At least 17 million Nigerian children are undernourished; stunted and/or wasted, giving Nigeria the highest burden of malnutrition in Africa and the second highest in the world.
Three-year-old Salamatu's face was gaunt, her eyes sunken and her tiny hands and legs tightly covered by flesh.
Wrapped in her mother's arm in a health facility in Maiduguri, north-east Nigeria, Salamatu struggled to force a tear as a nurse wrapped a white tape around her left arm.
She had suffered from fever, diarrhoea, and low appetite in the past three days which had left her weak. Salamatu slowly parted her lips as the nurse tried to feed her with a peanut-butter paste known as RUFT, a treatment for Severe Acute Malnutrition (SAM).
Salamatu ticked all symptoms of malnourishment and was one of the many malnourished children residing at the Munna garage IDP camp in Maiduguri, Borno State.
Her mother, Fatsuma Bakari, had brought her to the health facility after she stopped eating. Although she is three, Salamatu's tiny body seems like that of an 18 -month-old.
"I am sad about my child's health and her growth but I tried my best as a mother to feed Salamatu and her siblings with the food I can get," Ms Bakari, a mother of six, said.
Ms Bakari said she prepares one proper meal a day. At night, the family snack on what is left or resort to pap which she describes as their best meal.
"We cannot afford to eat three times daily," she said.
Her situation is understandable. Ms Bakari and her family were forced to move to Munna Garage after their community in the Dikwa area of Borno State was attacked and many houses burnt down by the dreadful Boko-Haram sect.
After five of her relatives were killed in an attack, Ms Bakari, then pregnant with Salamatu, fled the community and began the journey to what she describes as a "miserable life".
Feeding has become a luxury since Ms Bakari and her family got to the camp. "We struggle to eat even one fair meal a day," she said.
Salamatu can be described as a 'victim of circumstance'. Her life would have been better if her family was still at Dikwa, a serene farming community until the blight of insurgency. None of her five older siblings suffered from malnutrition.
Behind the crisis
For more than a decade, Northern Nigeria, and specifically the North-east, has been subjected to relentless attacks by deadly groups such as Boko Haram and the Islamic State's West Africa Province (ISWAP).
The violence has caused the death of thousands of people, wreaked havoc on agricultural output and other livelihoods, cut off crucial services and caused the internal displacement of millions of people
Ms Bakari and her family are part of the 2.7 million people that have been displaced from their homes in Nigeria, according to data obtained from the Internal Displacement Monitoring Centre.
A few of these displaced persons took residence in established camps, most of which are in and around Maiduguri like the Munna Garage IDP camp. Others sought refuge in places like Abuja, Kaduna, and Lagos.
Some also moved to neighbouring countries like the Niger Republic and Cameroon.
With farms empty or destroyed, trade and livelihoods ruined and the economy battered, many displaced families find it difficult to feed. This has led to an increase in the number of malnourished children in different parts of the country.
At least 17 million Nigerian children are undernourished; stunted and/or wasted, giving Nigeria the highest burden of malnutrition in Africa and the second highest in the world.
Oftentimes, malnourishment starts from the mother's womb. "Pregnant women are expected to consume healthy diets and after delivery, the baby is expected to be placed on exclusive breastfeeding and be fed nutritious meals afterwards," Mary Makanjuola, a nutritionist told PREMIUM TIMES.
Ms Makanjuola said all these steps are essential to be in sequence in ensuring that the child is well nourished. "All nutrients are needed and in the right proportion for every child," she said.
At the time Ms Bakari fled her community, she was already pregnant with Salamatu which, according to her, worsened the situation.
She said her family walked long distances every day and night until they arrived at the camp.
During this period, the family had little or nothing to eat as they tried to survive every passing day. "I thought we would be dead by now," she said.
Vulnerable children
Children below the age of two years are most vulnerable to all forms of malnutrition - stunting, wasting, micronutrient deficiencies, and overweight and obesity - as a result of poor diets, due to their greater need for essential nutrients per kilogramme of body weight than at any other time in life.
Sadly, a 2021 UNICEF report titled 'Fed to Fail', states that many children under age two are lacking the food and nutrients they need to thrive and grow well, leading to irreversible developmental harm.
The report also indicates that nutritional intake in the first two years of life can harm children's rapidly growing bodies and brains, impacting their futures.
"The findings of the report are clear: millions of young children are not being fed diets adequate for their growth and development," UNICEF Nigeria Deputy Representative, Rushnan Murtaza, said.
The UNICEF report which analysed 91 countries including Nigeria, found that half of the children aged 6-23 months globally were not being fed the minimum recommended number of meals a day. Two-thirds did not consume the minimum number of food groups they need to thrive.
Sadly, Salamatu and other children displaced by the security crisis fall in this category. They are unable to get the foods required to support their systems which most times leaves them in a malnourished state.
"You are not alone"
Like Salamatu, there are lots of malnourished children scattered in IDP camps across the country.
Maimuna Musa, who resides at the Silumnri host community in Maiduguri, said she lost two of her children to malnutrition.
With seven children left to cater for, Ms Musa said corn meal and cassava flakes (garri) have become their favourite meals because that is the most affordable food at the camp.
