Anka, Nigeria – Two-year-old Inno sits across her mother Safiya Jabi’s lap, her hair dishevelled, colourful beads around her neck and wrists. At intervals, she whimpers softly to get her mother’s attention, quietly protesting and trying to yank off a nasogastric tube that goes into her stomach from her right nostril.
When Inno was admitted at the Inpatient Therapeutic Feeding Centre (ITFC) at Anka general hospital in Zamfara last month, her weight had plummeted by nearly half – from 11kg to 6.6kg. She was weak and had lost her appetite. Doctors inserted the tube to aid the passage of food and medicine until she is able to eat by mouth or once again tolerate a high-calorie diet.
In the makeshift ward around them – one of four extensions built by medical NGO Doctors Without Borders, known by its French initials MSF – children receive treatment while families wait inside the hardwood, zinc and tarpaulin enclosure. The extensions and wards are filled with grandmothers and other relatives who provide a support system for the mostly sombre young mothers, whose gazes rarely leave their children.
A year ago, Safiya and Inno’s life did not look like this.
They were happy, living quietly with Safiya’s husband Ali, her father-in-law and extended family members in Maigalma – a remote mining village some 70km away. Miners, farmers and herders lived side-by-side peacefully until conflict overtook their community and eventually uprooted Safiya’s life.
It was an ordinary night in January when things changed. The family had just finished a late dinner when armed bandits on motorbikes stormed into their house. They shot Ali.
The following morning, the Hausa-Fulani herdsman was quietly buried according to Islamic rites. A week later, Safiya strapped Inno to her back and fled for her parents’ home in Anka.
Four months into her new life, she faced something she had never experienced when Ali was alive: hunger.
“Life was easier and good when he was alive; I do not lack money and food. But right now, life has been difficult since I started living with my parents,” she explained.
Safiya, who wears a chequered white, blue and black jilbab over a green head wrap, says her inability to feed Inno well enough caused her daughter’s illness.
Staple foods such as maize, millet and rice that they once had in abundance in Maigalma were now a luxury. Access to milk stopped and each day they had just one basic meal of bland maize porridge.
Soon after, Inno was diagnosed with severe acute malnutrition (SAM).
Hulking low and dusty in the scorching sun, Anka general hospital bursts at the seams from midday with dozens of mostly displaced families accompanying children diagnosed with SAM.
Inside the paediatric ward where MSF operates, the atmosphere is alive with conversations in Hausa. Groups of medical staff speak to parents and guardians about the childrens’ responses to treatment and offer brief medical advice.
Every week since 2018, an average of 60 children suffering from SAM across displaced communities in Zamfara get admitted into the paediatric ward. MSF says 7,445 children were treated for SAM between January and September this year.
Most patients come from far-flung villages, so the extensions and wards have also turned into temporary homes for their families until the patients are discharged.
At night, mothers spread thin-layered mattresses or mats on the floor beside their child’s hospital bed. They lay half-asleep most nights, keeping an eye on their child until dawn. They are provided with three meals – bread and maize porridge or bean cake for breakfast, Jollof rice and beef for lunch and the local delicacy, Tuwo Shinkafa, and soup for dinner.
Most families here, like Safiya and Inno, have fled the crisis in the northwest of Nigeria, where attacks between indigenous Hausa farmers and Fulani bandits have killed and displaced thousands of people in Zamfara since 2016.
In response, the Nigerian government intervened with two military operations between 2017 and 2019. But these failed to address the banditry crisis or curtail attacks, and killings and kidnappings have continued.
In July, the state government negotiated another peace deal with the bandits but analysts say it is a temporary solution to the complex crisis in Zamfara. A handful of bandit groups also shunned the peace negotiations and have clashed with the military.
As a result of the violence, some 60,000 people are internally displaced in Zamfara, according to a recent UNICEF assessment. In addition, the International Organization of Migration’s (IOM) Displacement Tracking Matrix found over 160,000 IDPs across the three northwestern states of Zamfara, Sokoto, and Katsina – all affected by banditry.
