Violent clashes in northcentral Nigeria have forced tens of thousands of people from their homes in recent years. Many have settled in camps around Makurdi, the capital of Benue state. Living conditions in the camps are precarious and daily life is a struggle, particularly for women.

After receiving reports of alarming levels of sexual violence against women and girls in the camps, Médecins Sans Frontières (MSF) teams are providing survivors with medical and psychological care. Some survivors have shared their stories.

“He promised me that he would give me money and asked me to meet him at a house outside the camp,” says Iyua*, a mother of six who lives in Mbawa camp, some 20 kilometres north of the state capital Makurdi. Desperate to borrow money to buy food for her children, she had asked the man, who was an acquaintance, for help.

“When I arrived there, he said he would help me only if I had sex with him. I refused, but he physically forced me,” she says. Following the sexual assault, Iyua sought treatment at MSF’s clinic in the camp, which provides care for survivors of sexual violence.

Benue state is an agricultural region in northcentral Nigeria, often known as Nigeria’s food basket, crossed by the country’s second largest waterway, the Benue River. In recent years, insecurity in northern Nigeria has forced many herders to move south into the northcentral region, while climate change and environmental degradation have reduced the availability of fertile land.

The enactment of a law in 2017 prohibiting open grazing led to the exodus of herders from Benue state who could not sustain their traditional way of life, leading to an intensification of armed clashes between herders and farmers. The resulting violence has displaced almost 400,000 people from their homes, according to the International Organization for Migration, with many settling in camps across Benue state.

Life in the camps is a struggle. Living conditions are precarious and unsanitary, while there are severe shortages of food, drinking water and basic services, including healthcare. There are also alarming levels of sexual violence, aggravated by impoverishment, power imbalances between women and men, people’s limited means to earn a living, and the wider context of violence.

According to MSF data, the majority of perpetrators of sexual violence are intimate partners of survivors, but sexual violence is also perpetrated by acquaintances and strangers, whether civilians or non-civilians. Often the lone providers for their families, many women have no choice but to leave the camps in search of food and wood for fuel, exposing themselves to the risk of sexual violence.

Dooshima*, a schoolgirl, was working on a farm one day when she was forced by her mother and sister to take a motorbike ride with men she did not know.

“As we were approaching a village, a crowd of people started shouting, singing and cheering,” she says. “I recognised wedding songs.”

At that moment Dooshima realised she had been sold by her family into marriage. Such was her desperation that she remembers wondering if she had anything with her that she could use to kill herself.

After being married to a man 30 years her senior, Dooshima was locked up in a small house. She tried to escape but was recaptured and beaten. After three days of being kept prisoner, her husband came into the house and raped her. Dooshima ran away again and this time evaded capture.

Reaching home, Dooshima found herself rejected by her family. “My mother did not want to see me ever again,” she says. “She took all my belongings, including my school uniform and books, and burnt everything”.

After seeking medical treatment from MSF, Dooshima discovered she was pregnant and decided to have an abortion.

Now Dooshima is selling oranges to make enough money to replace the clothes her mother burned. She plans to learn how to sew so that she can earn enough to buy books and go back to school. More than anything, she wants to continue her education. “I would like to become a doctor and save lives,” she says.

Shiana* moved to Mbawa camp five years ago with her older sister. She gave birth to two babies, but both died in early childhood. Since her own childhood, Shiana has been living with a disability.

“I was asleep when someone knocked on my door at night,” she says. “The man promised to bring me something to eat, then he forced the door of my tent, as the lock was broken, and insisted on having sex with me. I refused and tried to push him away but he squeezed my arms and raped me.”

Shiana was sexually assaulted twice by men who forced their way into her tent taking advantage of her physical disability. “Last night again, a man came and tried to enter, but I woke up quickly enough and blocked the door from the inside; this happens regularly in the camp,” she says.

Shiana has no means of earning money, but sometimes walks to a nearby market to pick up spilt grain from the ground, which she collects and sells.

A few tents away from Shiana lives Seember*. Seember’s husband was a farmer who was killed in a night-time attack. “My husband was captured and shot when he tried to run out of the house,” she says. “He was lying dead on the ground when another man came and cut off his head with a machete.”

