•Care givers adopt ‘hit-and-run’ strategy to deliver critical needs
The escalating terror unleashed by bandits in Niger State, particularly Munya and Shiroro local government areas, has plunged healthcare system in the area into crisis. JUSTINA ASISHANA reports that health workers in the area are braving the odds to deliver healthcare services to ensure that the plight of the embattled communities are not compounded by vulnerability to ill health.
In January 2024, Nancy Yakubu, a dedicated Community Health Extension Worker (CHEW) in Shiroro Local Government Area (LGA), made a heart-wrenching decision. After narrowly escaping an ambush by terrorists on the road between Gwada and Zaumba, two communities within the local government area, she sought a transfer to the ostensibly safer Gwada Primary Healthcare Centre (PHC) within Shiroro. Her journey along the perilous Gwada-Zaumba route had become too hazardous due to the broader security crisis engulfing Niger State.
She said: “I decided to transfer my service elsewhere, as I was returning from work one day and bandits attacked us (commuters) on the road.
“The attack was close to the bridge at Shiroro village. It was God that saved us.
“I secured a transfer to Gwada PHC because the insecurity was becoming too much and seemed to be extending to the community where I worked as a healthcare official.
“The attacks along Zumba Road have affected many people.”
Yakubu’s experience is emblematic of a larger crisis affecting healthcare in Munya and Shiroro LGAs, where terrorist attacks have left a tale of destruction. Between January and June 2024, no fewer than 360 people were abducted while 36 others were killed across communities in the aforementioned local government areas, according to media reports.
Insecurity forces shutdown of healthcare facilities
Bandit attacks have forced the complete closure of several PHCs in Shiroro and Munya local government areas. Ruthless criminals, motivated by abduction and ransom payments, have created a climate of fear that has crippled access to healthcare. The remaining facilities offering only skeletal services shuts down abruptly whenever news of an attack surfaces.
According to media reports, a relentless wave of violence sweeps through Shiroro and Munya, with some communities bearing the brunt of attacks that occur on a near-weekly basis.
For example, eight out of Shiroro’s 15 wards, including Manta, Gurmana, Bassa-Kokki, Allawa, Kurebe, Kushaka, Kwati, and Chukumba, are plagued by bandit attacks. Insecurity has forced the closure of most PHCs in these areas, prioritising the safety of staff and patients, but leaving many in remote areas without access to vital medical care.
Speaking to SOLACEBASE about the dire situation, Yakubu said: “Insecurity has depleted our manpower. People have fled, leaving us with a skeletal staff. We have no equipment and the facility is simply too small.
“When emergencies arise due to attacks, we are forced to refer patients elsewhere, because we can’t handle them.
“Fear has become our constant companion. Supervisors no longer visit for fear of being attacked.
“This has stalled many critical projects. Even a recent malaria net distribution campaign was hampered as supervisors refused to travel to Zumba, citing safety concerns.
“They focus on safer areas like Kuta and Gwada.”
According to her, the frequency of attacks has escalated in the last three weeks, with daily raids on villages. “Bandits are not only targeting lives but also burning homes and food stores, further jeopardising the well-being of the community,” she added.
Kuchi, a town in Munya LGA frequently attacked by bandits, faces a similar healthcare crisis. Amina Jagaba, a Community Health Extension Worker (CHEW) in the community, said the indefinite closure of Kuchi PHC was due to relentless attacks.
The situation is dire. In May 2024, more than 150 residents were kidnapped in a single incident. While 40 were released after hefty ransoms were paid, the fate of the remaining captives hangs in the balance. Negotiations drag on, with bandits demanding more money for their freedom.
Jagaba told SolaceBase: “Our community is deserted. Who would dare return, especially health workers like us?
“We stopped working immediately after the attacks. We can only reopen when it is demonstrably safe.
“Unlike night time raids, these bandits attack in broad daylight, and we refuse to be kidnapped.
“I have no one to pay millions in ransom nor will the government. So staying safe is paramount.”
