Severe malnutrition in Nigeria's northeast Borno alarms MSF, WFP

Thursday May 04 2023
malnutrition in maiduguri

Mothers with their children in one of the clinics for malnourished children in Maiduguri, the capital of Nigeria's Borno State. PHOTO | COURTESY | MSF


A good Samaritan picked emaciated twins dumped for three days near a marketplace in Bama, a troubled town in Nigeria’s northeast Borno State. 

The Samaritan, 86-year-old kola-nut seller Audu Yao took the children to a nearby government hospital where they were confirmed to be malnourished. 

The old man promptly provided fresh milk, food and fish to feed the two girls in the hospital. 

An investigation led police to arrest a 36-year-old woman in a nearby camp for internally displaced persons (IDPs).  

The woman and her five children had been in the IDP camp for six years following their displacement by Boko Haram terrorists. Aishatu Muhammadu confessed that she had to dump the twins because she feared they had died of hunger in her tent at the camp. 

“I couldn’t stand seeing the corpses. I thought they died not knowing they survived,” Muhammadu told the police.


“Look at the camp," she said while pointing at the heads of children sitting under a tree. "These children are hungry. It is now the norm to pick bodies of dead children every day,” she added. 

Cautioned and released

She was cautioned and released because, according to the police, abandoning children had become the norm in the area. 

The situation is as a result of the 14 years of a deadly insurgency orchestrated by Boko Haram and lately pepped up by the incursion of the Islamic State West Africa Province (Iswap) in northeast Nigeria. 

Read: UN seeks $1.3bn for victims of Nigeria insurgency

Aside from acute shortage of food and medicine resulting in severe malnutrition, more than 65,000 people have died since trouble started in 2009 and  infrastructure as well as agriculture have been decimated.

The situation has attracted the attention of the organisation Doctors Without Borders (MSF) and some other global humanitarian bodies into Maiduguri, the state capital of Borno State. 

“Between January 2017 and July 2021, 3,522 children died of malnutrition in Borno State,” Borno State's Nutrition Deputy Director Abdullahi Alhaji Madi reported. 

More than 849,148 children were admitted with severe acute malnutrition and 737,826 were cured of the malnutrition within the five years’ period. 

Mr Madi expressed fears that the situation may be more devastating if urgent steps are not taken. 

He said that data also indicated that in 2017, 216,639 children were admitted with severe acute malnutrition (SAM), 153,846 children were treated and 731 children died from it, as 22,547 defaulted in treatment while 4,165 children couldn’t recover from it. 

In 2018, the figure of children that suffered from SAM rose to 256,639. 247,491 of them were cured while 654 died, 13,599 defaulted in treatment and 3,552 children couldn’t recover from malnutrition. 

In 2019,150,422 suffered Sam in Borno State. 138, 241 were cured, 1,877 couldn’t recover while 6,399 defaulted in treatment and 544 children died. 

In 2020, 140,349 SAM cases were reported. 130,855 got cured, 3,233 couldn’t recover, 5,922 defaulted and 1,354 children died. 

In 2021, 85,027 children suffered from Sam. 67,393 children were cured, 1,664 defaulted in treatment and 574 couldn’t recover. Unfortunately, 239 of them died. 

a malnutrionished child in borno state

A malnourished child in Nigeria's northeast Borno State. Between January 2017 and July 2021, 3,522 children died from malnutrition in the state. PHOTO | COURTESY | UNICEF

In his report, Unicef Chief of Field in Maiduguri Samuel Sesay said that years of insurgency that led to the destruction of communities and displacement of people, as well as other factors, might have contributed to the devastating state of malnutrition in the country’s northeast states. 

He raised the alarm over the state of child malnutrition in the war-ravaged northeast states of Borno, Yobe and Adamawa, stressing that the posterity of the region is under serious threat. 

He disclosed that malnutrition has proven to be an underlying cause of nearly half of all deaths of children under five years globally and it is currently the biggest threat to child survival and development in northeast Nigeria. 

Urgent interventions needed

Sesay said malnutrition in the northeast has assumed an alarming state, hence the amplified call for improved local and international interventions to salvage the posterity of the region. 

“Households in the northeast are experiencing unprecedented levels of food crisis and hunger. Household food insecurity, poor infant and young child feeding and care practices as well as poor feeding environment, hygiene and health services have been identified as the underlying causes of malnutrition or under-nutrition in children,” he said. 

World Food Programme (WFP) on April 29, 2023 quoted March Cadre Harmonise projects projection that 4.3 million people in Borno, Adamawa, and Yobe in northeast states affected by insurgency face severe hunger during the peak of the lean season between June and August 2023. 

Read: Famine still stalks Somalia as rains fail

Brink of catastrophe

“Almost 600,000 are on the brink of catastrophe. These people will face emergency levels of food insecurity with extremely high rates of acute malnutrition and mortality in the absence of sustained scale-up of humanitarian assistance. Ongoing conflict has affected the nutrition status of children on several fronts,” Chi Lael, the head of communications, advocacy and marketing of the programme in Nigeria said in Abuja. 

“Two million children in the region are projected to suffer from acute malnutrition, and cases of severe acute malnutrition among children have quadrupled to 700,000 apart from northeast situation,” Chis said.

