March 17, 2023
Testimonial: Midwife Sarah Ibrahim in Ethiopia
Nigeria is experiencing one of the most severe humanitarian crises of the century. With a conflict lasting well over a decade and no end in sight, the consequences have been dire for civilian’s safety and wellbeing. There are 8.4 million people in need of urgent humanitarian assistance, while the conflict has claimed 27,000 lives, mainly civilians. The conflict has also displaced 2.2 million people, with over 80% consisting of women and children.
Similar to many conflicts, it is women and girls that unfairly experience the brunt of violence. Thousands have been abducted since the conflict began in 2009. Thousands more have also endured gender-based violence, including sexual violence, trafficking and forced survival sex in exchange for food and other basic items. For vulnerable households that are threatened by poverty, many have resorted to early marriage and child labour. Furthermore, children are forced into joining armed groups as child soldiers, while some women and children are forced to wear explosive devices.
Unfortunately, the ongoing conflict is not the only crisis that is ongoing in Nigeria. Heavy rains and flooding have exacerbated the country’s food crisis, with 4.1 million people facing hunger and malnourishment. OCHA estimates that there will be 1.74 million children under 5 that will suffer from acute malnutrition, with approximately 300,000 suffering from severe malnutrition and facing a high risk of death if they don’t receive the care they urgently need.
The situation in Nigeria is dire for the millions of civilians trapped between conflict, famine, poverty and climate change. Moreover, in some states like Borno, which is in the epicenter of the conflict, security concerns remain high. Armed groups have been attacking civilians and aid workers in the region, making it difficult to provide much needed humanitarian assistance. Doctors of the World has been working in north-eastern Nigeria since 2016, striving to provide access to healthcare for vulnerable communities.
Doctors of the World has been supporting 7 different health clinics located across Northeast Nigeria, providing free comprehensive primary health care to a total of 265,751 beneficiaries, 50% of which were Internally Displaced Persons (IDPs). The DotW medical and technical supervisory team focused on providing consultations, repairing clinics as well as building capacity through provision of equipment and training. By working with the local healthcare staff, we were able to reorganize the clinics to create new triage and consulting rooms, and build new latrines. Overall, our team trained a total of 75 healthcare staff members (40 male, 35 female), including 30 community mobilizers.
One of our primary goals for this project was to strengthen surveillance of communicable diseases by implementing early warning and alert response systems, along with providing care and building rapid response to outbreaks. In 2021, DotW reported 27,556 cases of malaria, 16,488 cases of diarrhea, and 20,000 cases of acute respiratory infection. Thanks to the work done by DotW team and local healthcare staff, lifesaving services were provided in a timely manner through the implementation of triage, as well as prompt referral of emergency cases to hospitals that DotW worked with. We are proud to announce that this approach successfully led to the record of zero mortality in all of our clinics. Along with communicable diseases, DotW also focused its efforts to provide consultations for non-communicable diseases like hypertension, diabetes, and asthma. A total of 7,436 consultations were achieved in 2021.
With the stress and trauma experienced during conflict, DotW also implemented Mental Health and Psychosocial Support in its humanitarian program in Nigeria. DotW MHPSS team sought to provide mental health consultations for those coping with less severe cases of mental health conditions. Overall, 52,111 beneficiaries took part in our MPHSS services, both from the host and IDP community. The services included various approaches, such as individual counseling, group psychosocial support for beneficiaries with similar challenges, family counseling and mass sensitization.
Beneficiaries with severe mental, neurological and substance used conditions benefited from mental health consultations by the psychiatric nurses, doctors and clinicians trained on mental health Global Action programming (mhGAP) until symptoms were treated as recommended by the WHO referral focal person. Overall, DotW provided a total of 7,142 consultations at its clinics. The counselors trained on mhGAP provided Mental health and psychosocial assessments that helped them arrive with an appropriate management plan and intervention in collaboration with the beneficiaries.
The violence, instability and poverty that runs rampant in Borno has severely hindered women’s access to sexual and reproductive healthcare. In response, DotW tailored several SRH to help pregnant and lactating women, working closely along community mobilizers and midwives to be sure that more women heard about our program. Thanks to the help of our local partners who stressed the importance of antenatal care (ANC) and follow-up consultations, we saw an increased turnout of mothers attending our clinics and workshops. In total, the DotW SRH team provided 14,976 ANC consultations from 2020 to 2021. Furthermore, the distribution of 2,39 SRH kits served as incentives for the mothers and increased post-natal care (PNC) consultation visits. The SRH team also provided education workshops for mothers about birth preparedness, and raised awareness on the dangers of home delivery. The DotW midwives were able to assist 2,978 births.
In Nigeria, especially in the Borno State where the conflict is concentrated, rape and violence against women is a horrible part of the warfare tactics used by the insurgent groups, especially by Boko Haram. Boko Haram exploits female vulnerability, using rape, abduction, forced marriage and captivity to promote its jihadist agenda. Thousands of women are left to deal with the physical and mental trauma, often with little access to healthcare. To provide women with the support they desperately need and deserve, DotW has formed a two tier approach to GBV: providing healthcare and developing community projects to prevent further cases.
Our first goal was to ensure that survivors of GBV received the best possible care. The DotW GBV team trained 985 healthcare staff on how to treat survivors, including case management, counseling and medical care. Through the clinics, we were able to successfully respond to 872 GBV survivors (25 male, 847 female). The GBV team also worked to improve the consultation rooms to allow more privacy and comfort to survivors. Finally, DotW set up a toll-free line as an alternative entry point for GBV survivors to access medical care in January, 2021. For those working in the toll line, DoTW provided a 5-day training to 90 staff including crisis line attendants, social workers and clinic staff.
DotW also worked with community members to help prevent future GBV cases by implementing different awareness and protection strategies . This included training to community mobilizers on how to carry out safety planning for beneficiaries to mitigate protection risks, as well as disseminating information through health education sessions about GBV, human rights, and available health services. Between August and September 2020, the team also re-advertised two radio dramas in local languages on rape/sexual assault and child sexual abuse. In total, 121,328 beneficiaries were reached through these different sessions held by both DotW and community mobilizers.
Doctors of the World’s humanitarian response in Nigeria also seeked to improve malnourished children’s access to quality nutrition treatment and reduce the risk of child malnutrition. Within the community and our health clinics, our team screened 33,265 children (6-59 months) for malnutrition. Overall, 1,152 children were enrolled to receive a 6-week treatment for Severe Acute Malnutrition (SAM), receiving a weekly ration of Ready-to-Use Therapeutic Food (RUTF), antibiotics and vitamin A supplements, and a nutrition kit when their treatment was completed. DotW is proud to announce that we achieved a 100% cure rate, disharching all the children who came into our clinic.
To decrease the risk of child malnutrition, DotW worked with community stakeholders to hold workshops on Infant and Young Child Feeding (IYCF) and behavior change intervention. DoTW engaged with members of the community through meetings, focus group discussions and distribution of fliers to bolster the message at home. Lead mothers invited women counseled at home to participate in the cooking demonstration and prepared a variety of meals using locally available ingredients. Through this program, we were able to pass on the lesson to 32,092 beneficiaries from IDP and host communities!