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THREE years after Doctors Without Borders  – Médecins Sans Frontières –  (MSF) ended its lead treatment programme in Zamfara State, resurgent outbreaks of heavy metal poisoning have left children battling for their lives, amid a poor healthcare system and failure to stop illegal gold mining –  the root cause.

Hafsat Rabiu sat on a mat under a neem tree. Beside her, lay her two young daughters: Safiya, 6, and Nasiba, 4. Too weak to speak, both groaned as their mother fanned them with the helm of her wrapper. Safiya woke up, gazing with her bloodshot eyes.

On the scorching afternoon of May 14, several caregivers at the Zamfara State Infectious Disease Centre, Gusau, tended sick children who had been diagnosed with heavy metal poisoning, the same condition that Rabiu’s children were battling with. 

Heavy metal poisoning occurs when toxic heavy metals, such as lead, mercury, arsenic, or cadmium, accumulate in the body and cause harm.

Before arriving at the facility on May 8, the 41-year-old mother said they had spent a few weeks at the Shagari Hospital, in Gusau, the state capital. The transfer of all heavy metal poisoning cases to the centre was said to be on the directive of the state government, with a pledge to offer free treatment.

However, the government’s supposed intervention turned out to be a despairing experience for Rabiu. In an interview, she lamented how her daughters had not received any medication or food from the government.

“I want to take them home,” she said, adding “At least there, I can give them something to eat.” 

While Rabiu prepared to leave due to lack of access to treatment, motorcycles carrying children with acute ascites continued to arrive at the centre. Ascites is a medical term for a sudden buildup of fluid in the abdominal cavity, a symptom of heavy metal poisoning. 

At the time of visit on May 14, Safiya and Nasiba were among children  lying at the Zamfara Infectious Disease Centre, gasping for breath, their fragile bodies too weak to sit or stand without someone holding them up, as a result of heavy metal poisoning.

Since 2010, when the federal government announced the discovery of lead poisoning in Zamfara, the epidemic remains the worst lead contamination in recorded history, resulting in the death of more than 600 children, and hundreds more left with brain damage and physical disabilities, a report by the Guardian UK, suggests. 

However, illegal gold mining; the root cause of the epidemic, has continued unabated, resulting in a widespread resurgence of heavy metal poisoning, despite remediation projects by the Federal and Zamfara State Governments, in conjunction with international environmental and health organisations.  

For victims, especially children battling for their lives as a result of heavy metal poisoning resurgence, the situation has been worsened by the government’s inability to provide efficient treatment, after Médecins Sans Frontières (MSF), or Doctors Without Borders ended its more than a decade lead poisoning treatment programme in 2022. Doctors without Borders is a medical humanitarian organisation that provide medical assistance to people affected by conflict, epidemics, disasters, or exclusion from healthcare, the organisation website says.

Poor treatment, hunger despite government’s pledge 

In the wake of the recent multiple heavy metal poisoning cases, the Zamfara government reopened the Infectious Disease Centre in early May, said Ahmad Muhammad Gusau, the state’s Epidemiologist and Head of Public Health Emergency Operations Centre (PHEOC). 

The facility which was built in 2020 to manage COVID-19 and other infectious disease. It was reopened in response to the fresh outbreak of the heavy metal poisoning, a staff member told The ICIR.

However, patients in urgent need of care are met with shortages of health workers and medications. For Hajara, a grandmother, the reality hit hard when she arrived with her seven-year-old grandson, on the evening of May 13. They live in Geba area of Gusau.

“When we noticed that his stomach was swollen (ascites), we rushed to Shagari Hospital in Gusau but we were transferred to this facility.

“We got here yesterday but they told us that the drugs he needed were not available. We don’t have enough money to continue staying here, and even feeding is difficult,” she said.

The ICIR observed only three health workers attending to over 60 patients. Multiple caregivers reported that the patients’ conditions had worsened due to inadequate medication and lack of food. 

