On the run from violence in Nigeria

Muhammad* does not speak. The little boy stands forlornly in a wide, stony field at the construction site of the new palace for the Emir of Anka. Now the plans to construct the palace have been put on hold and hundreds of displaced people from many villages of Zamfara state are living in unfinished buildings and shelters built here by MSF.

“Muhammad’s village, like all the villages of the people here, was attacked and destroyed by armed gangs,” says Anja Batrice, who works for MSF in Anka as a physician. “We think it was those experiences that made him so withdrawn.”

People here have lost everything. The deadly attacks forced them to flee their villages, leaving all their belongings behind. Now they live in makeshift shelters on the construction site and in school buildings. The people are ashamed of their poor living conditions here. That is why our teams try to show them that they are still human beings like you and me. Especially our Nigerian colleagues, who speak the local language, joke with them and play with their children, like Muhammad.

Anja Batrice, MSF Physician in Anka

Criminal groups and extreme violence in the northwestern Nigerian state of Zamfara have caused hundreds of thousands of people to flee their villages and seek shelter in the town of Anka. After delivering emergency care in various locations across Anka town for several weeks, the MSF emergency team is currently providing primary health care as well as ensuring the distribution of basic utensils to new displaced families in one informal settlement in town. With farms abandoned, a nutrition crisis looms large.

Medical care for displaced people

Nurse Sarah Bature is treating a child suffering from the consequences of malnutrition at the High Dependency Unit of MSF’s paediatric ward at Anka General Hospital. © Benedicte Kurzen

During the rainy season in Zamfara, which means a peak in malaria cases. Malaria is the first disease treated at MSF pediatric ward, located inside Anka’s general hospital. In the damp weather, the malaria-spreading mosquitoes are thriving. Anja and her team of doctors and health workers are running a permanent tented clinic at the site of the Emir’s palace. The medical team is equipped to do basic diagnoses and treat minor ailments.

Besides, from May to September this year, MSF Nigeria emergency team has ensured 12,677 outpatients consultations for internally displaced people in Anka town. In addition, between April and June, 1001 families have benefitted from non-food items distributions among others including cooking and personal hygiene utensils.

Over the last two weeks in October, our emergency team in Anka town has continued supporting newly displaced population who fled their homes fearing the surrounding violence. 336 families benefitted from primary healthcare consultations and received basic utensils including hygiene and cooking items.

“We suddenly heard gunshots. So we fled from the village.” Theresa and her children are now relying on the food distribution that the local government organises in Abagana camp in Benue, Nigeria. “One day, when the violence is over, I will go back to my village.”

Children in an abandoned building in Abagana camp. The building is used as a shelter for the population displaced by inter-communal violence.

Forced to flee from violence, abductions and killings

One patient to receive treatment at the tented clinic is 10-year-old Aisha* who was brought here by her mother, Zuwaira*. A rapid blood test confirmed Aisha had malaria.

Seven months ago, Zuwaira, Aisha, and the rest of their family fled their home in a village near Anka, after repeated attacks by armed men, who demanded money and threatened them with violence. “We brought them money, but they said we were lying and must have more,” says Zuwaira. “They threatened to kill us if they found we were hiding any more money from them.” The attackers returned to the village a number of times, stealing or destroying people’s belongings and sometimes using violence. “One time they abducted three young men,” says Zuwaira. “We didn’t hear from them for a very long time. We know now that they were killed.”

Many men in their village, including Zuwaira’s husband, earned a living by mining for gold. The artisanal gold mining practiced around Anka often leads to contamination of the land, causing lead poisoning, especially in children. Two of Zuwaira’s children suffered from lead poisoning. “MSF treated our children when they got sick from the lead. Now they are better,” Zuwaira says.

MSF teams have been treating children for lead poisoning for the past decade in the Anka area. In 2018, 337 children were treated.

Aisha and her mother Zuwaira © Benedicte Kurzen

Seeking a roof over their heads

Children from Anka come to sell basic goods at the IDP camps scattered around the town. © Benedicte Kurzen/NOOR

Aisha and her mother Zuwaira are now living in an abandoned school building. Half of the rooms in the grey concrete structure have no roof. With heavy rain falling most days, repairs are urgently needed if the dozens of families who live there are to stay dry. In the open courtyard, a large puddle of stagnant water has formed – an ideal breeding ground for mosquitoes. In conditions like these, no wonder Aisha fell sick with malaria.