Mariam, a resident who did not want her full name mentioned for security reasons, is a displaced mother of two from Munya Local Government Area, who currently stays with relatives in Kuta, the headquarters of Shiroro LGA. She said she nearly lost her six-month-old baby during delivery due to the closure of the health centre in her community in Dangunu ward.
Her husband, she said, had to risk travelling with her while in labour on his motorcycle to Comprehensive Healthcare Centre in Sarkin Pawa, also within the same LGA.
“By the time we got to Sarkin Pawa, my baby was almost out. I had to put my hands to keep it from coming out.
“I thank God for my husband. If not, I would have given birth at home with no care at all because the hospital that is close to us does not open again.
“The pain was much and I thank God I did not lose the baby.”
Another mother, Hadiza Audu, who was living in Tunga Kawo community in Munya LGA before she moved to Gwada in Shiroro Local Government Area, said her first two children missed out on the immunizations they should have taken before they got to two years as no health worker came around the community to give immunization, adding that only her third child got her full dosage before she got to two years.
“Each time we ask about immunization, they tell us to go to either Kuta or Gwada because it’s unsafe for them to travel here.
“I’m happy my children are okay, but I’m sad they didn’t get their full dosage of vaccines as the hospital said they needed to,” she said.
The Chairman, Munya LGA, Mallam Aminu Najume, said that health centres closed due to insecurity would be reopened once the violent attacks subside in the affected communities.
“Health services have more challenges than ever. The PHCs in the affected communities have been shut down because of regular attacks,” Najume said.
The Permanent Secretary, Niger State Ministry of Primary Health, Dr Abdullahi Imam, also acknowledged the PHCs closures due to safety risks for healthcare workers but did not disclose the exact number of affected facilities.
“Yes, it is true that some of the health facilities have been shut down, just like some houses and businesses.
“But I do not have the number now. Some are operating skeletally as they only attend to emergencies and offer essential services.
“The insecurity is not usually permanent in several of these areas, which is why those areas are running skeletal services, because the safety of the health workers is paramount, as those who are threatened have been moved to where they won’t be threatened.
“To ensure that health services are not completely halted, we have fortified the nearby health facilities which are offering the services without any challenge,” Dr Imam said.
Immunization, pregnancies at risk, other essential services on hold
Immunization, ante-natal services and basic healthcare delivery have been interrupted due to the incessant attacks. Polio and malaria campaigns, net distribution and maternal health week programmes are also affected.
In response to these persistent threats and the need to deliver essential health services, health workers in the Lakpma axis of Shiroro LGA have adopted a “hit-and-run” strategy.
The “hit-and-run” strategy, as explained by Mohammed Erena, Shiroro LGA health educator, involves health workers making several calls to assess the security situation before entering volatile areas affected by banditry.
In this, they rely on information from villagers who serve as Junior Community Health Extension Workers (JCHEWs) and Community Health Extension Workers (CHEWs) to understand the ground situation. Once they determine it’s safe, they quickly provide necessary health services and leave the area promptly to avoid being caught in any attacks.
Erena disclosed that due to the insecurity in Lakpma, which is the most affected area in the local government, health workers use this strategy (hit-and-run) to provide critical health services.
Erena said: “We have been finding it very difficult to access some areas to provide optimal healthcare services.
“Several villages have been attacked by bandits and people in these localities are scattered in various IDP camps and staying with relatives in safer places.
“Due to insecurity, especially across the River Kaduna in the Lakpma axis, almost all the wards in that area have been affected by banditry.
“Some of our health facilities have been shut down, and those still offering services do so using hit-and-run strategies to provide key health services in those areas.”
In the Gusoro/Zumba ward in Munya, regular immunization services have ceased, and residents cannot access basic treatment or antenatal care due to lack of access to the PHC in the ward.
The ward’s focal person, Lawal Mohammed, explained that they often rely on local staff, most of whom are residents, to provide health services to the people remaining in the community, as many have relocated to safer areas.
He said: “We flee when bandits attack and return when they leave. This has forced us to offer limited health services.
“Sometimes, we provide immunization, but at other times we cannot.
“We also visit neighbouring communities that are safe and ask residents to come and receive services there.
“Our services are now limited and skeletal. They are not as smooth as they were before.”
