By Nneka Egbuna, Folashade Adebayo, Christina Powell and Christine Cool
Malnutrition puts the most vulnerable people at risk. In Northeast Nigeria, millions are “food-insecure”, which means they do not know when or where their next meal will be coming from. People across the region face this threat to survival on a daily basis.
Ibrahim, a two-year-old boy from Maiduguri, is in a place that no parent would wish to see their child. He should be playing with his two older siblings in their home in Bolori area, Borno State capital. Instead, to save his life, his mother Falmata, has admitted him to a nutritional stabilisation centre.
A stabilisation centre (SC) is an in-patient medical facility that treats severely malnourished children with medical complications. Children with these complications are 11 times more at-risk of dying than normal children.
Falmata and Ibrahim are in an SC that is managed by Première Urgence Internationale (PUI), located in the Ngarannam Primary Health Care Center (PHCC) in Maiduguri.
Thanks to support from PUI, the Ngarannam PHCC is able to offer free access to health services for thousands of patients a month, mostly internally displaced persons (IDPs) in the surrounding host comm
Immune systems too weak to fight
Mothers and caregivers are also educated on how to nourish and feed the child. The latter is a huge challenge in the midst of this food security crisis, since the mothers are so malnourished themselves that they can no longer produce milk, nor do they have the means to purchase food.
For Ibrahim and other children across northeast Nigeria, the nutritional situation is deeply concerning and presents a dangerous impediment to daily survival.
An estimated 1.14 million children aged 0-59 months are acutely malnourished in the northeast. Levels of acute malnutrition in Borno and Yobe States are the highest recorded since 2016.
When people, especially children, are chronically malnourished, their immune systems are weakened, which means they become more susceptible to illnesses that are otherwise preventable in those with stronger immunity.
There is nothing that pains a mother more than watching helplessly as her sick child gets treated; the distress on Falmata’s face is evident.
The PUI medical staff at the SC busily attend to Ibrahim as he lays still, depleted of energy on the bed. He is so small that no one would guess he was two years old.
The staff move quickly and assuredly with a confident competence that indicates that they have treated children like Ibrahim one too many times, they are used to it.
Ibrahim’s mother, Falmata, 25, dreams for her three children to one day be well-educated. That dream seems far off as she faces the daily struggle of providing them with even basic food needs.
Normally, the family is able to eat once per day; on a good day, they are able to eat twice but never do they get the comfort of three meals a day. Malnutrition cases like Ibrahim’s are taking place in a context of a debilitating food security crisis.
Violence and insecurity feed this food crisis
This food security crisis is one of many consequences of the violent conflict that northeast Nigeria has been plagued with for 12 years. Over two million people across Borno, Adamawa and Yobe states have been displaced by conflict.
Severe acute malnutrition (SAM) admissions in nutrition treatment centres are at the highest levels since surveillance started in 2017.
This is caused by high rates of food insecurity due to increased food prices, high prevalence of diarrheal diseases including cholera and the influx of IDPs arriving from inaccessible areas (30 per cent of which have acute malnutrition).
In the face of these staggering needs, there are only 32 operational SCs across northeast Nigeria, against a requirement of 80.
To put it simply—if there were 100 children suffering from SAM, only an estimated 40 per cent of them would be able to receive the treatment they need.
The International Rescue Committee (IRC) reported that with the alarming number of admissions in their five SCs (four in Borno, one in Yobe) over the last three months there is not enough room to admit more patients and help more people.
This underscores the wider trend of rising malnutrition with rates exceeding those of previous years. This trend is shown in the recorded levels of global acute malnutrition (GAM) from 2016-2021.
In Borno, Adamawa and Yobe states, 4.4 million people need food assistance. Fifty per cent of households have reported their food consumption is inadequate.
Food insecurity both causes the onset of malnutrition and can also severely complicate recovery efforts.
Although the recovery rate for severe acute malnutrition is high after eight weeks of intensive treatment in PUI’s outpatient therapeutic programmes (OTP), many patients return to the same food-insecure environment that put them at risk of malnutrition in the first place.
“Look at the mothers, they have not eaten,” said Dr. Goni of Mashamari Primary Health Center (PHC) in Maiduguri, “I have been working here since 2017 and we have never had this high number of cases.”
Dr. Goni stressed the impact of increasing food prices that has either reduced or completely taken away people’s ability to purchase food.
When speaking about rising inflation and its impact on food security, Dr. Goni continues, “This is the first time that the price of beans will surpass rice. Even millet is expensive.
It is common to see IDP children from Muna IDP camp present with oedema [fluid retention], a clear indication of food shortage.”
Despite appearances, a child with a distended belly is not full, rather, it is an alarming indication that he/she is malnourished.
An act of compassion paves the way forward
Aisha, an 8-month-old baby, was brought by her grandmother to Maiduguri with nothing when they fled an attack by non-state armed groups.
When her mother died there was no one to breastfeed Aisha. She was severely malnourished when she was brought to the SC at the State Specialist Hospital in Maiduguri, supported by INTERSOS, in partnership with the Borno State Ministry of Health, World Health Organization (WHO) and UNICEF.
At the SC, Aisha rejected any breastmilk substitute, leaving staff worried for her survival. A mother in the SC saw the deteriorating situation and shared a small amount of her breast milk to feed Aisha. This compassionate act saved the baby from starvation and prompted the establishment of a breastmilk bank to help others as well.
“Because of Aisha, the milk bank was created,” said Dr. Atilio Rivera-Vasquez, the Medical Coordinator of INTERSOS Nigeria. “She was orphaned on the way to Maiduguri with her mother and others escaping the insurgency. She is now eight months old and has started normal food.”
INTERSOS supports the screening of approximately 15,000 children per month for acute malnutrition, from ten hard-to-reach local government areas (LGAs). They are able to reach this number through community nutrition mobilisers, the mothers of the children in care groups, and community volunteers.
PUI also uses a wide network of community volunteers to tackle malnutrition. The NGO, which operates SCs in both Maiduguri and Monguno, regularly reaches 2,550 individuals through the 117 mother care groups that it supports.
The care groups engage pregnant and lactating women to equip them with the skills and knowledge on maternal, infant, and young child nutrition to improve nutrition outcomes in the community.
The community volunteers communicate key messages on information and services for malnutrition, teach the community how to use local food in nutritious ways and provide other guidance on prevention.
Despite major funding gaps and access challenges, humanitarian actors are working together to deliver life-saving assistance to respond to Northeast Nigeria’s emergency nutritional needs.
The Nutrition Sector coordinates the collective response of government institutions, United Nations agencies, international and national NGOs.
Partners have the expertise and willingness to scale-up response activities, but of the USD$129M required for nutrition in the 2021 Humanitarian Response Plan for Nigeria only 27 per cent has been received.
While malnutrition continues to be the hardest on the most vulnerable people, children like Ibrahim and Aisha are the ones suffering the most.
For them, and people across northeast Nigeria, this malnutrition crisis is too dangerous for inaction. Others are already mobilized and treating cases, but they need all of us to ensure they continue to have the means to save more lives of children suffering from malnutrition.
