An MSF staff (health promoter), Shehu Alkali, accompanying Patience Lawan with her child (Ruth Daniel) after being discharged from the under-six ward of the Nilefa Kiji nutrition centre. Five-month old Ruth Daniel, who spent 15 days on admission, was treated for severe acute malnutrition and watery diarrhoea.

Nigeria: MSF alerts on unprecedented number of malnourished children to treat in Maiduguri

Unprecedented numbers of malnourished children in need of lifesaving treatment are being brought to therapeutic feeding centres run by Doctors Without Borders/Médecins Sans Frontières (MSF) in Maiduguri, the capital of Nigeria’s Borno state, in northeast Nigeria. MSF is warning of an impending catastrophe if immediate action is not taken.

The number of admissions since the start of 2023 is 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,” says MSF medical coordinator Htet Aung Kyi.

The team at MSF’s Nilefa Kiji therapeutic feeding centre in Maiduguri have seen a surge in admissions for both moderate and severe acute malnutrition. 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,” says Htet Aung Kyi. “The number of weekly admissions is two to three times higher than at the same period over the past five years – and it’s 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”       

Malnutrition is 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 hospitalized for intensive nutrition care. 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.

Late 2021 saw the closure of official camps for displaced people and cuts to humanitarian aid and food aid. For most people, living conditions are extremely harsh, while some face restrictions on their movements, preventing them from earning a living or growing crops. People’s vulnerability increased. More recently, people’s vulnerability further increased due to the redesign of the Nigerian currency in late 2022, which 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. MSF 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,” says 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 per cent of the funds requested by nutrition cluster have been secured. This is alarming as well.”

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

Next to this nutrition emergency in Maiduguri, MSF teams are also responding to large-scale health and malnutrition crises elsewhere in northwest Nigeria, working in 32 outpatient therapeutic feeding centres and 10 inpatient therapeutic feeding centres in Kano, Katsina, Kebbi, Sokoto and Zamfara states. Last year MSF treated 147,860 children with severe acute malnutrition across northwest Nigeria.