Dr Asma Aweis Abdallah is the medical activity manager with Médecins Sans Frontières/Doctors Without Borders (MSF) in Baidoa, Somalia.
Here she describes the situation the team is responding to.
The situation in Somalia is very dire - catastrophic.
We are facing one of the worst droughts in 40 years.
The country experienced famine in 2011, drought in 2017 as well as conflict and health emergencies like cholera, measles and malnutrition.
This is alongside high maternal and child mortality rates.
We haven't had enough time between one disaster and another.
The conflict and the possibility that rains will fail for the fifth consecutive year are the main reasons why people are leaving their homes and arriving in Baidoa – they are looking for health and humanitarian assistance.
The city hosts the highest number of displaced people in Somalia, second only to Mogadishu.
In this year alone we have received more than 200,000 new arrivals, with some taking long journeys to get here.
They do so without proper transportation and face security issues along the way.
Until they reach Baidoa, they're going through so much.
We see mothers who tell us they have lost babies on the way, but they continue their journey to bring other children for treatment.
We have witnessed a lot of critical conditions, people going through so much grief and pain.
One of the patients I remember is a 23-year-old mother who came in with her child – the mother had measles and the girl had malnutrition.
Because we don't have adult inpatient care in the hospital, we had this mother who had measles in the paediatric isolation room.
They´d walked 180km trying to find care before they arrived – we could not turn them away.
But because they had to travel so far, by the time they arrived they already had several other complications.
The child died two days after admission and the mother died one day later.
To witness families leaving the hospital with fewer members is one of the saddest things, but it´s the story of many families because of the impact of malnutrition or other diseases.
In Baidoa, most of the children we receive are already under weight.
Some lose subcutaneous fat and are skin on bone.
If this is chronic, repeated again and again it affects the development of the brain of the child, the productivity of the child for the future and in general the community because children are the asset for tomorrow's generation – all because of inadequate nutrition.
Another thing that malnutrition does to people is to reduce their immune system's response to other infectious diseases, so children who have malnutrition are prone to other health issues.
In Baidoa we are seeing this cycle of people coming in with infectious diseases, then coming back for malnutrition or the other way around.
There are also a lot of outbreaks attributed to the water shortage, climate change and the lack of vaccination coverage for children under 15.
It´s increasing the mortality of children.
MSF has an emergency programme in Baidoa where we support the regional hospital for paediatrics with an emergency room, outpatient and inpatient services.
We also provide sexual and reproductive healthcare, maternity and mental health services.
Our outreach programme focusses on health and nutrition services - we admit 500 children each week into our feeding programmes.
We build latrines and bring clean water by truck.
After an outbreak, we started supporting a cholera treatment centre.
With all these programmes we are supporting around 20% of the population, but the needs are far more than that.
It´s a difficult feeling for everyone, for every human to witness others going through difficult situations.
But being Somali and this being the situation of the Somali community, it makes me feel very sad.
But it is something we can alleviate if we all work together to establish the required services for the community.
In Somalia and Somaliland, MSF teams work in hospitals in Baidoa in South West State, Galkayo North in Puntland state, Galkayo South in Galmudug state, and in Somaliland in Las Anod and Hargeisa.
The focus of our medical activities are maternal, paediatric, and emergency care, nutritional support, and diagnosis and treatment of tuberculosis (TB).
MSF also run mobile clinics to deliver care to people living in displacement camps and the surrounding communities.