One of the staff members who sought anonymity because of fear of victimisation, said, “For the past four days, I have not had rest, and the drugs are not enough.”

The staff added that despite the government’s pledge to cover treatment costs, several parents and caregivers were left with no option but to buy the prescribed medication out of pocket. The staffer also said that several discharged patients had not fully recovered.

In random interviews, many families said they exhausted their resources and could no longer afford to stay at the Infectious Disease Centre, even if it meant leaving without proper care.

Zamfara government dismisses questions regarding poor care for patients

When The ICIR asked the government to respond to claims that it had failed to provide adequate personnel, medications, or food for patients as promised, Gusau, the Head of PHEOC, dismissed the claim during an inspection visit to the facility.

He was delegated by Nafisa Muhammad Maradun, the state’s Commissioner for Health, to respond to questions after The ICIR submitted a letter requesting an interview.

“No, that’s not true. In fact, there are no such people,” he said, referring to reports of patients lacking access to treatment.

Gusau added that he had supplied drugs for treatment as instructed by the Commissioner.

“We have nurses in the facility, we have doctors, and the Commissioner is planning to ensure that there are staff that will be stationed on call duty,” he said.

Responding to complaints of hunger by patients and caregivers, Gusau said, “Maybe it depends on the time you met them, whether they had taken their breakfast or not.”

The ICIR findings suggest that, despite Gusau’s assurances and the government’s pledge to cover medical bills, many caregivers and parents reported having to provide food and, in several cases, purchase medication out of pocket. Some caregivers, who spoke on condition of anonymity, cited fear of possible repercussions for declining recorded interviews.

In a phone interview, a deputy director at the Zamfara Environmental Protection and Enforcement Agency, Sagir Ali, said nutritional and social support was crucial for patients’ full recovery.

“Many patients come from already vulnerable communities and need more than basic treatment,” he said. 

Zamfara government fails to provide relevant data 

Despite promising to share data on the treatment of heavy metal poisoning at the Zamfara State Infectious Disease Centre, Gusau did not provide relevant information in follow up calls and an email. 

The email specifically asked to know: the number of children the state government has successfully treated and discharged, figure of patients, if any have died as a result of the recent outbreak, how much the government spent so far, and the nature of the treatment being provided. 

The email explained that Doctors without Borders (MSF) previously employed a lengthy chelation therapy to remove toxins from the children’s system.

Chelation therapy is a medical treatment that uses chelating agents to remove heavy metals and other toxins from the body. These agents bind to the metals, forming a complex that’s excreted in urine or feces.

“Has a similar approach (chelation treatment) been adopted? What are the challenges faced in providing the supposed free treatments? Which organisation has the state government partnered with to address the ongoing multiple heavy metal poisoning since MSF ended its treatment programme?” These questions were not responded to by Gusau. 

Why children are vulnerable 

In a briefing paper published in 2012, MSF said everyone living in areas of unsafe gold mining and ore processing is susceptible to lead toxicity, but “children under 5 are especially vulnerable.”

It said, “Children are closer to the ground than adults, and often crawl, getting dust on their hands, which then ends up being ingested as they eat with those dusty hands, or simply put their hands in their mouths. Young children absorb higher percentages of ingested lead: around 40-50 per cent compared to 10 per cent in adults.”

The paper posits that ongoing development of vital organs in young children, are more vulnerable to damage.

MSF’s decade-long struggle to save children 

The resurgence of heavy metal poisoning in the state comes three years after MSF concluded its lead poisoning treatment programme in Zamfara State. In February 2022, the organisation published a report that documented its achievements on the lead poisoning treatment programme and announced that it was handing over the project to the state government and local authorities. 

The report says between May 2010 and December 2021, the organisation screened 8,480 children under five for lead poisoning. Of this figure, more than 80 per cent of them were enrolled in a medical lead programme, including 3,549 children who received lengthy chelation treatment .  

However, following the recent outbreaks that have left scores of children hospitalised at the Zamfara State Infectious Disease Centre, MSF has not made any public statement regarding the situation. 