The medicine Aisha received at the MSF clinic seems to have had an effect. Yesterday, she lay sick and drowsy on the floor of the tented clinic; today she is back playing with the other children in the yard. “I hope they will all be able to return to their villages at some point,” says Anja Batrice.

Many of the buildings used as shelters by the displaced population are in urgent need of repair. Especially the broken roofs have to be fixed to keep families dry during the rainy season. MSF hired local contractors to improve the structures. © Benedicte Kurzen

Two children wash themselves in the yard of an abandoned building in Anka, used as a shelter for displaced people. In the improvised shelter, there is a lack of sanitation facilities. © Benedicte Kurzen

Displaced families now live in an abandoned building in Anka. Parts of the roof have collapsed and need reparation for people to stay dry during the rainy season. © Benedicte Kurzen/NOOR

Set back from the main building where Aisha and her family live are two overgrown ruins. They shelter a couple of families who prefer to keep to themselves. While most displaced people in Anka belong to the Hausa ethnic group, these families are Fulani – members of a tribe of cattle herders who are often nomadic.

Thirty-year-old Amina Alh Shehu has been living in one of the ruins for more than three years – proof that the insecurity in northwestern Nigeria is not just a recent phenomenon.

One of the daughters of Amina’s husband was abducted when she returned to their village to give birth to her first child. “She was seven months pregnant when armed gunmen abducted her,” says Amina. “We had to pay 1,000,000 Naira (2,520 euros) in ransom. We had to sell a lot of cattle to pay it. Our cows, goats and chickens used to be our security for the future – if something bad happened, we could sell them. Now we don’t have that security anymore.”

Amina’s husband is away, searching for grazing areas for what is left of their herd of cattle. He is currently near the village from which they fled, at constant risk of being attacked and robbed.

With the main source of her family’s livelihood gone to pay the ransom, Amina now struggles to feed her children. Her two youngest, the twins Hassana and Husseini, were born five months ago in this ruin. Husseini has already been treated for acute malnutrition by MSF.

Amina and her two children Hassana and Husseini © Benedicte Kurzen

At Anka general hospital, where Amina brought her son Husseini some months ago, MSF runs a 135-bed paediatric ward treating both internally displaced people and people from host communities.

Most of the children here are being treated for malaria, malnutrition and respiratory tracts infections, while others need intensive care.

Because the hospital is running at full capacity, children often have to share beds. During peak season for malaria, there are sometimes three children to a bed. With family members often sleeping at the hospital too, it can get very noisy and crowded.

At the hospital, Husseini received therapeutic food and was eventually strong enough to be discharged. However, feeding the two babies is still a challenge, says Amina. “I don’t have enough breastmilk for both children,” she says. “The doctors gave me a medicine to help me with the breastmilk, but it’s not working. Now I buy formula milk, which is very expensive.”

The biggest challenge for all the displaced people is uncertainty about the future.

MSF project coordinator Simona Onidi

As well as malaria, having too little to eat is an increasing health risk for children in the area. From January to the end of October 2019, our teams in Anka treated 8778 children for malnutrition. “The high number of children we treat for malnutrition in Anka has worrying implications for the situation in the rest of Zamfara state,” says MSF’s Dr Valerie Weiss, who supervises the high dependency unit. “With such high numbers here in Anka, we also have to expect many cases of malnutrition in areas where we cannot go due to security concerns.”

(All the testimonies were collected during summer 2019)

Deborah, 30 years old, from Torkula village, is sewing in an open hallway at Abagana camp. © Benedicte Kurzen

Women prepare food in open air in the Abagana Camp. © Benedicte Kurzen

MSF Medical Doctor Valerie Weiss taking care of a young patient at the High Dependency Unit of the MSF paediatric ward at Anka General Hospital. © Benedicte Kurzen

Access to health care

In the northern part of Zamfara state, the few functional hospitals are overwhelmed by the number of patients, coupled with the lack of basic medical supplies. In addition, most of the remote villages are inaccessible and the provision of primary health care to the local communities is severely disrupted by the ongoing violence. In September, MSF teams ensured an emergency assessment in Zumri and Shinkafi, two areas that have been particularly affected by the outbreak of violence. In Zumri, in only one day of screening, the team found seventy-three children suffering from acute malnutrition, including eight presenting medical complications. MSF is collaborating with the local health authorities to start providing emergency nutrition support in these locations.

