This update from MSF provides a rare insight into the conflict that is now having an impact across the region.
MSF OPERATIONS IN THE LAKE CHAD REGION, BY LOCATION
Clashes continue between the Nigerian military, other groups and members of Boko Haram (BH), causing population movement towards Chad. More than 18,000 Nigerian refugees are now in the Chad Lake area, according to UNHCR figures.
BH’s trans-border activities also impact the Chadian side of the lake, with population displacement and economic changes that are creating further tensions among the different communities living in the region.
The evacuation operation undertaken by the Government of Niger has caused further displacement into Chad. An estimated 6,000 persons have arrived to the village of Kaida Kindiria, a town on the Chadian border with Niger, which is inaccessible for security reasons. Over 2,000 persons crossed the lake to Hakoui Tchoulouma, a village located 95 km from Bagasola, where they were assisted.
· MSF has been responding to the displacement caused by the conflict with BH in the Lake Chad region since March 2015. In collaboration with local authorities, MSF has supplied around 6,000 people in Ngouboua, Bagasola, and nearby Forkouloum with hygiene and shelter kits. The kits included blankets and plastic sheeting, as well as mosquito nets to protect against malaria, which is endemic in the region. MSF currently also runs mobile clinics in Forkouloum, carrying out around 850 medical consultations per week mainly for respiratory infections and diarrhoea. Many of the patients are Chadian residents who have been displaced as a result of the violence.
· Psychological support has been a key part of MSF’s response. Many refugees have suffered anxiety or symptoms of depression directly linked to the violence that they witnessed or experienced. The majority of patients who MSF sees come from the Baga area in Nigeria, and fled BH violence in January 2015. MSF psychologists provide mental health care through individual and group sessions in Dar as Salam refugee camp and in Bagasola and Ngouboua. MSF also provide psychological support and medical assistance to victims of sexual violence. To date, MSF has carried out 183 mental health consultations.
The security situation along the border with Nigeria remains volatile, with regular incursions from BH despite a strong presence of Cameroon Armed Forces.
Kousseri: There are approximately 30,000 refugees and 40,000 IDPs scattered around Kousseri. The majority of people are being hosted by local communities, but some have been left without any assistance. Food security and malaria are the main health issues.
MSF is currently negotiating a Memorandum of Understanding with the health authorities to support Kousseri Hospital through surgical activities and responding to malnutrition in the area.
Maroua: According to UNHCR there are more than 34,000 people in the camps of Minawao and Gawar, at the border with Nigeria, where refugees continue to arrive on a daily basis. In terms of security, the situation is calm but BH remains active, particularly in the Kolofata area (about 40 km north of Mokolo).
MSF started to work in Maroua in February, conducting water and sanitation activities in both camps and providing medical care in the camp of Gawar, where an average of 170 medical consultations are carried out weekly. MSF is also supporting the local authorities in providing pediatric and intensive nutritional care to refugees, IDPs and local population in the Hospital of Mokolo. On 27 May, approximately 26 children were hospitalised in the intensive therapy malnutrition centre and 26 were receiving pediatric healthcare.
The conflict in northern Nigeria has forced thousands of civilians to seek refuge across the border, in different settlements in the Diffa region, southern Niger. In December 2014, the United Nations estimated that 150,000 Nigerian refugees and Nigerien returnees had arrived in the area since the beginning of the crisis in May 2013. At the end of April 2015, Nigerien authorities urged communities settled on the Lake Chad islands in Niger territories (including people from Niger, Nigeria, Chad and other nationalities) to leave the area following the deadly BH attack on Karamga Island on 25 April. Thousands of people (around 25,000-30,000 including refugees and IDPs) fled their villages for towns located near the lake, including Nguigmi and Bosso. At least 5,000 refugees from Nigeria were transported to Diffa and then transported back to Nigeria in Geidam (Yobe State).
MSF started working in Diffa last December. We were the first to respond, together with the Ministry of Health and other medical organisations, to a cholera outbreak that lasted until January 2015. In parallel, we began offering free healthcare to both refugees and the local population. In February, several BH attacks caused population displacements towards the interior of Niger and MSF’s team was evacuated for five days. People began to return late February.
MSF is currently supporting the regional mother and child health centre including the maternity, the pediatric ward and the laboratory, in Diffa town. MSF also provides a constant supply of water and electricity to the centre. At a peripheral level, MSF is supporting three health centres in Geskerou, Ngaroua and Nguigmi, where more than 16,000 medical consultations have been performed so far in 2015, 65% of which were for children under 5 years old. The main morbidities are reproductive tract infections, diarrhea, conjunctivitis and malaria.
