Maiduguri, Nigeria – One afternoon this August, Kaka Modu was wheeled into the emergency ward of the Umaru Shehu Stabilisation Centre in Maiduguri, the capital of the northeast Nigerian state of Borno.
The three-year-old had been brought in earlier that day from Konduga, a town 25km (15.5 miles) outside Maiduguri. She had shrunk in size and whimpered whenever her mother, Yagana Modu, adjusted her sitting position.
“She started by stooling for some days,” said Modu. “I was hoping it would stop. Then I noticed the belly and body were swollen.”
Kaka, who suffers from severe acute malnutrition (SAM), is one of more than 1.3 million children below five who are likely acutely malnourished in northeast Nigeria, according to the United Nations Food and Agriculture Organization’s (FAO’s) acute malnutrition analysis.
Food shortages and bouts of famine have affected the region for years as Boko Haram, which has been wreaking havoc since 2009, remains on a rampage. Thousands have been killed and millions displaced by the conflict.
Across the region, some 8.4 million people, primarily women and children, need humanitarian assistance, according to the UN Office for the Coordination of Humanitarian Affairs (OCHA). Many are on the edge of death, experts say.
In 2019, Boko Haram attacked the Modu family’s village of Takari in Konduga, destroying Modu’s family home and livelihood. Her family of eight was held captive for months until Nigerian soldiers recaptured the town and transferred them to Konduga to join thousands of others displaced by the conflict.
‘Health facilities … overwhelmed’
Health authorities and non-profits say the situation is squeezing available resources.
Every week, one of the three ambulances operated by the International Rescue Committee (IRC) travels to outpatient centres in Konduga and nearby communities in Borno to transport patients like Kaka. Since May, admission of SAM cases, mostly children, has skyrocketed.
“This year, we are experiencing what we have not experienced in a long time,” Martha Budidi, IRC’s nutrition manager, told Al Jazeera. “Cases of children with severe acute malnutrition are beyond normal that even all the health facilities around Maiduguri are overwhelmed.”
Daily, 30-40 of those cases are admitted into IRC’s three stabilisation centres in the state – and about 200 people weekly, its officials said.
Elsewhere, the situation is bleaker.
The NGO Doctors Without Borders (Medecins Sans Frontieres, or MSF), which has been treating malnutrition cases in Maiduguri since 2017, says there has been a record number of admissions since May, when health officials say malnutrition cases peak annually.
“Since week 30 [the last week of July], we are admitting 330 patients per week on average. In the same period, last year’s average number of weekly admissions was 69 patients.” Htet Aung Kyi, the MSF medical coordinator in Nigeria, told Al Jazeera.
This August, more patients were admitted in one week than in the entire month in the same period last year, Aung Kyi added.
Deepening food crisis
Two years ago, before armed groups struck Takari, life was good for Modu, a maize and millet farmer like her husband. Every year, they would rake in enough profits to feed the entire family.
But her fortunes changed after the attack. “I had no access to food and healthcare in captivity, so my children died,” she told Al Jazeera.
At the garrison town in Konduga, where internally displaced people (IDP) live, food is rationed so the family get one daily meal off her husband’s meagre income as a construction labourer.
Across the region, deteriorating food consumption patterns over the last year are deepening malnutrition.
The FAO’s analysis showed that 42.1 percent of households across the BAY states – Borno, Adamawa, and Yobe – had insufficient food intake, compared with 37.8 percent in the same period in 2021.
According to the organisation, the regional armed uprising has denied 65,800 farmers access to farms and agricultural inputs leading to a surge in food prices and a food crisis.
Within the Maiduguri metropolis, IDPs formerly dependent on food donations from NGOs such as Action Against Hunger and Save the Children at the camps are stuck in host communities, hungry.
Recovery and relapse
Since 2021, the Borno state government has resettled about 200,000 displaced people from relief camps across Maiduguri. While their resettlement gives them relative peace and stability, thousands are reeling from hunger.
According to a November 2022 report by Human Rights Watch, the government’s camp shutdowns exacerbated hunger and malnutrition in the city. IDPs interviewed in the report said the Borno State Emergency Management Authority (SEMA) and humanitarian organisations like Action Against Hunger stopped providing monthly food rations and cash donations that helped them buy food in Maiduguri camps.
“Once people don’t have access to food rations, it’s [malnutrition] is expected,” said Anietie Ewang, Nigeria researcher at Human Rights Watch. “For children, that’s more concerning because it has a lifetime impact on them and how they grow.”
In Maiduguri for instance, Hauwa Ali has struggled to feed her two children since being relocated from the Dalori I camp back in July. The 25-year-old is jobless, and her husband’s new life as a car mechanic’s apprentice has not taken off quite yet.
In June – and again in August – she rushed her nine-month-old daughter Hadisa to the stabilisation centre in Maiduguri and got a diagnosis of SAM with complications, including oral thrush and diarrhoea.
“The first time she was stooling and was treated,” she told Al Jazeera. “This second time I couldn’t breastfeed her, she started decreasing in weight. I noticed the symptoms one night when I checked her mouth and realized it was swollen.”
Hadisa’s is a case of relapse, which according to Ibrahim Mohammed, an IRC doctor in Bama, happens when a child returns to SAM after a recovery period. “It [relapse] can be caused by poor health or hygiene, but most times it is often the case of severe hunger,” he told Al Jazeera.
At the stabilisation centre in Bama, relapse cases are frequent due to food rationing and limited dietary choices.
Thousands of families eat only one meal a day across the region and “about 5,000 children could die of hunger if there are no resources shared to save them in the next two months”, John Mukisa, a nutrition sector coordinator for UNICEF, told Al Jazeera.
In the past, the Ali family relied on the food donated by the World Food Programme (WPF) and other donor agencies. But since relocating to a host community on the outskirts of Maiduguri in July, the household of four now eats only one meal per day.
Meanwhile, Hadisa who is on F.100, a calorie and protein formula used for quick weight gain for toddlers suffering from acute malnutrition, is recuperating.
But Ali fears another relapse is coming. “There’s nothing (food) to go back home to,” she told Al Jazeera. “I can’t feed her properly and I’m afraid she might be admitted again.”
