The Forgotten Children of Sokoto

The continued attack on villages in Northwestern Nigeria by bandits and terrorists has fuelled displacement of many families and has increased poverty. Martins Ifijeh, in this investigation, chronicles how children in Sokoto State are most hit, with many of them now severely malnourished

Twenty year old Aisha Musa is not a happy woman. Besides the pain of losing her loving husband to the cold hands of death from Boko Haram terrorists, the thought of not having a community to fall back on and the seeming ostracism this has caused her displaced family hurts her every day. But these loses are nothing compared to the pain of seeing her only child, Hassan, ‘waste’ before her eyes.

He was her beacon of hope when she hurriedly left Kamitau community in Goronyo Local Government Area of Sokoto State in the middle of the night when insurgents struck the village, killing anyone in sight, including her husband who persuaded her to run with his baby while he, along with other men, stayed back to ward off the terrorists.

They had named their son Hassan, an Arabic word for ‘handsome’ or ‘strong’, because it was the description of his true feature at birth. He was the most adorable human in the world to them.

But life happened. It served them lemons. Since a year and half, the little boy has not had good food to nourish that body. He has stopped growing in correlation with his age. The only prominent features in Hassan are his eyes, head, clavicles, rib cages and an almost defeated demeanour. He is a shadow of what his name portrays.

The otherwise three-year-old Hassan could pass for a nine month old child; a situation that has kept his mother wandering the villages of Goronyo looking for two most basic needs – food and shelter. But these two important life savers eluded her for over a year.

She would move from one community to the other begging for arms or ‘any work’ just so she could earn some stipends to buy millets and beans to feed herself and her only child. But with every passing day, it was obvious she was going to lose the only person remaining in her family, as he was repeatedly stooling and vomiting even on an empty stomach.

Health experts believe severe malnutrition, as suffered by Hassan, is one of the quickest factors for child mortality. Hassan was however a fighter, as not many children will suffer his level of malnutrition and live.

But in a last attempt to save him, and at least make lemonades from the lemons life served Aisha, she located the Gare Internally Displaced Persons (IDP) camp where the United Children’s Education Fund (UNICEF) is playing a prominent role to ensure no child dies from malnutrition.

With urgency, Aisha enrolled him at the Gare Dispensary IDP Camp Centre and the Sabon-Gari Dole Primary Healthcare Centre, both in Goronyo Local Government Area of the state where he is presently receiving emergency treatment.

Although Hassan is only two weeks old at the clinic, the Officer in Charge, Outpatient Therapeutic Programme (OTP), Sabon-Gari Dole Primary Healthcare Centre, Mr. Bashir Saidu believes that once his underlying ailments -diarrhea, fever and vomiting are treated, he stands a chance to embrace the Ready-to-Use Therapeutic Food (RUTF) provided by UNICEF.

Poverty and Link to Malnutrition

While Hassan’s severe malnutrition exposed the link between insurgency and malnutrition in Sokoto State, THISDAY’s discussion with Halima Yusuf, a 24-year- old mother of three, captures the link between poverty and severe malnutrition.

Halima, her husband, Audu and their three children live on less than one dollar per day. No thanks to the little stipends Audu makes from splitting firewood for people in Birjingo community where they reside.

Clinching to her two year old severely malnourished son, Mohammed, Halima gave a picture of how they struggle to make ends meet, and how their children (two sons and a daughter) have suffered the consequences.

“There are times my husband makes N1, 000 (less than $3) in an entire week. When we are lucky, he makes up to N2, 000 (less than $6). But this is not enough for feeding. I sometimes buy millet and beans on credit, but I have overused the privilege, so nobody gives me anymore. My children, on many occasions, have stayed an entire day without meals as we sometimes had to wait until my husband returns with money or food. If he comes with nothing, they sleep on empty stomach,” she said.

Halima gave birth to all her children under the condition, and this has reflected on their health, physiology and mental lives. For instance, her first two children, six and four years old, could pass for three and two years respectively. Going by science, lack of food may have caused irreversible damages to their mental and physical health, thereby losing the opportunity to contribute optimally to their future and that of the society when they eventually come of age.

Her last child, Mohammed, is still within the age of redemption, according to science. He is presently accessing treatment at the Gare Dispensary IDP Camp Centre. He is among the over 50 children currently benefitting from the RUTF offered by UNICEF in partnership with the state government. Although he still looked severely emaciated, the clinic personnel said he looked worse few weeks ago when he was admitted.

Hassan and the three sons of Halima are just four among the estimated 2.5 million children currently malnourished in Nigeria. They may end up adding to the burden of stunting in the country which currently affects over 11 million children.
Sadly, Sokoto State has the highest number of malnutrition among the 36 states of the federation with several thousands of their children currently living on empty stomachs in their formative years. No thanks to insurgency, poverty and lack of government’s prioritisation of their nutritional wellbeing.

On specifics, Sokoto’s burden of malnutrition stands at 7.9 per cent for children aged between six and 59 months, according to data from the 2018 National Demographic Health Survey (NDHS) obtained by THISDAY.

