By Abdulrasheed HAMMAD

In this report, Abdulrasheed Hammad uncovers the sad reality of Sokoto’s children, who are displaced and endangered by hunger and malnutrition amidst government neglect. The report also highlights the harsh lives of refugees in Wurno and Wamakko IDP camps, displaced by bandits and Boko Haram, and the impact on their livelihoods.

Fear of bullets, not hunger, gnawed at Umar Ali’s stomach. Bandits’ attacks on his village became incessant, forcing him to leave his farm uncultivated. The consequence? Not enough food for him and his wife and not enough milk for their five-month-old son, Abubakar.

Abubakar’s tiny body bore the brunt of this, and soon, he started falling sick. Rushed to the Marnona Health Post in Wurno Local Government Area (LGA), he was diagnosed with severe, acute malnutrition, a silent killer stalking children in the shadow of violence. The local health worker, with limited resources, could only offer a referral to the Sokoto State Specialist Hospital, which is miles away for specialised care.

For two agonising weeks, Umar clung to hope as Abubakar battled against the ravages of malnutrition before he was eventually discharged. Yet, the fight was not over. Umar painfully acknowledged that his child’s condition was further complicated by his mother’s inability to breastfeed. The mother was unable to breastfeed due to her inability to produce enough milk which was caused by not eating adequate and nutritious food. She is also facing health issues that prevent her from breastfeeding and forcing her to give the baby milk.

“After he was discharged from the hospital, his mother had to start preparing a better diet for him more often using available food such as mixing soya beans with groundnut and millet,” he said.

Abubakar’s story is not unique.

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Across Sokoto state, fear of bandits forces farmers like Umar to abandon their fields, which means that they cannot even cultivate food for their families. In this situation, many children are left vulnerable to malnutrition.

Thirty-five-year-old Fatima Ibrahim knows this pain too well. Displaced by bandits, she and her husband now beg for food in the Wurno Internally Displaced Persons ( IDP) camp.

“In 2021, the bandits chased us (myself, my husband and children) from Masama village in Wurno LGA, and we migrated to the Wurno IDP camp. Since we migrated here, life has been difficult for us because my husband has turned into a beggar. This makes it difficult for him to feed us because he left his farm to run for his life,” Fatima Ibrahim bemoaned.

“With five kids to feed, between 8 months to 10 years old, I’m desperate. For instance, today (time of interview0, my husband left for Wurno town to beg for anything to keep us alive. Right now, we have nothing. Despite my inability to eat a balanced diet, I still must breastfeed my baby. He often cries because there isn’t enough milk flowing from the breasts.”

Amidst dire circumstances, the living conditions of the IDPs remain lamentable. They endure squalor and grapple with contaminated water, which poses a severe threat of waterborne diseases, including cholera, to the camp’s children and pregnant women.

Facing financial constraints, most IDPs resort to seeking healthcare from local chemists and untrained traditional medicine practitioners for ailments like fever, malaria, or diarrhoea, as a visit to formal medical facilities is often beyond their means. The lack of financial resources extends its grip on education, depriving their children of schooling opportunities due to an inability to meet associated costs.

Despite their profound struggles, assistance from government agencies, non-governmental organisations, and health professionals remains elusive for these displaced families. The absence of support compounds their challenges, leaving them in a precarious situation with limited access to essential services and resources.

Amidst the stark realities faced by those displaced in Northwest Nigeria, a recent report by Integrated Food Security Phase Classification (IPC) sheds light on the grim prevalence of acute malnutrition. The risk factors, ranging from inadequate food quantity and quality to subpar health-seeking behaviours, highlight the need for urgent intervention. The nexus between malnutrition, poor health services, feeding practices, and overall insecurity further amplifies the vulnerability of populations affected by banditry and displacement.

This disconcerting report not only highlights the precarious conditions of the 575 individuals in this IDP camp, but also serves as a distress signal for the children among them.

In a parallel tale of hardship like Fatima’s family, 25-year-old Hafsatu Labaran and her family share a harrowing journey of displacement triggered by bandit attacks on Masama village in Wurno LGA. With five children to cater for, the youngest a mere nine months old, Hafsatu faces the heart-wrenching reality of sending her other children out to beg for alms.  Once a farmer, her husband now toils as a labourer, grappling with the challenge of securing their family’s survival in the aftermath of displacement.