A team of Médecins Sans Frontières / Doctors Without Borders (MSF) has conducted 32 surgeries for noma patients in another round of surgical intervention at the Noma Hospital in Sokoto from 23 October to 4 November 2022. Since the start of the activities in 2014, a total of 1249 major surgeries have been conducted for the noma patients.MSF is supporting the Noma Hospital in Sokoto through inpatient care, reconstructive surgeries, outreach activities, nutrition and mental health support.“Noma is preventable and treatable, but people still die from it because of the limited knowledge about the disease and on how to detect it. Up to 90 per cent of people affected by noma die in the first two weeks if they don’t receive treatment in time. That is why early detection is important,” says MSF project coordinator in Sokoto, Dr Sham`un Abubakar.“Early case detection and reporting through Nigeria Centre for Disease Control (NCDC) can be achieved through increased surveillance activities like training of Disease Surveillance and Notification Officers (DSNOs), Health Care Workers (HCW), Traditional Healers, Alternative Medicine Practitioners, Community, Religious and Traditional Rulers and Women and Youth Groups. Noma is a disease that shouldn’t exist anymore.”Noma is an infectious and non-contagious bacterial disease that starts as an inflammation of the gums, similar to a small mouth ulcer. In just two weeks the infection starts to destroy bones and tissues, potentially affecting the jaw, lips, cheeks, nose or eyes, leaving survivors with physical consequences including pain, breathing complications and difficulties in eating. Malnourished children and members of isolated communities with limited access to healthcare and vaccination are more vulnerable. People who survive noma either have to live sequels of the disease or manage to undergo extensive reconstructive surgery to improve quality of life. On top of that, they deal with the social stigma caused by the disfigurement.In collaboration with the health authorities and other stakeholders, MSF is commemorating the noma day (5th November), in order to raise awareness about the disease, address stigmata attached to it and highlight specialized activities on the disease, so the patients can access the services. Besides over 1000 surgeries since the beginning of the activities in Sokoto, MSF teams have held 16857 mental health counselling and 2185 health promotion sessions; furthermore, admitted 1349 patients for both medical and surgical management of noma. In addition, a total of 103 survivors were admitted to the Inpatient Therapeutic Feeding Centre (ITFC), and 35 were enrolled in the Ambulatory Therapeutic Feeding Centre (ATFC).MSF launched an international campaign in 2020 to raise awareness about noma and accelerate the research and advocacy agenda - a crucial step being to see the disease included in the World Health Organization (WHO) list of Neglected Tropical Diseases (NTDs). The inclusion would shine a spotlight on the disease, facilitating the integration of noma prevention and treatment activities into existing public health programmes and the allocation of much-needed resources for its eradication. Nigeria with the support of MSF and other noma stakeholders has taken the lead as a member state to get noma on the WHO’s NTDs list.“Noma is a neglected disease, but it’s still not included in the WHO list of Neglected Tropical Diseases although it fits all the criteria. We are supporting the Government of Nigeria’s (GoN) call for the World Health Organization to recognize noma as a Neglected Tropical Disease so more attention and more resources will be allocated to eradicate it,” Dr Sham’un added.Médecins Sans Frontières/Doctors Without Borders (MSF) is an international, independent, medical humanitarian organisation that delivers emergency aid to people affected by armed conflict, epidemics, natural disasters and exclusion from healthcare. MSF has worked continuously in Nigeria since 1996, and currently provides medical care, free of charge, in 11 states across the country.Contact: Field Communication Officer, Abdulkareem Yakubu Email: firstname.lastname@example.org Phone: +234 810 606 6159
The international medical humanitarian organisation Médecins Sans Frontières (MSF) also known as Doctors Without Borders in collaboration with the State Ministry of Health (SMoH) has expanded the capacity of its inpatient treatment facility for malnourished children to 565 beds to respond to an increasing influx of the patients in Katsina state.The capacity is increased through opening of 80-bed Inpatient Therapeutic Feeding Centre (ITFC) including 30 bed Intensive Care Unit (ICU) at Dr. Yusha’u Armaya’u Maternal and Paediatric Health Facility in Kofar Sauri and the extension at Turai Ummaru YarAdua Maternity and Children Hospital in Katsina, the state capital.Governor of Katsina State Aminu Bello Masari together with MSF team inaugurated the new ward in a ceremony, also attended by the commissioner of health, royal fathers, volunteers, and others on Monday.MSF teams has been witnessing an alarming rise in admissions of malnourished children in its facilities in Katsina since the start of the year. In June, the team had to quickly increase their inpatient capacity to 280 beds, but the influx of malnourished children was so significant both in outpatient and inpatient that restricted admission criteria had to be introduced for some outpatient treatment centres.Between January and July, MSF teams in Katsina have admitted and treated over five thousand children suffering from severe malnutrition with complications under its inpatient programme while about 50 thousand children have so far been enrolled under the outpatient program with currently more 20,000 children in the cohort for of follow up.