Maiduguri, Nigeria – One afternoon in August, Kaka Modu was wheeled into the emergency room at the Umaru Shehu Stabilization Center in Maiduguri, the capital of Borno state in northeastern Nigeria.
The three-year-old boy had been brought earlier that day from Konduga, a town 25 km (15.5 miles) from Maiduguri. He had shrunk in size and groaned every time his mother, Yagana Modu, adjusted his sitting position.
“He started defecating for a few days,” Modu said. “I was hoping he would stop. Then I noticed that his belly and body were swollen.”
Kaka, who suffers from severe acute malnutrition (SAM), is one of more than 1.3 million children under the age of five who are likely to be severely malnourished in northeast Nigeria, according to malnutrition analysis of the Food and Agriculture Organization of the United Nations (FAO).
Food shortages and bouts of famine have plagued the region for years as Boko Haram, which has been wreaking havoc since 2009, remains on the rampage. Thousands have died and millions have been displaced by the conflict.
Throughout the region, some 8.4 million people, mainly women and children, are in need of humanitarian assistance, according to the United Nations Office for the Coordination of Humanitarian Affairs (OCHA). Many are on the verge of death, experts say.
In 2019, Boko Haram attacked the Modu family’s Takari village in Konduga, destroying the Modu family’s home and livelihood. His family of eight was held captive for months until Nigerian soldiers recaptured the town and transferred them to Konduga to join thousands of others displaced by the conflict.
Health authorities and nonprofit organizations say the situation is straining available resources.
Every week, one of three ambulances operated by the International Rescue Committee (IRC) travels to outpatient centers in Konduga and nearby communities in Borno to transport patients like Kaká. Since May, admissions of SAM cases, mostly children, have skyrocketed.
“This year, we’re experiencing something we haven’t experienced in a long time,” Martha Budidi, IRC nutrition manager, told Al Jazeera. “The cases of children with severe acute malnutrition are beyond normal, even all the health facilities around Maiduguri are overwhelmed.”
Between 30 and 40 such cases are admitted to the state’s three IRC stabilization centers daily, and about 200 people a week, its officials said.
Elsewhere, the situation is bleaker.
The NGO Doctors Without Borders (Medecins Sans Frontieres, MSF), which has been treating malnutrition cases in Maiduguri since 2017, says there have been a record number of admissions since May, when health officials say malnutrition cases reach their peak. maximum point annually.
“From week 30 [the last week of July], we are admitting 330 patients per week on average. In the same period, the average number of weekly admissions last year was 69 patients. Htet Aung Kyi, medical coordinator for MSF in Nigeria, told Al Jazeera.
This August, more patients were admitted in one week than in the entire month in the same period last year, Aung Kyi added.
Deepening of the food crisis
Two years ago, before armed groups attacked Takari, life was good for Modu, a maize and millet farmer like her husband. Each year, they would make enough profit to feed the entire family.
But his luck changed after the attack. “I had no access to food or medical care in captivity, so my children died,” he told Al Jazeera.
In the garrison town of Konduga, where internally displaced persons (IDPs) live, food is rationed so that the family gets a daily meal from her husband’s meager income as a construction worker.
Throughout the region, the deterioration in food consumption patterns over the past year is deepening malnutrition.
The FAO analysis showed that 42.1% of households in BAY states (Borno, Adamawa and Yobe) had insufficient food intake, compared to 37.8% in the same period in 2021.
According to the organization, the regional armed uprising has denied 65,800 farmers access to farms and agricultural inputs, leading to a rise in food prices and a food crisis.
Inside the Maiduguri metropolis, IDPs who previously relied on food donations from NGOs like Action Against Hunger and Save the Children in the camps are trapped in host communities, starving.
Recovery and relapse
Since 2021, the Borno state government has resettled some 200,000 displaced people from aid camps in Maiduguri. While their resettlement brings them relative peace and stability, thousands are reeling from hunger.
According to a November 2022 Human Rights Watch report, government camp closures exacerbated hunger and malnutrition in the city. IDPs interviewed in the report said the Borno State Emergency Management Authority (SEMA) and humanitarian organizations like Action Against Hunger stopped providing monthly food rations and cash donations that helped them buy food in the camps. from Maiduguri.
“Once people don’t have access to food rations, it’s [malnutrition] expected,” said Anietie Ewang, Nigeria researcher at Human Rights Watch. “For kids, that’s more of a concern because it has a lifelong impact on them and how they grow up.”
In Maiduguri, for example, Hauwa Ali has struggled to feed her two children since she was relocated from Dalori I camp in July. The 25-year-old is jobless and her husband’s new life as an apprentice auto mechanic has yet to take off.
In June, and again in August, she rushed her nine-month-old daughter Hadisa to the stabilization center in Maiduguri and was diagnosed with MAS with complications, including oral thrush and diarrhoea.
“The first time he was defecating and he received treatment,” he told Al Jazeera. “This second time I couldn’t breastfeed her, she started losing weight. I noticed the symptoms one night when I checked her mouth and noticed that she was swollen.”
Hadisa’s is a case of relapse, which according to Ibrahim Mohammed, an IRC doctor in Bama, occurs when a child returns to SAM after a recovery period. “It’s [relapse] it can be caused by poor health or hygiene, but more often than not it is the case of severe hunger,” he told Al Jazeera.
At the Bama stabilization center, relapses are frequent due to food rationing and limited dietary options.
Thousands of families eat just one meal a day across the region and “around 5,000 children could starve if resources are not shared to save them in the next two months,” John Mukisa, nutrition sector coordinator, told Al Jazeera. of UNICEF. .
In the past, the Ali family relied on food donated by the World Food Program (WPF) and other donor agencies. But since moving to a host community on the outskirts of Maiduguri in July, the family of four now eats just one meal a day.
Meanwhile, Hadisa, who takes F.100, a calorie-protein formula used to help young children suffering from acute malnutrition gain weight quickly, is recovering.
But Ali fears another relapse is coming. “There is nothing (food) to go home,” he told Al Jazeera. “I can’t feed her properly and I’m afraid she will be admitted again.”
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