WHO teams assist people in hard-to-reach areas of Nigeria
Medical teams supported by WHO set up mobile clinics in hard to access areas of north-eastern Nigeria. The teams are called “hard-to-reach” teams (HTR) because their mission is to reach remote and insecure areas to provide urgently needed care to populations deprived of essential health services. The 8-year conflict has caused widespread forced displacement and acute food and nutrition insecurity. Large areas of Borno state, the most-affected state, remain inaccessible to humanitarian assistance.
The years of violent conflict in north-eastern Nigeria have deprived millions of people of even the most basic of health care services. The full scale of the humanitarian crisis begins to be revealed as towns and villages, previously occupied by armed groups, gradually become more accessible. Malnutrition is widespread and nearly 6 million men, women, children and infants urgently need health assistance.
Two-thirds of hospitals, clinics and other health facilities in the most affected states have been completely or partially damaged. Those that are functioning are often difficult to access, are short of health-care staff, lack basic medical equipment and medicines and seldom have access to safe water. As a result, the mobile teams set-up makeshift clinics under the shade of trees. Humanitarian partners are scaling up their response to the crisis, but with ongoing insecurity, reaching those in need in remote communities or internal displacement camps can be difficult and dangerous.
HTR medical teams are bringing basic health-care services to remote communities and to populations displaced by conflict. Ongoing insecurity means the teams are often based in towns that can only be reached by helicopter. From these bases, they deploy on a daily basis to surrounding areas, setting up clinics under trees to provide life-saving health care.
In a small village, a crowd of women and children wait patiently in the midday sun to be treated by one of the 24 HTR teams. Three-month-old Abubakar is the youngest of Zainab’s 7 children and is having breathing difficulties. But Zainab has a fever too. The health worker tests her for malaria and assesses Abubakar to see if he can be treated by the team or needs to be referred to the nearest functioning health-care facility. Malaria is the most common cause of disease and death in the conflict-affected zone, but acute respiratory infection also claims many lives.
Screening for severe acute malnutrition (SAM) is one of the key activities of the HTR teams. Malnourished children are particularly vulnerable to vaccine-preventable diseases, like measles and diphtheria, and to respiratory and diarrhoeal diseases. The combination of these diseases together with high levels of SAM in Borno State has led to under-5 mortality rates up to 4 times higher than international emergency thresholds. Children and babies identified with SAM are referred to government- and partner-run facilities, where they can receive therapeutic feeding.
Here the teams are attending induction training before deploying to the field. Teams are made up of nurses, midwives and community health workers. In addition to screening for SAM and testing and treating for malaria, the teams carry out a number of other vital primary health-care functions, including vaccinating children against polio, measles, yellow fever and other diseases normally included in routine immunization programmes.
Pregnant women who have been unable to access basic antenatal care are monitored by the HTR teams, given folic acid and iron supplements and, where necessary, receive intermittent preventive treatment for malaria. The HTR teams return at least once a month, as the security situation permits, ensuring continuity of care for pregnant women and for routine immunizations.
The teams dispense medicines to treat malaria and minor ailments, as well as vitamin A supplements and deworming tablets for children. The teams also carry out health promotion activities, teaching communities about important practices, such as hygiene and exclusive breastfeeding.
The 24 HTR teams give consultations to approximately 4000 people every week. This is just one of the mechanisms put in place by the government, WHO and partners, and other organizations working to scale up the response to the crisis and deliver essential, life-saving health services to conflict-affected areas.