“We had to put in place temporary structures by way of extension at the Turai YarAdua Hospital to effectively manage and treat the increasing number of children suffering from malnutrition, and further expand the bed capacity at Kofar Sauri”, says Hassan Issa, MSF Emergency Coordinator in Katsina, Nigeria. “We are working in collaboration with the state government and our teams are ready to treat up to 100,000 malnourished children this year in our nutrition programme in Katsina state alone.”Katsina is one of the chronically food-insecure states in Northwest Nigeria with a low level of coverage in terms of malnutrition case management. The state is going through escalating levels of violence and displacement have pushed many communities to their limits. In recent years, armed groups that are locally referred to as ‘bandits’ have intensified attacks, killings, kidnappings, lootings and sexual violence. Many people cannot farm, cattle are stolen, and markets and trade are disrupted amidst soaring staple food prices – which remain above the five-year average in most Nigerian markets– in an already fragile health context.“The lean season or hunger gap is approaching its peak, and the malaria transmission is further deteriorating the health and nutritional status with more severe cases admitted that need intensive medical care (blood transfusion, perfusion, NG tube to feed children etc) in inpatients.” says Hassan Issa. .MSF teams support in the treatment of malaria through test and treat for outpatients with about 800 treated since the beginning of July. MSF also continues to support Jibia IDPs with drug donations and in July about 500 consultation was done from which 70 percent were children under five years old. “We have reached at our maximum capacity, and the patients are still arriving in large numbers. We again strongly urge all other health and humanitarian actors to immediately take steps to address the alarming inflow of the malnourished children.”If the current humanitarian assistance lags far behind in northwest Nigeria, that’s partly because the UN have failed to include the region in its humanitarian response plan for the country for the current year, which primarily focuses on the critical situation in the northeast. As a result, many organisations are struggling to follow up on assessments and secure funding to implement lifesaving support in northwest Nigeria, despite the known acute needs.Other than Katsina, MSF teams has been providing treatment to malnourished children in Kano, Zamfara, Sokoto and Kebbi states. We are supporting 8 inpatient and 31 outpatient facilities across five states in the Northwest. In MSF run or supported outpatient nutrition centres, almost 53,000 patients of severe acute malnutrition (SAM) and about 25,000 patients of moderate acute malnutrition (MAM) were admitted between January and end of July 2022.Médecins Sans Frontières/Doctors Without Borders (MSF) is an international, independent, medical humanitarian organisation that delivers emergency aid to people affected by armed conflict, epidemics, natural disasters and exclusion from healthcare. MSF first started working in Nigeria in 1996, and currently provides healthcare services in 11 states across the country.
Violent clashes between the M23 armed group and the Congolese army (known by the French acronym FARDC) over the past two weeks in the territories of Rutshuru and Nyiragongo, in North Kivu province, Democratic Republic of Congo (DRC), have forced tens of thousands of people to flee their homes. This recent mass displacement compounds the already precarious situation for displaced people in the two territories.
Prior to the latest clashes in Nyiragongo, the territory was hosting many people who were displaced by the volcano eruption in May 2021. In Rutshuru, fighting between the M23 and the FARDC end of March 2022 had already displaced approximately 50,000 people, about 25,000 of whom fled to Uganda. Most have not yet returned home.
Since the end of March, it is therefore estimated that 117,000 people sought refuge in schools, churches or with host families following the new wave of violence in this region of North Kivu. Most of them left everything behind.
Precarious living conditions
"We are 18 families sleeping together, all crammed into a classroom,” said Noélla, who is living with two of her children in the school of Kinoni village, Rutshuru, with almost 350 other families. "We no longer have access to our fields. We eat what we can find, but often it's barely once a day."
In early May, Médecins Sans Frontières/Doctors Without Borders (MSF) set up a mobile clinic in Kinoni village, near the school where Noélla and many families are staying. Since then, the clinic has been running at full capacity. "We have done more than 2,200 consultations since we started the mobile clinic, meaning we see an average of 120 patients per day,” said Foura Sassou Madi, MSF’s head of mission in DRC. “The main diseases we see are malaria, respiratory infections and diarrhoea.”
MSF also organised a distribution of essential items including plastic sheeting, buckets, cooking utensils and soap for the displaced families staying in Kinoni. Our teams also built showers and latrines to improve the living conditions and hygiene in the village.
"Many people who have been displaced tell us that they have difficulty finding enough food,” said Foura Sassou Madi. “Some have been displaced for over two months now. Displaced people in Rutshuru territory need a food distribution as soon as possible to avoid a further deterioration of their health.”
Access to healthcare and drinking water is a priority
In mid-April, MSF began supporting the health centres in Mungo and Rutsiro localities, Rutshuru, to ensure access to free healthcare for both the host and displaced communities. "In April and May, we treated over 1100 displaced people in the health centre. Some of them walked up to 5 kilometres to get here," said Ezéchiel Biriko, head nurse at Rutsiro health centre. Following the recent displacements, MSF is preparing to strengthen its response in Rutsiro, where about 6,500 displaced people are staying, with water and sanitation activities and an additional support to the health centre.
Access to healthcare and drinking water are also urgently needed in Munigi, Nyiragongo, where 16,000 people have sought refuge according to the International Organisation for Migration (IOM). MSF is supporting free care to all patients and set up a referral system for urgent cases to an hospital in Goma.
In the last week of May, MSF trucks have brought more than 100m3 of drinking water per day to the health centre and two other sites in Munigi where many displaced people have temporarily settled. "Access to clean water is crucial to limit the risk of water-borne diseases, such as cholera, which is endemic in the region," said Abdou Musengetsi Katumwa, MSF deputy medical coordinator in Goma.
