite can be treated.
Children are also tested for malaria in this part of the centre.
The food rations we give to patients consist of beans, rice, oil and a corn and soya blend. They help to protect the patient’s family from becoming malnourished.
Between January and May this year, 1,099 tonnes of food have been distributed by our teams across Borno State.
There are 46,000 people living in the town of Banki who were displaced during the ongoing conflict. The camp and the original town are heavily controlled by the military.
We started working in Banki in July 2016, after finding an extreme humanitarian situation with health and nutrition indicators far beyond emergency levels.
In March, as the situation and population stabilised, we handed over our medical activities to UNICEF but continued water and sanitation support on flash visits several days per month.
Throughout the rainy season the team will scale up, visiting for one week every month to distribute mosquito nets and antimalarials for children under five. The team will also conduct a mass nutrition screening and mortality survey. We have made emergency preperations in case there are outbreaks of cholera, measles or hepatitis E.
From January to May this year, our teams across Borno State carried out the following activities:
- Admitted 20,760 people to therapeutic feeding centres
- Admitted 3,071 people to inpatient wards
- Provided 2,764 emergency consultations
- Delivered 5,181 babies
- Provided 56,160 antenatal consultations
- Built 282 latrines, 38 water tanks and 87 water taps
As a medical organisation that works where it's needed the most, we are deeply concerned that there may be people in parts of Borno State to which we have not been given access and who may be in need of lifesaving assistance.
As the rainy season intensifies the need for assistance is likely to increase across Borno. We are urging other organisations to increase their assistance and remain vigilant to further outbreaks of disease or movements of people.