Tanko Daudu, a health worker residing in Gwada and working at Erena Primary Healthcare, described the challenges they face during community outreach efforts, saying that when attacks occur, they seek safe places until it’s safe to return to the PHC.
While the Comprehensive Healthcare Centre in Erena benefits from a security presence, the PHCs in surrounding villages have ceased operations due to insecurity.
“Routine immunisation has decreased because of terrorist attacks. These attackers can strike at any time, and when we hear they’re nearby, we avoid those areas.
“Erena town is somewhat safe due to the presence of soldiers and policemen, but the villages are not,” Daudu explained.
He added: “There are primary healthcare centres in villages like Gaba and Rafin Seyin, where health workers visit occasionally.
“During attacks, we leave everything behind and return when it is safe.
“If an outreach is planned and there are reports of attacks, we cancel the outreach. It’s been an on-and-off situation.”
Daudu confirmed that despite Erena Comprehensive Primary Healthcare Facility being secure and well-equipped with drugs and necessary facilities, villagers cannot access it due to the insecurity.
“It takes courage to travel these roads because attacks can happen anytime. We provide family planning, antenatal care, deliveries and other services, but there are no patients due to insecurity,” he said.
In Munya, the same strategy is being adopted. Mr. Dumas Shashere, the Health Educator in Munya, explained that none of the health workers had been abducted due to their safety measures.
“We tell them to shut down the place and run away once they hear that an attack is imminent. Safety comes first, and they should not work where there is insecurity.
“So, none of them has been abducted because of these safety measures,” he said.
Shashere explained that the recent HPV immunisation campaign was affected in Munya local government as several communities, especially in Kuchi ward, could not benefit from the programme.
Despite tracing some displaced persons to the IDP camps in Sarkin Pawa, they could not locate the majority of the residents from the affected communities.
“Kudu, Dangunu, Sarkin Pawa and Kuchi wards are among the wards affected by banditry. Each of these wards has boundaries, so if the bandits are heading to Kuchi, they pass through Dangunu, causing havoc there first.
“Clinic activities have shut down in those areas as the health workers have to flee for their safety, which is very important to us.”
Health workers’ safety compromised
The contrast between official statements and the reality on the ground is stark. Despite Niger State Governor Mohammed Umaru Bago’s assurances that the security situation is improving, healthcare workers like Yakubu and Jagaba find the government’s actions insufficient. While the governor claimed that internally displaced persons (IDPs) are returning home, many healthcare workers remain skeptical.
Efforts by this reporter to visit these volatile areas were thwarted as security personnel and locals warned of the dangers.
“You face challenges either going or returning. You don’t know who you will encounter. Some are informants, and your safety is not guaranteed,” one official advised.
Instead, this reporter met with health workers in safer locations like Gwada and Kuta. However, most health workers were wary of speaking to the media, refusing interviews and only interjected when colleagues spoke boldly.
Although no health workers have been abducted in Munya, some have suffered the bandits’ wrath, being seriously beaten or injured during attacks.
“Some health workers were beaten and injured by bandits on their way to administer oral polio vaccinations in Tunga Ugwan. Fortunately, we haven’t heard of such incidents again,” Shashere said.
In Shiroro, the situation is equally dire. One health worker was killed in Allawa, and two others were abducted in the past two years, released only after their families paid hefty ransoms. One CHEW, Emmanuel Danjuma, was abducted in 2023 and he spent weeks in captivity until his family paid a ransom exceeding one million naira, according to Shashere.
In Munya, several PHCs have been vandalized by bandits during attacks on communities. Health facilities in Mangoro and Shape under Sarkin Pawa Ward, Luwi under Kabula Ward, Sohon Dangunu PHC in Dangunu Ward, Kazai Bgagy, Kazai Kadara, and Kamache PHCs in Kazai Ward have all been vandalized.
“The Kuchi PHC remains, but the community is deserted after an attack by bandits,” Shashere said.
Speaking about the abduction of health workers, the permanent secretary said he had not received any reports of such incidents since he took office a year ago. He also clarified that the government did not pay any ransom.