Armed conflicts, that have affected North Kivu for more than 20 years, continue to impact adversely on civilians. MSF has been present in Rutshuru territory since 2005 and is currently working with four hospitals in Rutshuru, Bwiza, Kibirizi and Bambu, as well as a dozen health centres. In Goma, our teams have been involved in the cholera response since 2008
Abuja 18.05.22- Médecins Sans Frontières/Doctors Without Borders (MSF) has handed over its lead poisoning project in Zamfara, northern Nigeria, to state authorities. Children are no longer dying of lead poisoning in the area, more than 11 years after environmental contamination caused the death of hundreds of children.In March 2010, MSF received an alert about a high number of child fatalities in Nigeria’s Zamfara state, where more than 400 children died within just six months in several villages. “When MSF arrived, we were suffering a lot,” remembers Alhaji Muhammadu Bello, head of Dareta village. “In my village, 120 children died. Six or seven were dying every day.”Laboratory tests later confirmed high levels of lead in the blood of survivors. The root cause of the poisoning was environmental contamination through unsafe, artisanal mining activities in the area, where gold deposits contain an unusually high concentration of lead. Lead can cause severe brain damage and death in children.“Artisanal mining had been going on for a decade in this area. People transformed the villages into processing sites and contaminated the environment for many years. Children were exposed to contaminated dust and soil in the villages”, says MSF project coordinator Benjamim Mwangombe.Before MSF could start treating patients, the contaminated areas needed to be remediated so that children would not be continually re-exposed to toxins. Between June 2010 and August 2013, TerraGraphics International Foundation, an environmental engineering organization, provided environmental management training to Zamfara state’s Environmental Sanitation Agency (ZESA). In partnership with the community, eight villages in Anka and Bukkuyum local government areas were remediated, by removing contaminated soils and mineral processing waste from residential areas, wells and ponds.Between May 2010 and December 2021, MSF screened 8,480 children under five for lead poisoning. More than 80 per cent of them were enrolled in a medical lead program, including 3,549 children who received lengthy chelation therapy to remove lead from their blood.Five years after the outbreak in Zamfara, another lead poisoning outbreak was discovered in two villages in Nigeria’s Niger state in April 2015. It was also caused by artisanal gold mining and resulted in the death of at least 30 children. MSF provided chelation treatment to 139 children shortly after remediation and handed over the project to Niger state authorities and traditional leaders in October 2018.Remediation and chelation therapy are not only very expensive, but also insufficient to eliminate the lead poisoning hazard in the communities. Due to the rampant poverty and lack of other employment opportunities in the area, small-scale mining remains the only option for many people. Many were unaware of the health hazards caused by their mining practices. Some previously remediated areas were re-contaminated.“We had children who were re-exposed more than three times. Even if their compound is clean, maybe they play on their uncle’s compound where the soil is contaminated,” says Mwangombe.The only sustainable long-term solution is the prevention of lead poisoning. MSF engaged OK International, an external partner specialized in occupational and industrial health, to develop and implement safer mining pilot projects in Niger and Zamfara states, in partnership with Nigeria’s Federal Ministry of Mines and Steel Development and the responsible state agencies.Miners were provided with information and tools to reduce exposure during mining and processing activities, and to minimize off-site contamination. The results of the pilot projects have been encouraging, and the state governments say they are committed to scaling up safer mining practices in Zamfara and Niger states. “We will continue to ensure that the environment remains clean, so that children will not get poisoned again,” says Alhaji Shehu Anka, general director of ZESA.Almost 12 years after MSF first started intervening in the area, no more children are dying of lead poisoning in Zamfara. As a result, MSF started the handing over process of the program to key ministries of the Zamfara state government, the Anka Emirate Council and the local community at the beginning of February 2022 and completed the handing over on 11th May with the official handing over ceremony.Mwangombe says the significant decrease in the under-fives mortality and morbidity related to lead toxicity is not the only success. “Another big achievement was that our intervention was community-based. The community has been involved throughout so that they could take ownership. We also improved local capacity. In the future, if there is another outbreak, there will be capacity to respond.”One of the key factors for the successful reduction of exposure to lead poisoning was the involvement of international organizations with expertise in environmental health, safer mining and occupational health that complemented MSF’s medical response.However, challenges remain. Artisanal mining is a poverty-driven activity that will persist as long as gold mining is profitable. Recently, another area with a high level of lead contamination was discovered in Abare village in Zamfara. At the end of January 2022, the Zamfara state government approved the financing of the environmental remediation of the contaminated area.For the long-term sustainability of remedies, and to prevent children from dying from lead poisoning again, all partners need to remain committed to promoting and maintaining safe mining practices.“Prevention requires involvement from everyone – from village chiefs and traditional leaders to state authorities and legislators, so that everyone’s efforts will help maintain the remedy that we have handed over and prevent any future outbreak of lead poisoning in Zamfara state”, says Mwangombe.