“I go into the bush to fetch vegetables and some leaves we use to make garri. I give my baby pap three times a day, and when she is sick, I buy paracetamol. We rarely get any medical help as health workers don’t come here; we go to Wurno Primary Healthcare Centre if it’s serious. Most women also don’t deliver in the hospitals when they are pregnant because of hospital bills.”

Rabi Issa, a middle-aged woman in Kasuwar Daji IDP camp, lost her husband to a Boko Haram attack in Faraskawa village, Baga LGA, Borno State in 2017. After being displaced by Boko Haram, she migrated to Dosso in Niger Republic with her nine children before being evacuated by the Nigerian government to Sokoto state. Since arriving at Kasuwar Daji IDPs camp, life has been difficult for her, and her struggles to feed her children with necessary nutrients has resulted in the deaths of them, four-year-old Fatimah and nine-year-old Aliyu.

She emphasized that hunger is not exclusive to children but also affects adults, citing her battle with an ulcer stemming from the lack of food. She urged the government to intervene, enabling them to achieve self-reliance in securing food for themselves and their children.

While narrating her experience in Niger Republic, she said there is no difference between the difficulties they are facing in Nigeria and Niger other than the fact that Boko Haram was displacing them from one place to another in the latter compared to the former where hunger is killing them. Boko Haram displaced them from Doron Baga in Borno State to Diffa in Niger Republic and from Diffa to Karanga also in Niger before they moved to Gashua and then Gaidam in Yobe State. It is from Gaidam that they moved to Sokoto.

She said, “We were also living in a terrible situation in Gaidam. Boko Haram were killing people consistently. That was when the Nigerian government sent some trucks to evacuate people. That time we didn’t care, as soon as we saw a truck, we would enter so as to save our lives. That was how we saw Sokoto buses and entered, we then found ourselves in Sokoto. Some people were even taken to Kebbi state.”

Hauwa’u Aliyu and her five children, displaced from Isa LGA in Sokoto in 2022, grapple with severe challenges. The family can rarely feed themselves and lacks access to clean water, resulting in chronic diseases among her children due to malnutrition. The older children, aged 8, 6, and 5, are compelled to beg for alms to fend for themselves.

Nine-year-old Haruna Imrana, another victim of bandit-induced displacement, battles not only a skin disease but the added challenge of malnutrition. Tragically, his mother lacks the financial means to seek hospital care, resorting to herbal remedies and topical treatments. Within a camp harboring over 160 children, as disclosed by Haruna’s mother, both boys and girls are compelled to venture into the streets, soliciting alms to combat hunger amidst widespread malnutrition and harsh living conditions.

“Look at his entire body and legs. The thing has affected all his body. I don’t even know what happened to him. We didn’t take him to the hospital but we are using herbal medicine where he drinks and apply the herbs on his body. I need assistance,” Imrana’s mother lamented.

Bandits deny Wurno children’s immunisation 

In an interview, Bello Muazu, Wurno Local Government Immunisation Officer, revealed a disturbing trend. He stated that there are wards and settlements that health workers cannot access for immunisation or any other medical intervention due to the fear of being kidnapped or killed by bandits. This has left children in these insecurity-prone areas more susceptible to malnutrition due to their inability to access health care.

Muazu noted that the eastern part of Wurno LGA is facing serious insecurity challenges, particularly in Chacho and Kwargaba wards. He added that the most recent attack occurred in the Dimbiso ward. He explained that the number of settlements in the eastern part is higher, and the area also shares boundaries with Isa, Rabah, and part of Goronyo LGAs, leading to increased insecurity in these areas.

“Specifically, settlements such as Kafarma, Aisa, Dandutse, and Tsohon Garin Magori under Dimbiso ward are grappling with insecurity. Under Kwargaba ward, locations like Arba, Barayar Zaki Ijjiya, Kawadata, Barayar Zaki Hakimi, Mazun/Sarkin Ruwa, and Dabagin Busau are inaccessible for health workers.

“Similarly, under Chacho/Marnona, settlements Kadagiwa, Masama, Gawo, Doliyal, Laka, Mashekari, Koliyal, Tudun Aligai, Sabon Garin Liman, and Digim settlements are affected. Under Lahodu ward, Farin Modibbo, Farin Dangaladina Rujin Waziri, and Gidan Shinkafa settlements are impacted, and under Dinawa, Gidan Isiya and Rafin Koro settlements are also affected,” he said.