Neglect of IDP Camp also Fueling Malnutrition in Sokoto

The establishment of the Gare Dispensary IDP Camp should ordinarily alleviate the burden of malnutrition in the camp. But a visit by THISDAY, which was facilitated by UNICEF Nigeria, showed that save for shelter and the outpatient therapeutic clinic, the residents usually go to neigbhouring villages to either beg for alms or engage in menial jobs in other to feed their families.
With many of them being widows whose husbands are either missing or dead due to Boko Haram or banditry attacks, the inability to get the stipends needed to feed their little off springs has become their biggest challenge, with the situation taking a toll on the nutritional status of their children.

On specifics, 28-year-old Farida is a widow with seven children in the camp. Every morning, she sends the three most senior ones out for begging. She believed she could only manage to carter for the last four children through the menial jobs she does. “Even at that, it has not been easy. We don’t get donations of food items as we used to. We are on our own in this camp,” she said.
One of the UNICEF Assistant Nutrition focal persons, Gare Dispensary IDP Camp, Abdullahi Aliyu told THISDAY that cases of severe malnutrition were commonplace in the communities in Goronyo because most of the women were widows.
“In Sokoto here, many of the women are widows and are displaced, and they cannot get food to eat as nongovernmental organisations are no longer coming to share foods like before,” Aliyu said.

He said most of the women who are desperate to survive, resort to cutting of firewood in the bush for sale, adding that the causes of malnutrition for the IDPs are insecurity and poverty as they do not have lands to farm.”
The UNICEF Nutrition Supervisor in Sokoto, Mrs Ijanada Jacob told THISDAY that the main cause of malnutrition in the state remains insecurity, ignorance and poverty, adding that many of the women cannot prepare balanced meal for their children with locally available resources.

Nutrition Clinic Enrolls 25 Cases Daily

Aliyu, who said UNICEF provides them with free RUTF at the centre, disclosed that they see between 15 and 25 new cases of malnutrition every day.
“Apart from the ones already admitted, the clinic gets up to 130 to 150 new cases every month. The centre opened for treatment of malnutrition in October 2018 and serves 10 communities,” he said.

Consequences of Malnutrition
Apart from stunting, wasting and underweight, health experts believed malnutrition is one of the highest killers of children, noting that for those lucky to survive, it could have a toll on their health, education, social and even economic lives on the long run.
A Nutritionist with The Ville Memorial Clinic, Ogun State, Daramola Olalekan told THISDAY that adults who were malnourished during their first two years of life are more likely to earn income 10 per cent below what they would have earned if their childhood was malnutrition-free.

She said: “Stunting has the tendency to lead to incessant recurrent illnesses due to decreased immune system. In almost half of the cases, it may lead to death. This is one of the reasons Nigeria has a high child mortality rate, as majority are due o malnutrition.”
She said Sokoto’s high burden of malnutrition will on the long run have a negative outcome on the lives of the children when they grow up, as well as affect the state’s economic and security chances.

UNICEF’s Intervention

UNICEF, with support from the European Civil Protection and Humanitarian Aid Operation (ECHO) of the European Union and the Primary Health Care Development Agencies of Sokoto has established seven therapy sites scattered across three local governments – Rabah, Goronyo and Sabin Bini.
At Sabon-Gari Dole Primary Health Care Centre, one of the treatment wards for Community Management of Acute Malnutrition (CMAM), several hundreds of children have been saved from stunting and death.

On his part, the UNICEF Nutrition Head Sokoto, Walton Beckley said about 4,565 children with severe acute malnutrition have been admitted for treatment in Sokoto and 3,963 have been successfully treated.
“The number of pregnant women that received iron and folic acid supplements are 3,716. About 5,688 pregnant women and caregivers of children less than two years have received advices on how to take care of their children and feed them to prevent malnutrition,” he said.

Way Forward

Although UNICEF’s intervention has yielded positive results, this unfortunately is a drop in the ocean; as increased efforts from government and other stakeholders are needed to addressing the high burden of the public health challenge in the state.
Indications have shown that the Sokoto State government has not shown enough commitment towards the programme. For instance, its 2019 budget for nutrition has not been released till date.

According to Mr. Beckley, if this is released, it could be channeled programmes like the Community Management of Acute Malnutrition (CMAM).

“The state governments are our main partners. The facilities and staff are provided by government while we provide technical support with hope that government will eventually complete the programme. The setting up of a stabilisation centre or In-patient Centre (IPC) is not as easy as OTC. We have been working with donors to ensure that we get the centre working but only UNICEF is responding for the crises in Sokoto at the moment. We are trying our best to ensure that the children do not develop medical complication before being brought to the OTC,” he added.

He said for a more robust intervention, the support of other agencies, including the World Health Organisation (WHO) was needed. “We have huge number of children who are moderately malnourished but our programmes are not designed to address this. We are focused on children that are severely malnourished so we need other agencies that can address this such as World Food Program (WFP), to step in and assist,” he said.