Child malnutrition in Borno, Nigeria: Urgent humanitarian response needed

• Since May, Médecins Sans Frontières (MSF) has been witnessing an unprecedented influx of malnourished children to our nutrition centre in Maiduguri, Nigeria, suggesting an alarming nutritional crisis in Borno state.
• An urgent scale up of the humanitarian response in Borno is needed in advance of the ‘hunger gap’ peak period, which could be much more severe than previous years if current trends continue.
• The UK government, as a key donor in Nigeria, must scale up support.

The traditional malnutrition season has not yet even begun in Maiduguri, Nigeria, and already the numbers of malnourished children requiring hospital level care is far beyond what MSF has ever seen in this context.

“It is critical that action is taken now, in advance of the seasonal malnutrition peak, to avoid an even worse situation,” says Shaukat Muttaqi, MSF head of mission in Nigeria.

“We are only at the very beginning of the hunger gap period and already our facility is overwhelmed with more patients than we’ve ever seen on a monthly basis since the project opened in 2017. Previous trends tell us the worst is still to come. This represents a big flashing warning sign. Unless urgent steps are taken to prepare for the looming peak, people in Maiduguri will suffer deadly consequences,” says Muttaqi.

So far this year, we have admitted 2,140 malnourished children for hospital care in our inpatient therapeutic feeding centre (ITFC) – about 50 per cent more than from the same period last year.

For six weeks in May and June, even though the peak hunger gap season had barely begun, more malnourished patients arrived than at any time since the project opened in 2017 – including at the very peak of the season in previous years. Up until May, our outpatient therapeutic feeding programme saw a 25 per cent increase in enrolments compared to last year.

In response, our teams extended the existing ITFC capacity from 120 beds to 200 beds. Even with that emergency measure in place, for some days in June there were not enough beds for all the malnourished children being admitted.

Other humanitarian organisations have also been operating at full or beyond their capacities. In some cases organisations have had to reduce services due to a lack of funding – including the closure of 16 much-needed outpatient therapeutic feeding centres. As a result and if current trends continue, services will be overwhelmed, and many more malnourished children will be at risk of dying.

MSF is urging the UK government, as an important donor to Nigeria, to scale up support to the humanitarian response in northwest Nigeria, notably support to health facilities and the provision of medical supplies and ready-to-use therapeutic food to treat malnutrition. As the UK continues to cut overall humanitarian funding, critical medical and humanitarian aid must be protected, in order to meet the needs of the under-served population of Borno.

“Most urgently, we need to see an increase in hospital capacity for treatment of severely malnourished children, but that must also be met in parallel with a major scale up of interventions at the community level to get ahead of a potential worst-case scenario,” says Muttaqi. “That means expanding outpatient feeding programmes, food security, immunisation, and access to water and hygiene.”

Malnutrition is a chronic and multi-faceted concern in Borno State, driven by the cumulative impact of displacement, insecurity, poverty, lack of access to healthcare and other factors. It is historically most acute between July and October during the ‘lean season’ – the period between the planting of crops and the harvest period. The added stressors of low immunisation, lack of access to clean water, hygiene and healthcare, too often combine with chronic food insecurity to produce devastating effects for children.

Periodic outbreaks of diseases, particularly measles and cholera, as well as seasonal peaks of malaria, can further compound the situation. Last year, Nigeria experienced an exceptionally large outbreak of cholera while immunisation rates among children in Borno State are alarmingly low. Access to healthcare is also a daily challenge for people, particularly those who are displaced.

“My children never got vaccinated apart from their immunisation at birth. My four-year-old son becomes sick during the rainy season every year. There is no free medical facility in our area, so I just take him to the pharmacy and get medicine there,” says Hussaina Ali, whose youngest child is now also malnourished and is undergoing treatment at the ITFC.

The cumulative impact of years-long conflict and insecurity continues to drive long-term displacement, which undermines peoples’ ability to cultivate food and access healthcare. As a result, rising food prices are taking a particularly high toll on displaced people. In the MSF ITFC, 32 per cent of the malnourished children admitted belong to internally displaced families, who are particularly reliant on humanitarian assistance.

“As the traditional peak of the lean season is approaching, Borno is standing on the edge of a crisis that could put the lives of thousands of children in danger,” says Dr Htet Aung Kyi, MSF medical coordinator in Nigeria.

“There is no time to lose. An urgent scale up of the nutritional response is needed now, and humanitarian organisations have to be much better prepared for the peak,” says Kyi. “This means tackling malnutrition by scaling up the medical response, but also in parallel preventing health threats such as measles, cholera and other infectious disease outbreaks.” 

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Background: Nigeria’s Borno state is world’s one of the major humanitarian crises caused by a longstanding insurgency. This has resulted in displacement of thousands of families settled in informal camps and with host community in and around the Maiduguri city.
 
Nutrition crisis is chronic and seasonal in Maiduguri. It is most acute during the “lean season” period occurring between planting and harvesting and when job opportunities are scarce and incomes plummet - usually from July to October each year. During those months, MSF sees the highest numbers of patients in its facility, which is equipped with expansion capacity specifically to cope with the malnutrition peak.  Malnutrition is also aggravated by the outbreaks such as measles or others caused by the rains, such as cholera and malaria, as well as multiple factors which contribute the high rates of malnutrition in the region including: limited access to healthcare, fragile water and sanitation situation, poor health practices, etc. 

Since 2014, MSF has a permanent presence in Borno that has high humanitarian needs particularly related to healthcare. Among other activities, MSF has been running a 120-bed Nilefa Kiji nutrition centre in the Kusheri area of the city. The centre provides inpatient and outpatient treatment for children under the age of 10 with severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) with complications. In 2021, MSF teams provided inpatient care for 3,029 children and outpatient care for 4,932 children.