The humanitarian context in northeast Nigeria

Nine years of conflict between the military and non-state armed groups have taken a heavy toll on the population, with serious humanitarian consequences. Thousands of people have been killed; others have been deprived of access to medical care and died of easily treatable disease such as malnutrition and malaria.

According to the United Nations Office for the Coordination of Humanitarian Affairs (OCHA), 1.9 million people are internally displaced in the northeastern states of Borno, Adamawa and Yobe, and 7.7 million people are in need of humanitarian assistance. More than 230,000 people have fled to the neighbouring countries of Niger, Chad and Cameroon.


In northeast Nigeria, services remain inadequate and there are many gaps in the humanitarian response. Security and access issues hamper the delivery of aid, and humanitarian organisations cannot provide assistance in all locations where it is needed.

Nevertheless, hundreds of thousands of people remain heavily dependent on aid for their survival. In some places, people have been stranded for nearly three years with little prospect of returning home due to the continuing conflict.


Much of the humanitarian aid is concentrated in Maiduguri, the capital of Borno state, which hosts one million internally displaced people, but services remain insufficient even there.

MSF recently scaled up its activities in the town to respond to a cholera outbreak which was declared by the Ministry of Health on 5 September 2018. MSF teams are also treating an increasing number of children suffering from severe acute malnutrition, malaria and lower respiratory tract infections.

Outside Maiduguri, the ongoing conflict restricts the movements of the population and of humanitarian organisations.


Most people live in towns or enclaves controlled by the military. Due to restrictions on their movements, most people are unable to farm, fish or sell their goods, leaving them dependent on humanitarian assistance.

In some locations, living conditions are catastrophic. Basic amenities are overstretched, water shortages are common, and sanitation is inadequate. Any disruption to the provision of assistance in these areas could have deadly implications.


MSF is currently providing lifesaving medical care in permanent facilities in Gwoza, Pulka, Bama, and Ngala. Mobile teams are providing medical aid in Rann and Banki, and via mobile emergency clinics in Yobe and Adamawa.

Little is known about the needs of people living outside the enclaves. OCHA estimates that around 800,000 people live in areas that are inaccessible to humanitarian organisations. The only information that MSF has about these areas is from newly displaced people who continue to arrive – not always by choice – at towns controlled by the military.

The conflict is not over in northeast Nigeria and civilians are caught in the middle. MSF patients have reported harrowing stories of extreme violence perpetrated by all sides to the conflict.

What is MSF doing to respond?

Across Borno state, MSF is running 12 permanent health facilities. In our clinics we provide life-saving treatment for malnutrition, primary and secondary healthcare, maternal healthcare, vaccinations and malaria prevention.

It is difficult to deploy emergency medical teams in rural areas. Many are isolated and fighting still rages around settlements already burned to the ground. Travel by road is out of the question because of insecurity.

Yet our teams assume the risks because another planting season has come and gone, markets remain empty, health staff have fled and medical facilities have closed.

Hunger gap

The need for food assistance is likely to increase even further from May, when last year’s harvest runs out. With this lack of food, peoples’ immunity falls, nutrients in their diet decrease and the number of infections rise.

The hunger gap is coming, the situation could be even worse this year as millions remain displaced by the conflict.

our doctors: responding to the crisis

Laura Heavey, MSF Paediatrician in Borno State

"One of the hardest things about malnutrition is that these kids are so prone to infection. A normal infection that a well-nourished child can fight off, can often be fatal to a malnourished child. 

"You never get used to seeing children die from preventable illnesses, but you have to focus on the positives. To keep perspective, I always remind myself that we have more children walking out of the hospital than dying here."

If we weren't here, mortality rates would be so much higher. Every day the paediatric unit is full, we treat over 60 patients per day and we have hospitals and treatment centres wherever we can reach across Borno State. 

Now we are worried. The ‘hunger gap’ is coming - the season between harvests when there isn’t enough food - maybe as soon as the end of April, with the rainy season following. Amidst the violence and the insecurity in this region, we’re doing everything we can but it feels like a race against time.

This article was last reviewed on 30 April 2019.

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