The security situation deteriorated in many areas of Nigeria in 2014. Violence and displacement took their toll on people’s health and reduced their access to medical services.
Médecins Sans Frontières (MSF) continued to try and provide healthcare to communities in need, but some clinics experienced temporary closures due to insecurity.
Healthcare for the displaced
Political instability, numerous attacks by Boko Haram and security operations by the Nigerian army forced thousands of people to flee their homes. Up to 400,000 internally displaced people settled in and around Maiduguri, the capital city of Borno state, with host families or in camps that were set up in July. Medical supplies and physicians remain extremely limited.
In August, MSF began providing care to displaced people in two of the largest camps. Weekly mobile clinics screened for malnutrition and offered antenatal care to pregnant women. By the end of the year, 10,000 consultations had been carried out across the camps. A health surveillance system was also established to respond to disease outbreaks and launch vaccination campaigns, if necessary.
There was a cholera outbreak at the end of September and in the space of a month 4,500 cases and 70 deaths from cholera were reported in Maiduguri. MSF set up a cholera treatment centre with 120 beds and five posts for oral rehydration. By December, MSF had supported the care of 6,833 patients, 40 per cent of whom were displaced people living in camps.
Focus on obstetrics
At Jahun hospital, Jigawa state, where maternal mortality rates have been among the highest in the country, MSF continued to support the emergency obstetrics programme, which admitted a total of 7,980 women, an 11 per cent increase over 2013. More than 5,700 births were assisted. ‘Kangaroo care’, a technique in which women spend time holding their babies skin to skin, was implemented after more space was created in the new neonatal unit. Kangaroo care was originally used in low-resource settings that had no incubators for premature babies and has been shown to support infant development and wellbeing.
Jahun hospital also treats fistula, with MSF support. Obstetric fistulas are injuries to the birth canal, usually caused by complicated or prolonged labour and resulting in pain, incontinence and often social stigma. MSF offers reparative surgery, as well as psychosocial support, helping women to reintegrate into their communities. A total of 264 women benefited from fistula surgery in 2014.
From the Noma children’s hospital in Sokoto, MSF provided care to children suffering from noma, a rapid-onset gangrene infection that causes facial disfigurement. It is most common in children under the age of six. The exact cause of the disease is unknown but malnutrition, poor hygiene and unsafe drinking water are among the risk factors. Psychosocial counsellors carried out 90 group sessions and 12 individual consultations, and 50 children were admitted to hospital for treatment. Nutritional and psychological support was offered and corrective surgery is planned for 2015. Without medical treatment, noma has a mortality rate of around 90 per cent. Approximately 140,000 new cases are reported each year, predominantly from sub-Saharan Africa.
Teams also continued to treat children with lead poisoning in eight villages in Zamfara state. Lead poisoning can cause brain damage, kidney problems and even death. As patient numbers decreased over the year, MSF closed three outreach clinics but continued to lobby the Nigerian government to assist local villagers. Staff also screened children for measles, meningitis and yellow fever, treated over 3,560 for malaria and carried out more than 7,680 outpatient consultations.
Responding to disease outbreaks
The MSF-run Nigeria Emergency Response Unit (NERU) provides early warning and rapid response to seasonal outbreaks of infectious diseases in the northwestern states of Zamfara, Kebbi, Sokoto and Niger. From June to December, NERU treated over 6,000 people for cholera in Goronyo (Sokoto state), Aliero (Kebbi state), and Mada, Anka and Shagari (Zamfara state). Some 330 people were also treated for meningitis in Aliero. Banditry and attacks on villages, mostly in Zamfara, limited the movement of the emergency team for short periods from time to time.
MSF provided Ebola-related technical support to health authorities in Lagos and Port Harcourt from July to October, assisting with isolation and contact tracing, and providing training and public education. There were 20 confirmed cases in Lagos and Port Harcourt and eight patients died. The outbreak in Nigeria was declared over by 20 October.
No. staff in 2014: 508 | Expenditure: €9.8 million | Year MSF first worked in the country: 1971 | msf.org/nigeria
 ‘Visor flap for total upper and lower lip reconstruction’: a case report, Peter Nthumba and Louis Carter, Journal of Medical Case Reports 2009, 3:7312