Tackling Acute Malnutrition in Insurgency Ravaged Areas

 It is a recognised fact that areas prone to deadly outbreaks of malnutrition often overlap areas of war and conflict. Many areas across the globe with acute malnutrition and starvation, are areas of armed conflicts and international agencies are never too far away to see that the nutritional needs of such areas are met. The North-east states of Borno, Adamawa and Yobe have had the misfortune of attacks from Boko Haram in the last six years and as such a region which is perhaps the most affected by poverty and starvation even before the armed conflict, is further degraded and subjected to extreme poverty and malnutrition.

In Borno, undoubtedly the most affected state of the lot, some areas have been inaccessible to not only human but to foodstuffs and other items, they are in fact cut off from civilisation and to make matter worst for those areas, the people have been denied the luxury of having to farm and as if this was not enough cross to bear, the insurgents who have no other place to find food ransack them for food from time to time and living them with barely nothing to feed on. Some of them die of starvation and many of them suffer from acute malnutrition. Over 400 children were confirmed dead across 28 Internally Displaced Persons’ camps in Borno State as a result of malnutrition in 2015.

Once they have the opportunity to escape from the captivity in their homelands, one feature that is common denominator with them is malnutrition, they also bring along other baggage of illnesses and complications, but one good news is that international agencies of which United Nations Children’s Emergency Fund (UNICEF) rates high, are always on hand in Maiduguri to assist them get back to good health.

Among those that have a story to tell is Maryam Bukar, who was held up in Shuwari Village within Bama Local Government Area of Borno State. Bukar, who is 35-years-old with three daughter, said: “It was as if they were in prison for about a year, we were not able to come out of our village, we found it difficult to feed ourselves, and had to ration the little food that we had. We sometimes go on days without food and at time live on just wild leaves. Many children died during this time and it was a miracle that I did not lose any of my three children to starvation.

“We were not only battling with hunger but fear and were at the mercy of the insurgents who come at will to take our livestock and little food we have. They kill any one that resists them. When some of the routes along Bama were cleared by the military of insurgents, we had to take the long trek to Maiduguri to flee from starvation. Many died during the journey as they had no energy to withstand the stress of the long work. When I arrived in Maiduguri with my children and the rest of my neighbours that we trekked together with, we were barely alive and so emaciated and I thought we were going to die in minutes. But all thanks to the Almighty God the health workers on the camp took care of us and gave us special supplementary, we were back to life and healthy in just about a week.”

To Falmata Baba, hers was not a different tale, she took the long trek from Mafa to Maiduguri with his son, when she started the journey she was with her sick husband whose diabetic condition was aggravated by hunger. During the journey to Maiduguri through the bushes, her husband gave up the ghost and he had to be buried in the bushes. On arrival in Maiduguri, her soul was dying and was revived by the health workers on the camp. Her case was not just hunger and malnutrition but psychosocial as she was so traumatised. Though her trouble was multi-faceted but she was attended to by the staffers of UNICEF on the camp. All she has now are memories but she is has gotten back to good health as well as her son.

Treatment in Maiduguri is not only restricted to the internally displaced persons (IDPs) camp but to the host communities through the numerous clinic scattered all over the town; the health centres though run by government are provided the needed drugs by UNICEF who equally gives the technical assistance.

One of the women that spoke at the health centre, Umma Shettima, 35, a pretty trading mother of eight. She was seen with her daughter Aisha who is only eight months old at one of the health facilities in Maiduguri.

She said: “When I brought her here two months ago, she was not this healthy, she has emaciated so much, she was very ill and was not able to sit down. I was really afraid and thought I was going to lose her. She is full of energy now and have started playing around. She is still undergoing treatment, she has never defaulted for once since I brought her here, I bring her every week for her session with the nurses. I am thankful to God and I wish every other mother would come around to allow their children to be treated and they can also learn from what we are taught here.”

On how her baby got malnourished, she said: “I am doing exclusive breast feeding but I became ill at a time and the flow of milk from my breast was minimal, I believe this was responsible for why the baby was getting lesser milk and each time she cried to be breastfed I could only give her water. She was taking water with little breast milk for about a month. And when I now discovered that she was getting leaner and sickly, I brought her to the clinic where I was treated and she was also treated and placed on some food supplements donated by UNICEF.”

Another woman who recounted her experience was Bintu Usman, a 20-year-old, housewife, mother of two, seen with her daughter, Falmata (9 months) at an health facility which attended to malnourished children, she said: “when I brought my daughter about a month ago she was so thin. She was having diarrhea and found it difficult to sit, in fact she was in so much discomfort. At that time I was only breast feeding her even when she was above six months. I knew that after she was above six months, she should be taking other food but she was not taking any other food from me. She was so thin and in discomfort and she was crying all through the night, making it difficult for all of us at home to sleep. But when she brought her here about a month ago and she was placed on this special food supplement she has regained her strength and has started behaving like every other child.”

Findings have shown that the Severe Acute Malnutrition (SAM) burden in Nigeria is amongst the highest in the world, with over 10 per cent of the global burden, resulting in an estimated two million children affected. Since 2009, the Government of Nigeria, with the support of UNICEF, started tackling the problem by piloting Community-based Management of Acute Malnutrition (CMAM) in two Local Government Areas, one in Kebbi State and the other in Gombe State. Since then, Nigeria has proven their strong commitment to the fight against SAM, with geographical coverage extending to 91 LGAs in 11 states of the country; Kebbi, Sokoto, Zamfara, Katsina, Kano, Jigawa, Bauchi, Yobe, Gombe, Adamawa and Borno, including 642 health facilities. The fight against malnutrition has also been possible as partners and donors have supported federal and state Ministries of Health (MoH) to institutionalise Severe Acute Malnutrition management as part of regular routine health services. More than a million children received treatment between 2009 and mid-2015.

A large component of this scale up has been possible due to a strong partnership launched between the Children’s Investment Fund Foundation (CIFF), UNICEF and the Government of Nigeria in 2013.

The case of Borno and Yobe States, two states mostly affected by Boko Haram insurgency required special attention, and special attention they were given by UNICEF which has greatly supported Integrated Primary Health Care (PHC) services in the two states. Records from January – December 2015 alone showed that Integrated PHC services provided in health clinics in 26 IDPs camps and host communities in states were reached are follows: A total of 491,356 (95,355 men, 150,546 women and 245,455 children) reached with emergency PHC services, immunisation activities reached 86,806 children aged between 6 months to 15 years with measles vaccines; 53,378 children aged between 14 weeks to five years were immunised with Inactivated Polio Vaccine (IPV); 109,345 children under five years with Oral Polio Vaccine (OPV); 84,410 children aged between six months to five years received Vitamin A; and 78,962 children aged between six months to five years received deworming tablets, antenatal care services were provided by skilled attendants reaching 11,137 pregnant women and 1,872 deliveries performed in the camps, long lasting insecticide-treated mosquito nets were distributed in the camps reaching 32,180 mothers and children under five years of age and 973 patients with various medical conditions including obstetric emergencies were been transported by the ambulances to designated referral centers in Borno State for referral services.

One would have thought insurgency would have slowed down the pace of intervention in emerging health challenges in the North-east especially Borno and Yobe states but rather it has spurred on UNICEF and the other international agencies including other stakeholders, no wonder Maryam, Falmata, Umma and Bintu, among other numerous women have their children alive today and not taken away by the cold hands of death brought about by insurgency initiated malnutrition cum starvation.