Seember and her two children escaped and fled to Mbawa camp. In April 2023, she was working on a farm, harvesting crops with other women, when they were ambushed by five men – three with guns and two with machetes. The men discussed whether to kill them but decided to rape them instead.

“When I saw these men arriving in the field, I felt anger,” she says. “I thought of my husband´s death and thought it was my turn to leave this world, but I refrained from defending myself against the perpetrators so that I could remain alive to take care of my children.”

The rape left Seember unable to walk unaided. A relative brought her to MSF’s clinic in Mbawa camp, where she received medical care and mental health support.

Seember says that she feels very lonely without her husband and that when she sits by herself the disturbing memories come flooding back. Her teenage son Fanan does his best to comfort and distract her by making her laugh or plaiting her hair.

Iyua, Dooshima, Shiana and Seember are just four among thousands of women and girls living in camps in Benue state who have survived sexual violence. Without preventive action, MSF warns that the risks for women will continue to escalate.

“It is important to highlight that the social environment is not getting better,” says Resit Elcin, MSF project coordinator in Nigeria. “There is a lack of livelihood options for displaced people, particularly for women, and protection and prevention efforts are barely in place. The situation is not improving.

“Survivors of sexual violence, both in Benue state and across Nigeria, deserve access to free-of-charge and quality medical care and mental health support,” says Elcin.

“Women and girls need access to services including safe housing and emergency shelter, legal assistance, and livelihood and financial support. The key to preventing sexual violence is to address people’s humanitarian needs and ensure that vulnerable people are safe within the camps,” he says.

“Humanitarian and development organisations, both local and international, must work alongside the Nigerian authorities to ensure that medical and psychological support is freely available to survivors of sexual violence in Benue state and, more broadly, to support displaced communities regain their dignity and control over their lives,” he says.

*Names changed to protect patients’ identities

MSF launched an emergency response to assist displaced people in Benue state in 2018, providing them with medical care, including sexual and reproductive healthcare and comprehensive care for survivors of sexual violence. In 2023, MSF teams in Benue treated more than 1,700 survivors of sexual violence.

Distributed by APO Group on behalf of Médecins sans frontières (MSF).

The Republic of Namibia has achieved high food self-sufficiency levels, thanks to sustained output from smallholder and large-scale farmers and WFP’s support for end-to-end food systems in Namibia. For the first time in fifteen years, the country has reached 45 percent self-sufficiency.

Namibia, a desert nation, has significantly reduced food imports, especially for staple grains such as maize, pearl millet, and wheat. Collaborative efforts between farmers, agro processors and industry marketing agreements that have boosted crop production, market access, and overall sustainability. Lawrence Sampofu, Governor of Zambezi Region, highlighted the region’s significant contribution to white maize and pearl millet grains, emphasizing the need for farmers to utilize fertile land and favourable rainfall. He said the Zambezi region accounts for seven percent of white maize and 25 percent of pearl millet grain production.

The Namibian Agronomic Board regulates agronomic and horticultural product movement, facilitating import restrictions to protect local producers from competition and promote food self-sufficiency through the market share promotion, special controlled products, and grain marketing schemes.

“The objective is to expand operations, increase crop production, and propel Namibia towards food self-sufficiency while diminishing dependence on imports,” said Dr. Fidelis Mwazi, Chief Executive Officer of the NAB. “We reaffirm our commitment to implementing a robust import substitution programme, including initiatives like the MSP, to create a conducive environment and a thriving market for local farmers.”

The UN World Food Programme is promoting end-to-end food systems in Namibia, providing climate-smart technology, drought-resistant seeds, infrastructure investment, clean energy, market access, and agricultural training.

“Over the years, WFP has been complementing the Government of Namibia’s priorities in scaling up domestic food production, facilitating partnerships and investments that enable the country to capture greater value from the food system as well as strengthen systems and structures that demonstrate efficiency and effectiveness to deliver on this mandate,” said George Fedha, WFP’s Representative and Country Director in Namibia.

WFP provides technical support to the government to help strengthen food systems value chain as well as accelerate rural transformation towards the attainment of Zero Hunger.