The displacements have also spilled into neighbouring Niger, where the UN refugee agency, UNHCR caters to 40,000 Nigerians fleeing the crisis.
‘Our livelihoods have been taken’
In Anka, Safiya misses Ali. She holds fond memories of him and recalls his diligence and sense of responsibility as a husband and father.
Before the crisis intensified in 2017 with spates of attacks and mass abductions, Safiya cultivated a field a few metres from her home in Maigalma for millets, maize and sorghum for the family. Meanwhile, Ali tended to the herd of 50 cattle she calls their “life investment”. But four months before Ali was killed, the bandits rustled the cattle at gunpoint.
“It broke my husband and my family so bad that we lost my father-in-law who died as a result of thinking too much,” she says.
Since our livelihoods have been taken, we have little to eat at my parents’ house and it contributed to my daughter’s illness.
Nigeria has a population of 200 million people. With an expanding market for milk and meat, more than 90 percent of cattle are in the hands of transhumant nomadic herdsmen in the northern region. Nigerians depend on the herdsmen in the north to meet the huge demand for meat and milk. Many Fulani pastoralists say owning a herd of cattle is similar to stashing money away in a bank, or an investment with high-profit margins.
Although cattle prices vary based on breed, location and other factors, the average price ranges from 130,000 naira ($360) to 450,000 naira ($1,244) – a substantial amount of money compared to the 18,000 naira ($49) a month minimum wage in Nigeria.
With the cattle stolen, Safiya’s family’s hopes of making a profit from their sale were dashed.
Broken, yet undeterred, Safiya and Ali resorted to farming with the intent of selling half of their crop and keeping the rest for the family. That was before Ali was killed.
This time last year, when Ali was alive, Safiya says life was good. They ate three square meals per day and had enough groceries to share with extended family. Now at the home of her parents – farmers who are also affected by the banditry crisis – it is the opposite.
“Since our livelihoods have been taken, we have little to eat at my parents’ house and it contributed to my daughter’s illness,” she says, cradling Inno.
‘Displacement can exacerbate malnutrition’
At the hospital, amid the stress of dealing with emergencies and the loud shrills of ailing children, doctors and nurses – mostly Nigerians who understand the living conditions of their patients – patiently offer treatment, guidance and medical consultations.
“Malnutrition is endemic but the fact of displacement of the population makes it more susceptible. If people cannot plant or farm something they depend on for sustenance, displacement can exacerbate malnutrition,” says Prosper Ndudumaro, an MSF project coordinator in Zamfara.
Every Monday to Thursday, SAM patients discharged from the inpatient ward are transferred to the Ambulatory Therapeutic Feeding Centers (ATFC) – the final stage of the nutrition programme – for a routine check-up and medical consultation.
Depending on the progress of a child, parents are given ready-to-use therapeutic food, a mineral and vitamin-enriched food that requires no preparation and will serve a child until the next ATFC meeting day.
Known as Plumpy’nut, it contains peanut paste, vegetable oil, sugar, and milk powder. While it tastes similar to peanut butter, each small 92g pack packs a punch. The food is designed specifically to treat SAM patients for between six to eight weeks, until the child reaches their target weight.
The ATFC programme is set up in clinics across Zamfara state, MSF says. To ascertain a malnourished child’s progress, a routine check-up is done to test their weight, height and their mid-upper arm circumference.
Little Inno has been responding well to treatment at the inpatient ward. As the next stage of her treatment approaches, Safiya, like dozens of parents who share similar stories of displacement, contemplates her next move once Inno is discharged: how to survive and keep her child healthy and well fed.
“Since reports of farmers getting killed in their farms emerged last week my parents are afraid to visit their farm,” Safiya says. “Right now there’s no hope of getting food but I have faith that God will provide.”