In October 2016, Médecins Sans Frontières (MSF) commenced primary healthcare services in Pulka town, situated on Nigeria’s border with Cameroon, which has become a last resort for people fleeing Boko Haram and the Nigerian military’s onslaught against the insurgents in Borno state. MSF’s project coordinator in Pulka, Danca Paiva, speaks to ADAM ALQALI about the medical charity’s operation in the region.
Tell us about the Médecins Sans Frontières work in Pulka?
We commenced operation in Pulka in October 2016 due to the difficult security situation and the consequent absence of adequate healthcare in the region; we felt it was important to make healthcare and other services accessible to everybody. We therefore now run a clinic that provides treatment for malnourished children and offers antenatal care for women.
Our teams also carry out water and sanitation activities like trucking water and building latrines, mainly for internally displaced people (IDPs) coming from different communities around Gwoza local government area, especially from villages bordering Cameroon, and who are also living within the compound where our clinic is.
Can you give us an idea of the number of people MSF is catering for in the area?
Recently, Pulka has registered a dramatic increase in new arrivals: more than 11,300 since January. It currently has an estimated population of 42,000, the vast majority of whom are IDPs. People arriving in Pulka have fled from different parts of Borno state where fighting is still on-going.
They report that hospitals and markets are not functioning [in their communities] because they have been destroyed and that they cannot cultivate their farmlands due to insecurity. Most of the people arriving in the town first settle inside the hospital compound, where MSF, along with other NGOs, are providing basic healthcare and other services to them.
In March, around 1,000 families (about 6,000 people) were moved to newly constructed camps but many more needed a proper shelter with services like latrines and a regular supply of water in place.
Our teams are usually on standby whenever new waves of people arrive. We carry out medical and nutritional screening on them, check their general health condition and refer those requiring further medical care to the health clinic. Most of the people arrive with nothing, in a condition that suggests they have very little.
We give them BP-5 high-calorie biscuits to help build up their strength because they are often very weak due to hypoglycemia. These people have been trapped in the conflict for a long time in areas where there are no humanitarian actors operating, so we assume that they had no access to healthcare. Most of the children, for example, had never been vaccinated.
Therefore, we sorted out children from six months to 10 years old to be included in an Expanded Programme of immunization (EPI) against measles, whooping cough etc. We then give them food and non-food items that would last them till when they are registered under the food distribution program of the World Food Programme (WFP).
What major challenges are people in the area grappling with?
In Pulka, the most common morbidities we find among our patients are acute respiratory infections, acute non-bloody watery diarrhoea, malaria, gastritis and conjunctivitis.
Our primary objective is to take care of these people’s health needs but due to the magnitude of the problems they come with and the inadequacy of the support, we have had to step in to provide shelter as well since they are also living in the compound where we work.
People are living out in the open and are very much exposed to the sun. So we try to provide them with shade and shelter, knowing that their health is in danger and the risk of an outbreak of communicable diseases is high in the camp.
That is why we also do a lot of health promotion, to ensure that people maintain a high level of personal hygiene. This is one of the most complex projects we have in Nigeria in terms of needs, context and challenges.
How big is the need for improved delivery of healthcare services and humanitarian assistance in the area?
As the population in Pulka increases, so does the pressure on the existing resources being provided by the few humanitarian actors present. For instance, we saw that the demand for water was very high and people were fighting over it, so we had to fill the gap. We created a lot of water points in the camp and organised two trucks to bring in water on a daily basis.
Currently, we are providing 4,000 litres of water per day to around 1,800 people living in the hospital compound, what makes an average of around three litres a day per person. In the newly constructed camps, OXFAM has provided several boreholes, in one of the camps; people are receiving as high as16, 000 litres of water daily from both OXFAM and MSF.
The needs are huge, and more so, there is the challenge of establishing a comprehensive referral system because of the lack of secondary healthcare facility in the area.
Right now, if something happens to someone in the night, or even during the day, and which requires urgent evacuation, we are no longer able to evacuate them due to the fact that the helicopter is not medically equipped and we can’t move our vehicles out of this place because of the security situation.