This situation implies that all the children in these wards and settlements are deprived of access to immunisation, food, and also medical intervention, putting them at risk of malnutrition due to the prevailing insecurity.

A Sokoto-based doctor and the Medical Officer at Wurno General Hospital, Anas Chika, stated that there are various vaccines outlined in the national guidelines for children under the age of five. He emphasized that these vaccines are essential because young children are more vulnerable to diseases and have weaker immune systems, adding that the purpose of administering these vaccines is to boost their immunity. He further explained that certain diseases, known as Vaccine-Preventable Diseases, can only be prevented through vaccination and If a child has been vaccinated against a particular disease, their body is already equipped to deal with the virus if they come into contact with it in the future.

“Most of these diseases are deadly and cause significant morbidity. Each country has its own set of vaccines recommended for children. In Nigeria, there is the National Programme on Immunization (NPI) that outlines the vaccines to be given to children at specific periods. Immediately after birth, a child is given three types of vaccines: BCG for tuberculosis, OPV for oral polio vaccine, and Hepatitis B.

“A child is vaccinated against three viruses: tuberculosis, polio, and Hepatitis. Malnutrition, on the other hand, is not a disease that can be prevented by vaccination. It occurs due to abnormal nutrition. If a child does not receive adequate food for his age, he may suffer from malnutrition due to reasons such as poverty, illness preventing food intake, or lack of breastfeeding,” he explained.

While giving a response to the story of a woman unable to breastfeed her baby, he stressed that infants are expected to be exclusively breastfed for the first six months after birth, stating that insufficient breastfeeding can lead to malnutrition. He identified poverty and disease as factors contributing to her inability to breastfeed, which results from the mother’s inability to consume nutritious food necessary for producing breast milk.

He concluded, “The consequence of not immunizing a child against diseases like Polio, Hepatitis, or Tuberculosis can be severe. If the child contracts these diseases and is not immunized, the consequences can be severe. The financial burden of treating these diseases is much higher than the cost of vaccination. Additionally, the time required for treatment is also a concern. Without proper care, a child may suffer long-term morbidity or even death from these illnesses. For instance, Polio can lead to permanent disability, affecting the child’s ability to walk for the rest of their life if they survive it.”

Amid these challenges, a community health worker at Marnona PHC, Hassan Haruna, highlighted ongoing efforts to combat child malnutrition in the area. However, he emphasized a critical gap, which is the absence of adequate health facilities to accommodate children suffering from malnutrition. Haruna elaborated on their existing strategy, which involves the use of the MUAC tape (middle-upper arm circumference) to assess children’s weight.

When the measurement falls within the yellow range, indicating a potential diagnosis of moderate malnutrition, Haruna offers counsel to caregivers.

“I will advise them to maintain a balanced diet for the children. This protocol includes a follow-up appointment scheduled three weeks later, preceding a potential discharge.”

Despite their efforts, the lack of necessary health facilities remains a pressing concern in their fight against malnutrition.

“However, if it shows red, we will refer them to Wurno Town Dispensary or Achida Health Care, or far away Sokoto State Specialist Hospital for proper treatment. We have referred a lot of patients with severe acute malnutrition, and we do receive patients from IDPs camps and neighbouring villages,” he noted.

The Sokoto State Nutrition Officer, Mustapha Abubakar, said the challenges facing the fight against malnutrition is that most of the budgeted funds are not always released.

“This is hindering us from carrying out the plans we have for combating malnutrition in insecurity-prone areas and in IDP camps in Sokoto. While the government often makes promises, the issue is in poor release of funds.

“Our fight against malnutrition includes educating communities on incorporating nutritious foods and integrating services like immunization into our efforts for a combined approach.

“Funding remains a key hurdle, limiting our reach. We’re activating food and nutrition committees at the local government and ward levels to ensure our methods can be sustained even beyond our direct presence,” he said.

While speaking with Hajia Asabe Balarabe, the Sokoto State Commissioner for Health, she noted that this reporter should reach out to the Executive Secretary of the Primary Healthcare Agency. She clarified that the Executive Secretary is responsible for handling issues related to malnutrition in Sokoto State.

Executive Secretary of Sokoto State Primary Health Care, Larai Aliyu Tambuwal, said she recently assumed office and finds it challenging to provide a response regarding the steps they are taking to combat malnutrition in the state. She noted that all the directors from whom she could gather information have been dropped, and she does not want to provide inaccurate information to the reporter.

