HKI Niger and the Lake Chad Crisis: Combating Malnutrition in a “Forgotten Emergency”

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Since February 2015, attacks by the Boko Haram terrorist group have spread from northeastern Nigeria to Cameroon, Niger and Chad, affecting a total of nearly 21 million people in what is called the Lake Chad Basin. Across the four countries, at least 2.6 million have been displaced — only to move into communities who are themselves vulnerable. These attacks have resulted in violence against civilians, displacement, and a worsening food security and nutrition crisis for millions of people. The insecurity has also interrupted normal economic activity, disrupting crop and animal production, deepening hunger and poverty, and increasing tensions within these communities.

The Diffa region of Niger, nestled in the southeastern corner of the country more than 807 miles from the capital of Niamey, is particularly affected. In the best of times, Diffa’s malnutrition rates among small children are alarmingly high, and existing structural food security and nutrition problems have been exacerbated by the conflict. Global acute malnutrition in the Diffa region now exceeds the 15 percent emergency threshold.

Helen Keller International (HKI) has been combating acute malnutrition in Niger’s Diffa region since 1987. HKI has long been a leader in preventing malnutrition in vulnerable communities while ensuring treatment of those who are malnourished. I had the opportunity to visit our program earlier this month, and the privilege of witnessing our work on the ground.

As we drove the 40 miles northeast from the regional capital to the remote outpost of Kindjandi, I was immediately struck by the endlessly repeating sight of obviously temporary villages along the paved road. Each settlement had scores or even hundreds of dwellings, traditional tents woven from local materials and reinforced by plastic sheeting provided by UNICEF, UNHCR and other humanitarian actors. In Kindjandi, the director of the local state-run health clinic told us that in the last month they treated as many patients as they normally would see in a year. A high proportion of them, particularly children, were suffering from life-threatening acute malnutrition.

In another community we visited, Boulangayasgou, villagers reported that the village’s population had nearly doubled as a result of an influx of displaced persons, refugees and returnees. One village elder told me, “Nobody is helping the displaced among us. We want to help them, but our trade and source of income has been blocked by the war.” Another added, “So much movement … we hear shooting and we are traumatized — we don’t know when we too will be forced to move.” A sense of anxiety and uncertainty about the future was palpable in all the sites we visited.

Over the course of over 19 months of crisis in Diffa, HKI has modified its activities in order to respond to increased need. We don’t work alone. Local networks of community health workers, traditional healers, midwives and model mothers—good examples of exclusive breastfeeding and other Essential Nutrition Actions — carry our message. Health workers, “Husband Schools” and “Hygiene Brigades” teach community groups nutrition and hygiene practices:  add small portions of meat or an egg to the baby’s cereal, or build a handwashing station that conserves water and serves as a visual reminder of the importance of keeping hands germ-free. They then discuss among themselves the challenges and share solutions, like inviting the mother-in-law to the meetings so they are also convinced to reserve some of the household’s precious animal source foods for the small children.
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Community volunteers are also taught to use a simple color-coded measuring tape to identify children whose arm circumference is in the red (emaciated) zone and to refer those children immediately to the health center. Because many of the families are too frightened of attacks by Boko Haram to bring their children to health centers for preventive services or treatment for illnesses, HKI has helped the health centers organize outreach visits to bring these services into the villages or encampments where refugees have settled.

The head doctor at Diffa’s state-run Center for Intensive Nutritional Recuperation, Dr. Moustapha Saley, told me HKI is a key partner for severe acute malnutrition (SAM) referrals. The current crisis has put additional stress on the system, with over one-third of the critical cases of malnutrition he sees being people displaced by the war.

HKI and other actors, including the Nigerien government, local and international NGOs, U.N. agencies, and donors (including the USAID Office of Foreign Disaster Assistance, which funds HKI’s work in Diffa region) are doing an impressive job providing support to vulnerable populations in their time of greatest need. Nevertheless, of the need remains great for immediate food supplies, therapeutic foods for children, handwashing and sanitation supplies, etc., but also in restoring community self-reliance and combating structural causes of poverty and hunger in a sustainable way. As the governor of Diffa region told us, “This is a forgotten crisis, and we need more help”.

Given the turbulent times across the globe, the Lake Chad Crisis remains a neglected and under-funded humanitarian emergency. HKI is committed to continuing efforts to support people in some of the poorest communities in Niger and around the world.