“A total of 24.8 million people or 1 out of 8 individuals are experiencing acute hunger this year in Nigeria’s 26 states and Abuja,” he added.

WFP said it will provide emergency food and nutrition to 2.1 million people affected by conflict and in dire need of humanitarian assistance.  

Chi expressed the programme’s concern that years of armed conflict in northeast Nigeria had contributed to hunger and malnutrition among people, with millions in need of life-saving assistance and so much at risk of famine. 

Risk of starvation

He explained that the more people in need of urgent food assistance go unassisted, the greater the risk of starvation and death among the most vulnerable, and that the more people would be forced to resort to coping mechanisms such as survival sex, selling possessions and child labour. 

He added that lack of assistance increased the risk of youth recruitment into armed groups and displaced populations that returned to inaccessible areas, where they were beyond reach of humanitarian assistance and other social services. 

“Chronic insecurity is preventing many people in the northeast from growing the food they need or earning an income. Last year, conflict left households unable to leave their homes due to an increase in movement restrictions, killings and abduction of civilians particularly in Borno where the violence is concentrated. Thousands of people are left with only one month’s food supply as households in conflict-affected areas rely on minimal income to purchase food,” he said. 

“The hunger crisis worsens an already bad situation for many families struggling with economic hardship, surging inflation, impacts of the Russia-Ukraine war, the currency redesign policy, slow post-Covid-19 recovery and unprecedented floods in 2022, which limited agricultural production and overall food availability. WFP requires $190 million over the next six months to provide life-saving food and nutrition assistance to the most vulnerable people,” he said. 

Read: Hidden hunger stalks 98m sub-Saharan Africa children

Impending catastrophe

Mostly concerned is MSF which said  that unprecedented numbers of malnourished children in need of lifesaving treatment are being brought to therapeutic feeding centres run by it in Maiduguri. 

It is warning of an impending catastrophe if immediate action is not taken.  

It said that the number of admissions since the start of 2023 was the highest ever recorded by MSF teams in Borno State for the period preceding the annual ‘hunger gap’, when food stocks from the previous harvest traditionally run out and malnutrition levels peak.  

“The massive increase in malnourished children calls for malnutrition prevention and treatment activities to be scaled up immediately to avoid a catastrophic situation when the hunger gap arrives,” said MSF Medical Coordinator Htet Aung Kyi on April 27, 2023 in Maiduguri. 

Htet said that a team at MSF’s Nilefa Kiji therapeutic feeding centre in Maiduguri have seen a surge in admissions for both moderate and severe acute malnutrition.  

training on malnutrition

Nigerians being trained by Unicef on how to handle malnutrition. PHOTO | COURTESY | UNICEF

In January, around 75 children were admitted every week for severe malnutrition – around three times the average for the same period in the past five years. By early April, the weekly figure had risen to close to 150, twice that of the same time last year.  

“We have not seen anything like this since we started running malnutrition activities here in 2017,” said Htet.  

“The number of weekly admissions is two to three times higher than at the same period over the past five years and is still rising. Last year, we sounded the alarm in June when admissions skyrocketed at the start of the hunger gap but this year, we are already seeing alarming numbers while we are still weeks away from the pre-harvest shortage period. The clock is ticking for action if we want to avoid a catastrophe. Immediate action is required,” Htet warned. 

MSF confirmed also that malnutrition was not new in Maiduguri, where years of conflict and insecurity have caused a critical humanitarian situation.  

Many people have been displaced from their homes and now live in precarious conditions in informal sites, with host communities, or in transit through detention camps.  

The number of patients treated by MSF for severe malnutrition exploded in 2022, with over 8,000 children hospitalised for intensive nutrition care.  

Read: 8m at risk of hunger in South Sudan: UN

“One in seven was coming from the Hajj detention camp for former members of armed opposition groups, their families and those who lived under their control. Many arrived in this camp in an already precarious state of health which further worsened due to the harsh living conditions in this transit camp,” MSF said. 

Vulnerability increased

According to MSF, it saw the closure of official camps for displaced people and cuts to humanitarian aid and food aid in late 2021, causing extremely harsh living conditions especially while some face restrictions on their movements and preventing them from earning a living or growing crops.  

“People’s vulnerability increased more recently due to the redesign of the Nigerian currency in late 2022. This led to a shortage of cash and the recent destruction of big markets in Maiduguri. 

“MSF teams are providing inpatient and outpatient treatment for malnourished children and providing targeted feeding for children with moderate malnutrition to prevent their condition deteriorating. Its mobile teams also run clinics providing basic healthcare to people living in Hajj camp and Muna and Maisandari informal sites. Food aid alone will not be enough. Food aid alone will not be enough,” said Gabriele Santi, MSF project coordinator in Maiduguri.  

“Authorities and aid organisations need to immediately ramp up malnutrition-related activities and increase bed capacity in intensive therapeutic feedings centres. But they also need to improve living conditions in transit camps and expand people’s access to healthcare. This must be backed by a swift scale-up of donor funding and a strong coordination of these funds to make sure that food reaches those most in need. At this stage, only 16 percent of the funds requested by nutrition cluster have been secured. This is alarming as well,” Santi added.

MSF reported that from early January to 20 April 2023, 1,283 malnourished children were admitted for intensive hospital care at the MSF feeding centre – about 120 percent more than from the same period last year.