Distributed by APO Group on behalf of World Food Programme (WFP).

Sitting holding her newborn in the courtyard of her home, Aissata*, a displaced person in Ménaka city centre, remembers the day she fell ill while pregnant. “My stomach hurt that day, I was weak and I had no appetite. Worst of all, I had no money and my husband was away,” she recalls.

The living conditions of Aissata and her family deteriorated dramatically when they were forced to leave Anderamboukane in 2021, due to security concerns. Now, she is among hundreds of thousands of Malians whose access to quality health care has been negatively impacted by the country’s security crisis.

In 2023, more than 72 500 people were displaced in Mali as a result of clashes between rival armed groups, inter-community conflicts and military operations by the Malian armed forces against non-state armed groups. The regions of Gao, Kidal, Ménaka, Mopti, Taoudénit and Timbuktu are worst impacted, along with certain areas in the south of the country.

The security situation has resulted in shortages of medical staff, with several health institutions no longer operational. In the Menaka region, the situation is exacerbated by a shortage of medicines and medical equipment.

“The crisis has also escalated the number of patients seeking treatment, with the living conditions of displaced and low-income households aggravating promiscuity, » explains Dr Tiangoura Traoré, head doctor in the Menaka district. The district is also struggling with increased incidence of acute respiratory infections, acute malnutrition and associated complications, diarrhoeal diseases, malaria, dermatitis and chronic diseases such as high blood pressure.

To help Mali maintain delivery of quality health services in areas impacted by insecurity, World Health Organization (WHO), supported by the Central Emergency Response Fund (CERF), is providing medicines and other consumables to the Health Ministry, and helping to upskill health workers on the ground. WHO is also supporting mobile clinics to reach isolated populations in the centre of Menaka and the two districts worst impacted by the insecurity, Tidermane and Anderamboukane.

Between July 2022 and January 2023, WHO provided vital medical and nutritional assistance to almost 75 000 people affected by the humanitarian crisis in the Menaka region. Working with partners, the organisation provided critical health and nutritional assistance to almost 4000 children under the age of five, referred 1034 malnourished children to appropriate treatment units, and supplied paediatric medicines and equipment for around 500 children.

WHO also supported awareness-raising sessions on good nutritional practices and infant feeding for almost 1400 pregnant or breast-feeding women, and trained 67 community support facilitators, 13 health workers in the management of severe acute malnutrition, and 123 humanitarian workers in psychological first aid.

“WHO’s support is helping to improve access to free health care for the population. The staff are motivated and available, and care is being made accessible to people in remote areas via the mobile teams,” Dr Traoré adds.

CERF support enabled WHO to initiate a large-scale, coordinated multisectoral response to this humanitarian crisis, in order to meet the growing health needs of affected populations in the Menaka region.

« WHO’s reinforced presence on the ground symbolises much more than the delivery of medical equipment. It is an ongoing commitment to the health of displaced people and host communities,” says Dr Christian Itama, WHO Representative in Mali. “It is also a pledge of continued support to ensure access to desperately needed essential health services by these vulnerable people. »

Mohamed Toure was among those who underwent training in epidemiological surveillance, rumour management and psychological support. Along with conducting active research, passive surveillance, data collection and rapid detection of incidents of side-effects following vaccination, Toure is also equipped to offer psychological support. “My role is to provide relief to survivors while helping to reduce their fear and stress, so that they can access health care with confidence and remain in good health,” he explains. 

Ongoing health assistance is continuing to ensure free access to quality health care and improved health of IDPs and the host population.

Thanks to the mobile clinics, Aissata was able to receive the care she needed. “A friend told me about the free care provided by health workers who come in a vehicle. I was also given free medicines. »

She was monitored throughout her pregnancy, which saved her life and that of her baby. « If it wasn’t for the free consultation that day, I don’t know what I would have done, » the young mother says.

Distributed by APO Group on behalf of WHO Regional Office for Africa.