In response to an email The ICIR sent to MSF’s communication team, the Country Representative, Simba Tirima said, “MSF handed over the operations in 2022 and is not currently monitoring the situation.”

Tirima did not provide information on how much MSF spent on the lead poisoning treatment programme, or how much it cost to successfully treat a child of lead poisoning using the chelation therapy, as requested.

The project report which documents MSF’s achievements on the treatment programme did not disclose how much the organisation received as donation for the project and how much was spent.

Meanwhile, recent updates on MSF website indicate a shift in the organisation’s focus toward addressing severe nutritional challenges across northwest Nigeria. In Zamfara alone, MSF reported treating approximately 65,000 children for malnutrition in 2024.

Recontamination of Zamfara communities after remediation efforts

When the federal government announced the discovery of the lead poisoning in Zamfara, the solid lead concentrations in the affected areas exceeded 100,000 parts per million (ppm), far above the internationally accepted standard of 400 ppm for residential areas, according to a report by Pure Earth, a global non-profit organisation that protects the environment from the harms of toxic pollution.

The report notes that the processing of lead-rich ore to obtain gold by artisanal miners notably in Anka and Bukkuyum LGAs of Zamfara State resulted in extensive dispersal of lead dust, causing widespread ingestion and inhalation of lead particles by residents, especially children. 

“Never before has there been a lead poisoning epidemic of this magnitude anywhere in the world. People were dying everyday. On-going exposure and blood lead absorption were higher than any previously recorded in the international literature,” Pure Earth says. 

As part remediation efforts, the report notes that contaminated soil was removed to secure landfills and replaced with clean soil after the Zamfara and the Nigerian governments formally requested the assistance from WHO, CDC, MSF and the Blacksmith Institute to address the problem.

“In total, seven villages were remediated, including 282 residential compounds. 107 exterior areas and 23 processing ponds, allowing for MSF to provide chelation treatment. The  project also removed highly contaminated material from seven ponds that were used to make bricks for compound repairs.”

In a telephone interview, the deputy director at the Zamfara Environmental Protection and Enforcement Agency, Sagir said recent findings by the agency revealed that lead poisoning has worsened in the state, due to “enforcement gaps.”

Unlike in the past, when lead poisoning was confined to mining communities such as Anka, Maru, and Bukkuyum LGAs, Ali said the agency has now found the spread of the contamination to areas with no mining activity.

“Surveillance data shows cases in nearly all LGAs, whether or not mining is happening there. Recontamination is a real issue. Despite earlier cleanup efforts, villagers resumed illegal mining in remediated areas.

“Some are villagers driven by poverty; others are outsiders. In some cases, insecurity and banditry are involved, making the situation more complex,” Sagir said.

 Double jeopardy, health and security crisis

At the time of handover in 2022, MSF project report says: “Children are no longer dying of lead poisoning,” but the organisation was still concerned that “challenges remain.” 

Shedding light on the situation, it says, “Artisanal mining is a poverty-driven activity that will persist as long as gold mining is profitable,” adding that another area with high lead concentration was discovered in Abare, a community in Anka LGA. 

Unfortunately, carrying out environmental remediation in Zamfara state has become more challenging than before largely due to armed violence, kidnapping and banditry in mining communities, said Ali.

In March 2025, a few weeks before The ICIR’s visit, gunmen killed six operatives of the Zamfara State Community Protection Guards  and four local vigilantes in Anka LGA, the epicentre of lead poisoning in the state. 

Also, a 2020 report by International Crisis Group says more than 8,000 people have been killed – with over 200,000 internally displaced and about 60,000 fleeing into the Niger Republic between 2010 to 2020.

Ali said these criminal activities have worsened environmental contamination, and invariably the resurgence of multiple heavy metal poisoning in the state.  

“To be honest, without proper security backing, many areas are inaccessible, even to us. I wouldn’t go to some of these communities without government protection,” he added.