“I haven’t fully taken over the office, and I am not familiar with the programs they are implementing. I come from WHO, and I lack complete information. With the absence of the directors I relied on for information, it’s difficult to give you a response. I hold a strategic position, and any information I provide will bind me. Therefore, I refrain from making statements to avoid any repercussions,” she explained.

“I am accountable for all activities within the agency, and I am cautious not to make statements that will come back to me. I am currently gathering this information, as I have not been actively involved in the system. Previously, I worked at the WHO, focusing on surveillance and immunization. I have just arrived at the office, and it is empty. Please give us time to gather the necessary information,” she added.

When the reporter approached the commissioner after Mrs. Larai’s response, she declined to comment, citing the division of departments within the ministry. She insisted that the reporter should communicate directly with Mrs. Larai, adding that they have only been in the system for a few months and do not possess detailed information about the reporter’s inquiries at the moment.

Scary Data

According to Sokoto, Kastina, Zamfara, SMART Survey and Integrated Food Security Phase Classification (IPC) Acute Malnutrition (AMN) Analysis survey, Sokoto is among the states with the highest number of malnourished children. Specifically, the report showed that 297,832 children were severely malnourished in the state in 2023.

As part of its strategy to address the alarming malnutrition cases in Sokoto, Governor Ahmed Aliyu allocated 15 per cent of the 2024 budget to the health ministry. This dedicated funding is intended to spearhead comprehensive initiatives addressing different challenges, including malnutrition, which is identified as a significant factor contributing to the prevalence of NOMA, a rapidly progressing severe gangrenous disease of the mouth and the face. It mostly affects children aged 2–6 years suffering from malnutrition, affected by infectious diseases, living in extreme poverty with poor oral health or with weakened immune systems in the state. However, a crucial hurdle remains the uncertain release of these appropriated funds.

A staggering 44 per cent of households in Sokoto State live below the poverty line of $1.90 per day, according to a 2021 study on the nutritional status of children under five. This dire situation translates to 11.2 per cent of children suffering from severe hunger and 18.8 per cent facing moderate hunger. The study also revealed a combined impact of poverty and hunger affecting a staggering 73 per cent of Sokoto households, far exceeding the national average of 45.4 per cent.

When compared to global and national averages, Sokoto falls short on measures of weight and height for age, indicating both immediate and long-term nutritional deficiencies, according to a 2022 study conducted in the Department of Pediatrics in Usmanu Danfodiyo University, Sokoto.

Findings showed that 57.2 per cent of respondents had normal weight for age, 40.8 per cent were severely stunted, 82.2 per cent had normal weight for height, and 56.7 per cent had a normal mid-upper arm circumference.

Expert Weighs In

A medical doctor and nutrition specialist with Médecins Sans Frontières, MSF, Muhammad Salih, said the factors contributing to the high rate of malnutrition in children are classified into modifiable and non-modifiable factors. The modifiable factors include kidnapping and banditry, which need to be fought by the government, while others are in between.

“Some caregivers lack the knowledge to prepare balanced meals despite having food, while others struggle with access to treatment,” he explained. “Children with common, treatable illnesses like dialysis often go undiagnosed or neglected due to dysfunctional healthcare facilities. Even reaching these facilities doesn’t guarantee proper treatment.

“And when families reach the hospital, they face crippling costs. Hospital fees and transportation, especially with long distances, are often insurmountable obstacles. Some are even referred from primary healthcare centres to these facilities, only to hit another wall.”

He further highlighted the limitations of his organisation in reaching insecurity-prone areas, stating, “While we aren’t currently present in insecure areas or IDP camps, we’re exploring ways to provide support. For instance, we operate an IDP camp in Makura with an advocacy team educating caregivers on balanced diets for their children.”

Criticising the government’s lack of action, he added, “Promises to end malnutrition ring hollow without concrete steps. It’s the government’s responsibility to  complement the efforts of international NGOs in tackling this crisis.”

Chika the doctor earlier mentioned, said the main causes of malnutrition are poverty, ignorance, giving birth to many children without taking care of them, and insecurity. He added that the best way to solve the malnutrition problem is for the government to reduce the poverty rate among the populace, provide job opportunities, and most importantly, secure the land so that those who want to farm should be able to do so, and those who want to do business should be able to do it freely and earn a living.

 *This report was done with the support of the International Centre for Investigative Reporting, under its Promoting Democratic Governance in Nigeria Project.