* Names have been changed to protect the patients.

Benue state, Nigeria

“No one knows when they will feel safe enough to return home with their families”

Disputes over land for grazing and farming have escalated into shocking violence in Nigeria’s central Benue state, forcing thousands to flee their homes.

Médecins Sans Frontières (MSF) project coordinator Simona Onidi in Benue state, Nigeria explains the difficulties the displaced people are facing and what MSF is doing to help.

Why did MSF decide to start working in Benue in 2018?

“In Benue state, intercommunal violence resulting from disputes over land for grazing and farming has been happening for years, but the situation has worsened in the past two years. The scarcity of land, due to environmental changes, has increased the levels of violence, which has forced thousands of people to flee their villages.

MSF’s team in Benue is focused on the needs of the thousands of people who has been displaced from their homes since January 2018 in the most recent wave of violence between herdsmen and farmers. The displaced people often give us accounts of harrowing violence and destruction. Many have lost family members and everything they owned and are now too scared to return to their villages.”

Where have the displaced people settled, and how many need aid?

“The exact number of displaced people across the state and the wider region is unknown. Most are living outside the six official camps for internally displaced people. Thousands have found refuge with relatives or other people in communities so-far unaffected by the conflict. Many are surviving thanks only to the host communities, who share their houses, food and other resources. In exchange, the displaced people often work with and for them.

We can’t be sure how many people are in need of aid. The displaced people who are not registered have received no support so far. They can only get healthcare if their families are able to pay for it – and most have no money.”

What is MSF doing to help?

“Near the state capital, Makurdi, we are working in two camps called Mbawa and Abagana. We also work in Ugba and Anyiin in the Logo area (some 100 kilometres east of Makurdi). In December, we will close our medical activities in Ugba and Anyiin IDPs camps as the exposure of the IDP population to high mortality has stabilised over the recent time.

In all four places, we provide primary healthcare for free to around 8,000 displaced people, plus additional people from the surrounding communities who come for help, and we refer patients in critical condition to hospital for specialist treatment.

For example, our team diagnosed a patient with a strangulated hernia, and then transported the patient for emergency surgery to Benue State University Teaching Hospital. MSF paid for the procedure and all the necessary medicines, because public health is not free and many of the most vulnerable (including the population MSF is supporting) can’t afford the costs.

From May 2018 until September this year, our teams have provided 37,143 outpatient consultations. We also supply clean drinking water by trucking water to the camps, fixing existing boreholes and drilling new ones. We also distribute essential relief items such as hygiene kits, and we build latrines and showers. In one camp we have constructed hundreds of shelters to protect people from the rain and wind.”

What are people’s main medical needs?

“In the four camps where we work, we see a number of recurring health problems related to people’s living conditions and lack of water and sanitation. In places without proper shelters, our patients suffer from respiratory tract infections. The most common disease we treat is malaria, which increased even further during the rainy season. We see cases of acute watery diarrhoea and skin infections such as scabies. We also see patients with gastritis, which we suspect is often connected to the psychological hardships they have suffered.

The environment of the camps and informal settlements has a negative impact on people’s health. We see problems like improper waste management, overcrowding and stagnant water in which mosquitos can breed.

For those living outside the camps, in abandoned buildings, the situation is even worse. Many do not have enough food or access to even the most basic services, such as primary healthcare, clean drinking water, latrines and washing facilities.

But the biggest challenge for all the displaced people is uncertainty about the future. Some return to their farmlands periodically to take care of crops, but they do this at a high personal risk. The same people who forced them to flee may attack them again. No one knows when they will feel safe enough to return home with their families.”

What would improve the situation for the thousands of displaced people?

“The most important thing is for people to be safe. Patients tell us that they desperately want to go home – if only it was safe enough. For people to return to their villages, it needs to be a safe, dignified and, above all, voluntary return.

It will take careful dialogue, supported by the Nigerian authorities, between all the groups involved to ensure that people can coexist in safety and peace in the long term. But until then, the people who are currently displaced, and who don’t yet feel safe enough to return home, need more and better shelters and access to free healthcare. The people who don’t live in official camps are in especially urgent need of aid.