Twenty-five-year-old Yainkain Sesay is expecting her first child. Before her first antenatal visit to King Harman Maternity and Child Hospital in Freetown, Sierra Leone’s capital city, she was anxious. “When I visited the hospital before I was pregnant, it was hard because I couldn’t afford to pay for all the treatment,” she says. But when she returned this time, she was pleasantly surprised. “The health services here are good and I feel safe. They don’t ask for money and they provide good treatment. Pregnant women like me are treated well.”

The change that Sesay has experienced is due to continuing efforts by government to promote the right to health for all people in the country. A new strategy, developed by the Government of Sierra Leone with support from World Health Organization (WHO) and launched in May 2023, aims to entrench a people-centred life stages approach to health care, strengthening health systems and advancing the country towards universal health coverage (UHC). 

“The person-centred life stages approach seeks to provide holistic one-stop care for clients, through integration of services and mechanisms. It requires investment in primary health care systems to provide health promotion, disease prevention, curative, rehabilitative and palliative services at all life stages, leaving no one behind,” explains Dr Austin Demby, Sierra Leone’s Minister of Health.

According to data from WHO, in 2021 the UHC service coverage index in Sierra Leone was 41 out of 100, a medium ranking. The service coverage index uses a selection of indicators to represent overall coverage of essential health services across the entire population in a country, ranked from zero (worst) to 100 (best) and is used to measure progress towards the Sustainable Development Goals related to UHC.  Sierra Leone’s has almost tripled since 2000, when it was ranked very low at 14 out of 100. The country has made efforts to improve health services amid challenges including the devastating Ebola outbreak in 2014 and the COVID-19 pandemic, which stretched the health system to the limit.

This improvement is in part thanks to Government’s free health care for pregnant women, lactating mothers and under-5 children since 2010. With the new strategy, government aims to accelerate progress towards its ambitious 2030 goal, which is that all people in Sierra Leone will have equitable access to quality and affordable health services without any undue financial hardship.

The approach is being rolled out to cover the whole country. The Community Health Officer at the Waterloo Community Health Centre in Freetown, Emmanuel Marcathy, says that in the past year the centre has made significant changes that are encouraging patients back in large numbers.

“One of the key issues we identified was the inadequacy of the facilities to support patients. We focused on improving staff attitude and upskilled nurses in various clinical procedures. The free health care programme is thriving in our facility, with consistent drug supplies, particularly for people like under-5 children, pregnant women and lactating mothers,” he says.

Mariama Bah, a midwife at King Harman Maternity and Child Hospital, is grateful to witness the extensive infrastructure changes and repairs that she says have transformed care. Among these are improved drug availability and testing capacity, sufficient beds and improved support, especially for pregnant women.

“Over the past two years in the new building, the hospital proudly recorded zero maternal deaths, reflecting our commitment to quality health care, despite the challenges we face,” Bah says.

The country has taken other steps to put policy into action. In May 2023, the government worked closely with WHO to conduct a Universal Health Preparedness Review, a process designed to bolster health emergency preparedness and response, while simultaneously building health system capacity to deliver quality universal health care. One of the recommendations of the review was to establish a national public health agency, a pivotal step in the country’s journey towards UHC. Seven months later, in December 2023, the country launched the agency, a foundational institution that will provide science-based leadership, expertise and coordination for public health efforts.

Commending the Government of Sierra Leone for the significant achievements in improving health and well-being since the 2014 Ebola outbreak, WHO Representative in Sierra Leone, Dr Innocent Nuwagira, is upbeat about the progress being made. “Government is committed to the process. We have seen remarkable change, high-level commitment and partner collaboration,” he says. “WHO will continue to support the government towards meeting the set targets as we advance to the year 2030.”

It has been a long and complex process of identifying gaps and strengths, and this has translated into many opportunities for improvement, says Dr Demby. “We must ensure the availability of strong programmes throughout the life course, while superimposing on that a system for early detection and effective response to outbreaks and emergencies. Those are all the hallmarks of the universal health coverage,” he says.

For users like Sesay, the changes have brought about a sense of peace for the future. “Since I registered at the hospital as a pregnant woman, I’ve never regretted it. I look forward to delivering here safely,” she says.    

Distributed by APO Group on behalf of World Health Organization – Sierra Leone.