Meanwhile, in the 2012 briefing paper, MSF warned that chelation treatment alone was ineffective without environmental remediation, as “the child continues to live in a contaminated environment and ingest lead.”

Illegal mining activities persist despite FG’s ban 

Following the resurgence of multiple heavy metal poisoning Zamfara, particularly in Bugundu LGA, the federal government recently suspended all mining activities in the state.  A statement by Dele Alake, Minister of Solid Minerals Development said the suspension would remain until new standard operating procedures were released.  

Since 2010, the federal government has placed a series of bans to curtail illegal mining activities, however, the menace has continued. Speaking on the recent outbreaks, Alake blamed traditional and local authorities for allowing illegal miners to operate in their areas.

Responding to the Minister’s allegation, the Emir of Bugundu, Hassan Attahiru said addressing illegal mining activities must start from tackling insecurity challenges. He spoke with The ICIR in an exclusive interview at his residence in Gusau.

“The bottom line is that much of the mining activity is happening in areas that are inaccessible, even to the government. Without improving the security structure, managing this issue will be extremely difficult,” he said.

Food consumers at risk 

Ibuwumi Nwachukwu, a professor of Soil Science at Michael Okpara University of Agriculture, Umudike, said the failure of the government and local authorities to end illegal mining has a far-reaching consequence on agricultural output and health of food consumers across the country.

“It’s not localised; that is what we call diffuse contamination. The danger is that, even though I’m far from that place and not directly exposed to the contaminants in the soil, I’m still at risk.

“All the food produced in those areas gets transported across the country, and anyone can buy it in the market,” said Nwachukwu, a member of Soil Science Society in Nigeria, America, and Britain.

In addition to suspending illegal mining activities, Nwachukwu urged the government to ensure remediation of lead-contaminated areas.

“There is no quick solution, but the government must stop the unregulated mining activities.”

While Sagir, the deputy director at the Zamfara Environmental Protection and Enforcement Agency sees remediation as a necessary step, he expressed worry about the capacity of the state government to carry it out.  

“The process is very expensive and complex. It involves many stages, from site characterisation to full cleanup. But if there is a proper government and international support, especially from security agencies, it’s possible,” he said.

“It is difficult to remove lead from the environment. All the contaminated soil must be removed from the villages and replaced with clean soil. This process is expensive, and some regions in Zamfara are still waiting for the contaminated soil in their villages to be removed,” explains a report titled Lead Poisoning Investigation in Northern Nigeria by the U.S. Center for Disease Control and Prevention (CDC).

Rising cases, incomplete recovery

Moments after The ICIR’s conversation with Hafsat Rabiu, the mother of two sick daughters at the Zamfara Infectious Disease Centre, an almsgiver offered her and another caregiver ₦1,000 note each. She accepted it with a faint smile and said, “thank you,” before turning her attention back to her children.

Rabiu and her children live in Rijiya, a non-mining community in Gusau, the state capital, yet affected by the recent outbreak of heavy metal poisoning. 

At the time of filing this report, the number of patients at the facility had risen . The staffer, whom The ICIR granted anonymity confirmed some discharges, but noted that majority of the patients left without full recovery, including the Rabiu sisters. 

When The ICIR inquired whether the Zamfara State government planned to reestablish partnerships with organisations like MSF as it had during previous lead poisoning crises, Gusau, the state’s Epidemiologist and Head of PHEOC, responded, “For now, all I can say is that I have been instructed by the Commissioner to treat these patients.”

Meanwhile, MSF’s 2012 Briefing Paper warned that “neither MSF nor the Nigerian authorities possess sufficient expertise to manage the crisis without assistance and advice.”

Sinafi OMANGA

Author Page

Sinafi Omanga works as a multimedia and investigative reporter at the International Centre for Investigative Reporting - ICIR. He has a keen interest in accountability, health and environmental issues.
Twitter handle:
@OmangaSinafi
Email:
somanga@icirnigeria.org