In the 70-bed Doctors Without Borders/Médecins Sans Frontières (MSF) measles unit inside Maiduguri's State Specialist Hospital, Doctor Muhammad Abdullahi checks on five-year-old patient Mustapha Osman. The boy arrived for treatment at the hospital in Nigeria's Borno state just over three days ago, and should be ready for discharge in a few days. "He's one of the lucky ones to be discharged so quickly from the hospital," says Dr. Abdullahi. "Most children we see are admitted for days, if not weeks."
MSF teams have treated 2,922 children for measles in Borno since November 2018 as part of the organization's response to a spike in cases of the potentially deadly disease. But a lack of vaccination coverage among the most vulnerable people in the region, coupled with a lack of capacity among health actors to respond to the outbreak, raise serious concerns. "Since I started practicing as a doctor in 2016, I have not seen such high numbers of measles cases in Maiduguri," says Dr. Abdullahi.
Conflict and displacement have left millions at risk
Most children suffering from measles in Borno come from internally displaced populations and the communities that host them. The decade-long conflict in northeastern Nigeria has displaced thousands of people, both within their country and across borders. The disruption and chaos have left nearly two million people dependent on humanitarian assistance for their survival.
The ongoing measles outbreak is due partly to insufficient routine vaccination, which has left thousands of children at risk of getting infected. In the four months from January to April alone, MSF teams treated 2,343 children with measles. And the number of cases in April was four times higher than in January. There are so many patients that all 73 isolation beds at Gwange Hospital, in the west of Maiduguri, are full.
"We are all working in crowded wards," says Dr. Theresa Chan, MSF medical team leader at Gwange. "The enthusiasm exhibited by the staff is the reason why we've been able to cope so far."
An unacceptable toll
"She started sneezing and had a high fever," explains the mother of a three-year-old girl who was treated at Gwange. "The inside of her lips turned red and she was constantly vomiting. I was so worried and I thought she was going to die." After nearly a month of treatment the girl recovered and was taken home by her grateful mother.
Many are not so fortunate. Some children die from measles due to complications such as severe acute malnutrition, malaria, and pneumonia. In both the State Specialist Hospital and Gwange Hospital, MSF has recorded 58 deaths since January. But this is only part of the total death toll.
"It is unacceptable that there are still high numbers of children passing away from such a treatable disease," says Caroline Masunda, MSF medical team leader in Maiduguri. "It has brought a lot of loss and a lot of sadness to the community."
To encourage uptake of services and limit the number of complicated cases that increase the mortality rate, the population must have access to free primary health care in Maiduguri. MSF is also urgently calling for better, faster coordination between all actors, including Nigerian authorities, UN agencies, and nongovernmental organizations, to provide routine vaccination to children across northeastern Nigeria to protect them against measles--and prevent future outbreaks.
MSF has been working in Nigeria since 1996 and has had a permanent presence in Borno state since 2014. MSF teams provide lifesaving medical care in northeastern Nigeria, running projects in Gwoza, Maiduguri, Monguno, Ngala, and Pulka, while our emergency teams respond to disease outbreaks and other urgent humanitarian needs.