“If they say that some of them were abducted and had to pay ransom for their release, I will say the ministry is not aware of that.
“The Niger State government does not pay ransom nor do we support the payment of ransom in any way.
“We are dealing with those bandits, using both kinetic and non-kinetic methods, so we are not aware of any ransom being paid.
“Nobody asked us (the government) to pay ransom and we did not pay any ransom. However, we thank God that those who were abducted have been released,” he said.
The rains to the rescue
Security sources indicated that bandits often come in from Zamfara through Kaduna to enter Niger State, frequently crossing the River Kaduna to access these communities, wreak havoc and retreat via the same route.
The River Kaduna passes through Sarkin Pawa, Dangunu and other towns in Munya LGA, and during heavy rainfall, it becomes difficult to cross.
Erena said: “Now that the rainy season is here, the bandits will no longer be able to cross to these villages because they move on bikes, and these bikes cannot cross the overflowing river.
“From previous years, we have noticed that heavy rains prevent attacks, so we always look forward to the rainy season as it helps in reducing this menace.
“Even as we speak now, our health workers are preparing to return to their various duty posts.”
Grace Musa, a Junior Community Health Extension Worker (JCHEW) in Dangunu, confirmed this to SolaceBase.
She said: “The wards in Munya always have relative peace from attacks once the rains start. The last time they came to abduct about 150 people, the rain fell during the attack, and they had to stay by the river bank for long before they could cross.
“During that time, we were calling security, even the Chairman was calling security and the government, but nobody came until they finally crossed and took the people they abducted away.
“Government should do more in terms of security.”
The deteriorating security situation has led to widespread calls for more proactive measures from the government. Findings showed that after several attacks that left soldiers and other security personnel dead or injured, security forces are increasingly reluctant to take up watch in the affected communities.
As a result, security presence is more concentrated in the local government headquarters than in the communities where the attacks occur.
In August 2023, the Nigerian Defence Headquarters said at least three military officers and 22 soldiers have been killed and seven seriously injured by suspected terrorists in Niger State.
In May 2024, four members of the Joint Security Taskforce stationed in Kuchi community in Munya Local Government Area were killed when terrorists invaded the community.
The chairman, Munya LGA, Mallam Najume, expressed frustration over the lack of effective security intervention. “These people usually come from Kaduna State to operate in Niger State and return. They move in their hundreds, yet the security agents don’t see them,” he said.
A cross-section of health workers who spoke with SolaceBase urged the state government to bolster security and provide resources to ensure their safety.
“We keep hearing that the government is doing a lot, but we are not seeing anything. The government needs to take more proactive measures because the whole of Shiroro local government is affected.
“The Niger State Governor needs to take the security of this area seriously,” Yakubu emphasised.
Shashere highlighted the need for proactive responses from security personnel during attacks. “If the security personnel are proactive whenever there are attacks and respond immediately, the bandits would not attack so often,” he said.
He further stated: “The government and security agents need to be proactive. When these people (bandits) come the first and second time and the security agents deal with them, they will not attempt a third attack.
“These attacks have continued because there are no security agents on the ground.
“The government should also provide the security personnel with the necessary weapons, logistics and mobilization required for them to carry out their work.”
Erena said the solution to this challenge lies in the hands of the government because they control the security forces and can provide the necessary directives.
“We are relying on the government to provide more security to us all, especially Allawa community, which is a total no-go area as all security personnel there have been withdrawn.
“We know the government is doing its best, but they need to double their efforts in providing security so that the people can live freely and access optimal health services.”
Lawal Mohammed, the health focal officer for Gusoro/Zumba Ward, emphasised the need for better support for health workers.
“Apart from the government being proactive in the area of security, health workers need to be provided with vehicles and motorcycles to help them escape faster when there is an attack.
“In addition, there is a need for professional training of health workers on safety and how they can respond to different types of hostile situations.”
This SolaceBase publication is produced with support from the Wole Soyinka Centre for Investigative Journalism (WSCIJ) under the collaborative Media Engagement for Development, Inclusion, and Accountability Project (CMEDIA) funded by the MacArthur Foundation.
