In Nigeria, “The Needs are Huge and We Are Struggling to Fill the Gaps”

Doctors Without Borders/Médecins Sans Frontières (MSF) began offering primary health care and other services in Pulka, in the northeastern Nigerian state of Borno, in late 2016. Over the past few months, this small town, situated next to the border with Cameroon, has become a hotspot for people fleeing the Nigerian military operations and attacks by Boko Haram, and those in search of food and basic services.

Water is the most pressing need in Pulka today. According to OXFAM and a local water supply agency, water is the main limiting factor against bringing more people to Pulka, above security, shelter, and other basic necessities. The water carrying capacity in the area should not be more than 15,000 people—but the current population is already more than double that number. According to Oxfam, Pulka is built on a giant slab of granite and it is not possible to drill any additional boreholes beyond the existing two, which have gone from running five hours per day to more than 10 hours per day.

Danca Paiva is MSF’s project coordinator in Pulka.

What is MSF doing in Pulka?

We opened this project last October because there was no adequate medical care available to the people. Due to the difficult security situation and the absence of adequate health care, we felt it was important to make services accessible to everybody.

We now run a clinic that provides treatment for malnourished children and offers antenatal care for women. Our teams also carry out water and sanitation activities, like trucking water and building latrines, mainly for internally displaced people coming from different villages around the Gwoza local government area—especially from villages bordering Cameroon—who are staying within the compound where our clinic is.

What is the situation regarding new arrivals?

Recently, Pulka has registered a dramatic increase in new arrivals: more than 11,300 since January. It currently has an estimated population of 42,000; the vast majority are IDPs.

People arriving in Pulka have fled the conflict from different areas of Borno state, where fighting is ongoing. They report that hospitals and markets are not functioning because they have been demolished and people have a very limited possibility to farm and get food or firewood to cook.

Most of the people arriving in the town first settle inside the hospital compound where MSF provides basic health care and other services along with other NGOs and other actors. In March, around 1,000 families (about 6,000 people) were moved to newly constructed camps, but many more need a proper location to live with adequate services in place, like latrines and a regular supply of water.

Our teams are usually on standby whenever new waves of people come. We do medical and nutritional screening, check their general health condition and refer those requiring further medical care to the health clinic. Most of the people arrive with nothing, in a condition that suggests they had little financial capacity.

We give them BP-5—high-calorie biscuits—to help build up their strength because they are often very weak due to hypoglycemia. People have been trapped in the conflict for a long time in areas where there are no humanitarian actors operating, so we assume that they had no access to health care.

Most of the children, for example, had never been vaccinated. Therefore, we filter children from six months to 10 years old to be included in an expanded program of immunization against measles, whooping cough, etc. We then give them food and non-food items that should last them till they are registered for food distribution by the World Food Programme.

What are the main challenges in the area?

In Pulka, the most common morbidities we find among our patients are: acute respiratory infections; acute, non-bloody, watery diarrhea; malaria; gastritis; and conjunctivitis. 

Our primary objective is to take care of people’s health needs, but due to the magnitude of the problems they come with and the inadequacy of support, we have had to step in to provide shelter as well since they are living in the compound where we work. People are living out in the open and are very exposed to the sun. So we try to provide them with shade and shelter, knowing that their health is in danger because the risk of an outbreak of communicable diseases in the camp is high.

That is why we also do a lot of health promotion, to ensure that people are careful to maintain a high level of personal hygiene. This is one of the most complex projects we have in Nigeria in terms of needs, context, and challenges.

Is there a need to increase the health care and humanitarian assistance?

As the population in Pulka increases, so does the pressure on the existing resources being provided by the few humanitarian actors present.

For instance, we saw that the demand for water was very high and people were fighting over it, so we had to fill the gap. We created a lot of water points in the camp and organized two trucks to bring in water on a daily basis. Currently, we are providing 4,000 liters of water per day to around 1,800 people living in the hospital compound, which makes an average of around three liters a day per person.

In the newly constructed camps, OXFAM has drilled boreholes to allow people get water from the ground. OXFAM and MSF are trucking 16,000 liters of water daily into one of the two camp sites.

The needs are huge and on the top of this there is the challenge of establishing a comprehensive referral system because of the lack of secondary health care in the area.

Right now, if something happens to somebody in the night, or even during the day, that requires urgent evacuation, we are no longer able to evacuate them due to the fact that the helicopter is not medically equipped and we can’t move our vehicles out of this place because of the security situation.

MSF has been working in Maiduguri in Borno state since August 2014. The organization is currently managing 12 medical facilities in seven towns in Borno: Maiduguri, Ngala, Monguno, Damboa, Gwoza, Pulka, and Benisheikh, and conducting regular visits in four other towns: Bama, Banki, Dikwa, and Rann.