According to the local authorities, there are currently approximately 9,000 IDPs without any assistance around Bosso, 95 km northeast of Diffa. Refugees have been forced to set up their own makeshift shelters while authorities try to organise their response. Most groups are around Yebbi (5km north of Bosso), ‘Blatoungour’ (2km of Bosso), Tchoukounjani (20 km north-west of Bosso) and Toumour (22 km west of Bosso). Security is highly volatile, with frequent BK attacks. MSF established mobile clinics in Yebbi camp (in Bosso) and in Kimegana site (Nguigmi), where MSF teams are currently providing basic health services to this displaced and isolated population. MSF will start supporting IDPs in Tchoujani and Baroua in Bosso district, as soon as the security situation permits. There is also a plan to support two additional health centres in Toumour and Baroua.
Given the ongoing meningitis epidemic in the country, MSF is reinforcing epidemiological surveillance in collaboration with the local health authorities. MSF also plans to support existing health facilities during the malaria peak in the coming months.
The security situation in northeastern Nigeria remains unpredictable and volatile. Attacks have continued in Borno State, particularly in the Kaga, Mafa, and Marte Local Government Areas (LGAs). Nigerian military operations in the Sambisa Forest, an insurgent stronghold, have resulted in the capture of four camps. Despite the Nigerian army’s major gains, return trends are erratic. There are an estimated 1.5 million insurgency-related IDPs in Nigeria, the majority in northeastern states. They have been encouraged to return to their areas of origin, but many do not have homes to go back to. Moreover, the majority of those displaced are women and children who have expressed a fear of return and face elevated risks associated with sexual and gender-based violence, forced recruitment and trafficking.
The newly-elected Nigerian President Muhammadu Buhari will be sworn in on 29 May.
Maiduguri (Borno’s state capital): There are 13 different IDP camps around Maiduguri. Large number of people is still displaced by violence, lacking healthcare services, shelter, and water and sanitation systems. Some 1,600 out of an expected 4,000 refugees have returned to Nigeria so far. The Nigeria State Emergency Management Agency (SEMA) of Borno State established a camp for these returnees in Gubio on 9 May.
A monitoring/surveillance system was introduced in two camps, Federal Training Centre (FTC) and Teachers Village (TV). Children aged between 6 months and 5 years were screened for malnutrition; 21 community workers have been trained.
MSF currently provides primary healthcare in four IDP camps near Maiduguri: National Youth Service Scheme Camp (6,611 IDPs), Arabic Teachers College (9,880 IDPs), Teachers Village (6,500 IDPs) and Gubio (4,500 IDPs), providing around 2,000 medical consultations every week. Main morbidities are respiratory infections, malaria, malnutrition, and diarrhea.
MSF set up a 72-bed hospitalisation unit at the Maimusari health centre in Jere district, a slum of Maiduguri town, to provide health services to 120,0000 people who have mostly been displaced by fighting. The facility includes 12-bed maternity and 60 beds for pediatrics, nutrition and intensive care.
MSF has built 192 latrines and 200 shelters in several camps, and we provide 3.218 million litres of water every week.
LAKE CHAD REGION CONTEXT OVERVIEW
Due to BH’s activities, the situation in Northern Nigeria remains critical, particularly in Borno State. The various military operations undertaken since 2009 by the Federal Nigerian Government have highlighted its general inability to protect civilians.
On 14 April 2014, over 270 girls were kidnapped from the Chibok secondary school, causing an international outrage and generating significant media attention. Boko Haram officially affiliated with the Islamic State of Iraq and the Levant (ISIL) on 7 March 2015. The Islamic State’s West Africa Province (Iswap), as Boko Haram now calls itself, aims to expand its regional influence, and has triggered a regional military response from countries including Nigeria, Niger, Chad and the Cameroon Armed Forces.
In March 2015, Boko Haram lost control of the Northern Nigerian towns of Bama and Gwoza, believed to be their headquarters. The Nigerian authorities said that they had taken back 11 of the 14 districts previously controlled by the Islamist group, who was believed to have retreated to the Mandara Mountains, along the Nigeria-Cameroon border.
Chad and Niger are currently coping with the impact of the violence by hosting thousands of refugees and returnees, while also facing the threat of cross-border attacks. Niger, with its population of 18 million, ranks last on the Human Development Index, while Chad falls fourth from last. According to latest figures, 2.4 million people in Chad and 2.6 million in Niger are food insecure. The international community, however, is failing to share the burden. Both countries’ humanitarian appeals are severely underfunded, at just 17 per cent for Chad and 25 per cent for Niger.