She said she gets money to buy food by selling caps. But this, she said, is not a lucrative business.
"One plate is what we buy, grind and cook to eat after we sell caps and when there are no sales, we sleep like that," she said.
A nutrition officer with UNICEF, Nkeiruka Enwelum, explained that poor nutrition contributes largely to the high rate of child mortality in Nigeria.
Ms Enwelum said poor nutrition sometimes begins from the conception of the child; noting that poor nutrition from the conception of a child to two years of age results in permanent damages.
"When an expectant mother does not feed well, it affects the unborn baby," she said.
Zainab Gangare lives in Gangare community in Tarmuwa area of Yobe State. Three of nine children are malnourished.
Ms Gangare narrated how the relocation of the family to another community has affected their means of livelihood.
"We fled from Marte to Gamboro but Boko Haram fighters kept attacking every place we resided. We have lived in Balanguwa, we fled to Jemina and we left there and came here," she said.
She said living in such a place is not pleasant. "Since we got here we do not eat, we do not get food, we are hungry and I have nine children to feed every day," she said.
She also lamented that her children suffering from malnutrition lack access to RUTF.
"We went to the health centre for drugs but they didn't give us and I didn't go back again because they don't give us," she said.
A 2018 Nigeria Demographic and Health Survey shows that among children aged six to 23 months in Nigeria, only 23 per cent have the minimum necessary dietary diversity, and only 42 per cent have minimum adequate meal frequency.
Children turn beggars
Halima Shehu had fled her community in the Faskari area of Katsina State due to banditry attacks that left many residents dead and some kidnapped.
Now residing in Hayin DanMani, Igabi Local Government Area of Kaduna State, Ms Shehu said they beg to feed.
"We go round to beg. Some people give us happily and some give us grudgingly. Sometimes they say hurtful words but what can we do? We give them space and move on to the next," she said.
She said some passersby give raw food while some also give them cooked food. She, however, said this is not the best life for anyone to live as every day is a different struggle.
Falmata Bukar, residing at Silumnri host community in Maiduguri, said she too sends her children to the streets to beg.
Ms Bukar has eight children. She said since her displacement from Dalwa in Borno, feeding has become an uphill task for the family.
Narrating her ordeal, she said she gave birth to her sixth child on the road while fleeing from the attackers.
"After the attackers came, we walked for days. I was heavily pregnant at the time and gave birth on the road one evening," she said.
Ms Bukar said she has been living in the host community for over seven years but she is not sure how much longer they can survive the hardship.
"We send our kids to beg for food and when they come back we eat together," she said.
She also said her husband cannot go to work or farm due to fear of being kidnapped or killed.
Similarly, Umaru, a three years old boy residing with his family in Gangare community in Tarmuwa area of Yobe State, is still battling for his life. He was diagnosed with malnutrition in early June but getting treatment has been an uphill task for the family.
"My child is sick, the people at the health centre told me he is sick because of lack of food," Rashida Babangida, his mother, said.
Disaster looms
Unless adequate food is provided for the children and persons displaced by the security crisis, more disaster looms ahead.
At least 1.4 million children under the age of five years in Northeast Nigeria are projected to suffer from acute malnutrition in the coming years, Matthias Schmale, a United Nations representative told PREMIUM TIMES.
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Mr Schmale said starvation is already threatening the lives of millions of children in the region's war-torn states of Borno, Adamawa, and Yobe.
"I fear the harm that yet another tough lean season would bring. Severe acute malnutrition admissions in nutrition treatment centres are already at the highest levels since surveillance started in 2017," he said.
The United Nations' predictions align with a 2021 report on food security and nutrition which states that approximately 12.1 million people in Nigeria are expected to be in a food insecurity crisis by December 2022.
The report states that the crisis will affect 21 states and Nigeria's Federal Capital Territory, including 416,000 Internally Displaced Persons (IDPs).
The report also reveals that the number of people in critical phases of food insecurity may increase to about 16.9 million unless efforts are made to scale up and sustain humanitarian support and other government interventions for livelihood recovery.
These figures have also proven Nigeria is off-track the Sustainable Development Goal 2- Zero Hunger, which seeks to 'end hunger, achieve food security and improved nutrition, and promote sustainable agriculture,' all by 2030.
To change this trajectory, Ms Enwelum, the nutritionist, said the time to act is now to review not just food, but health and social protection systems.
Chidi Ezinwa, a public health expert from Enugu State University of Science and Technology, said Nigeria can no longer afford to lag on nutrition targets and the overall SDG goals.
Mr Ezinwa said the rising poverty and hunger are denying children some of their basic rights, such as the right to quality healthcare and education.
Global Malnutrition Data -2020"Now that we have this crisis, it is reasonable to think that malnutrition will be on the increase because you can't separate conflict from malnutrition and hunger," he said.
"Given the situation, we are not likely to make any progress."
The public health expert explained that SDGs cannot be realised without recognising and fulfilling the rights of children.
"The SDG index shows that many rights of children are yet to be fulfilled in Nigeria. Hence, Nigeria is far from realising the SDGs," he said.
For Nigeria to achieve SDG 2 by 2030, displaced children like Salamatu and Umaru must have access to adequate and nutritious foods to cover for the years lost.
