At the end of 2016, Médecins Sans Frontières started to offer primary healthcare and other services in Pulka, in the northeastern Nigerian state of Borno. Over the past few months, this small town has become a hotspot for new arrivals of people fleeing violence, and in search of food and basic services. Danca Paiva is Médecins Sans Frontières’ project coordinator in Pulka.
“Due to the difficult security situation and the absence of adequate healthcare, we felt it was important to make services accessible to everybody. We 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 villages around the Gwoza local government area (LGA), especially from villages bordering Cameroon, and who are staying within the compound where our clinic is.
"This is one of the most complex projects we have in Nigeria in terms of needs, context and challenges"
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 being IDPs. Our teams are usually on standby whenever new waves of people come. We do medical and nutritional screening, check their general health condition and refer those requiring further medical care to the health clinic. Most of the people arrive with nothing and they report that hospitals and markets are not functioning because they have been demolished, leading to limited food and health accessibility. We also provide food and non-food items. Likewise, since most of the arriving children have never been vaccinated, we’ve established an expanded programme of immunization against measles, whooping cough, etc.
In Pulka, the most common morbidities we find among our patients are acute respiratory infections, acute non-bloody watery diarrhoea, malaria, gastritis and conjunctivitis. People are living out in the open and are very exposed to the elements. We try to provide them with shade and shelter, knowing that their health is in danger because the risk of an outbreak of communicable diseases in the camp is high. We do a lot of health promotion, to ensure that people are careful to maintain a high level of personal hygiene.
The needs are huge and, on the top of this, there is the challenge of establishing a comprehensive referral system because of the lack of secondary healthcare in the area. Right now, if something happens to somebody in the night, or even during the day, that requires urgent evacuation, we are no longer able to evacuate them since the helicopter is not medically equipped and we can’t move our vehicles out of this place because of the security situation. This is one of the most complex projects we have in Nigeria in terms of needs, context and challenges.”