Adama Adam, 15, cries next to the body of her baby, Fana Ali, on September 28. Fana was unable to get to a hospital for treatment because of the war zone. Photo /Jane Hahn for The Washington Post
Adama Adam, 15, cries next to the body of her baby, Fana Ali, on September 28. Fana was unable to get to a hospital for treatment because of the war zone. Photo /Jane Hahn for The Washington Post
They survived Boko Haram. Now many of them are on the brink of starvation.
Across the northeastern corner of this country, more than three million people displaced and isolated by the militants are facing one of the world's biggest humanitarian disasters. Every day, more children are dying because there isn't enough food. Curable illnesses are killing others. Even polio has returned.
About a million and a half of the victims have fled the Islamist extremists and are living in makeshift camps, bombed-out buildings and host communities, receiving minimal supplies from international organisations. An additional two million people, according to the United Nations, are still inaccessible because of the Boko Haram fighters, who control their villages or patrol the surrounding areas.
"We will see, I think, a famine unlike any we have ever seen anywhere," unless immediate assistance is provided, said Toby Lanzer, the top UN official focused on humanitarian aid for the region.
The staggering hunger crisis created by the insurgents has been largely hidden from view, partly because it has been extremely dangerous for aid groups and journalists to visit the area. But institutional failures have exacerbated the situation: For over a year, the United Nations and humanitarian groups dramatically underestimated the size of the disaster, and the Nigerian government refused to acknowledge the huge number of people going hungry in Africa's second-richest nation. Thousands of people have already died because of the inaction, aid experts say.
"It's just a complete failure of the system," said Natalie Roberts, an emergency programme manager with Doctors Without Borders, an international aid group.
It took over a year for UN humanitarian teams to arrive in cities that were "liberated" from the rebels by the Nigerian military in a major offensive starting in early 2015. Until recently, the United Nations had only tiny staffs working in the northeast. The world body had deferred to Nigeria's woefully unprepared government agencies to provide assistance, not realising, UN officials said, the scale of the disaster.
Even now, the United Nations admits that it is distributing food to only a fraction of those who need it. It says its mission in Borno state, the focus of the crisis, is dramatically underfunded. UNICEF warned recently that as many as 75,000 children will die in famine-like conditions in Borno and two adjacent states over the next year unless more assistance arrives.
The rising toll of the crisis is evident in such places as Banki, a city of about 15,000 near the Cameroonian border that was controlled by Boko Haram until a year ago. On a recent morning, four malnourished children writhed in beds in a clinic run by Doctors Without Borders.
Doctor Belen Ramirez Bourdages, left, and nurse Thomas Ngoune treat Fana Ali, 6 months, at a clinic in Banki, last month. The baby weighed 12 pounds. Photo / Jane Hahn for The Washington Post
One of them, Fana Ali, was 6 months old but weighed only 12 pounds (5kg), her skeletal frame convulsing with each breath. She wore a tiny, bright yellow dress and she had big brown eyes. A doctor fed her sugar water through a syringe. She locked her lips around it.
Less than an hour after she arrived at the clinic, health workers decided Fana needed to be evacuated to a hospital with electricity and more medicine. Xavier Henry, the local coordinator for Doctors Without Borders, called the Cameroonian military for an escort. This is still a war zone, and access to roads is largely dictated by the armed forces in the region.
But the request was rejected without explanation. Thirty minutes later, Fana died. She had malaria and severe acute malnutrition.
The baby's aunt carried the body back to their two-room home. Fana's mother, Adama Adam, wept, the tears streaking onto the blue headscarf wrapped under her chin. She was only 15, her skinny arms mostly hidden under flowing clothes.
"We never have enough food," said Jeme Bukar, Adam's cousin, who lives in the same house.
Male relatives washed Fana's tiny body and placed it in a wheelbarrow. Then they picked up shovels and axes, walking toward the packed cemetery just outside the town.
"I tried to call for the escort," said Henry, shaking his head, his voice cracking.
His last posting was in Yemen, where yet another hunger crisis was unfolding. But the desperation and the scale of the problem in Nigeria have leveled him.
Family members wash Fana's body before her burial. Fana died on September 28. Photo / Jane Hahn for The Washington Post
Progress too slow
In 2014, after years of guerrilla attacks, Boko Haram fighters swept across Borno, forcibly recruiting young men to fight and detaining young women in what effectively became rape camps. The insurgents killed thousands of civilians. The rebels became notorious worldwide in 2014 for kidnapping nearly 300 schoolgirls, an atrocity that prompted the "Bring Back Our Girls" campaign. Less well-known was the insurgents' destruction of the agricultural output of Borno, a Belgium-size state that was once a breadbasket for the region.
The Nigerian military, working with the armies of neighboring countries, launched an offensive in 2015 that reclaimed major cities across Borno. But Boko Haram fighters still moved freely throughout much of the vast countryside. Often, humanitarian workers say, it was too dangerous to send food to those areas, and it wasn't even possible to learn the level of need in isolated cities. Only the military moved around much of the state.
Even as malnutrition rates soared, army commanders in this oil-rich country were reluctant to call for international assistance. They finally did so in June. Now aid trucks can move along some roads.
A Nigerian Defense Ministry spokesman, Brig. Gen. Rabe Abubakar, defended the performance, saying that security was the first priority of the armed forces.
"We had to get that right before we started providing for these people. Nobody predicted this kind of situation would exist," he said.
But aid workers acknowledge that they only belatedly realized that the crisis had outstripped the government's ability to respond.
"Progress was far too slow in jointly recognizing the enormity of the situation," said Simon Taylor, the deputy head of the UN Office for the Coordination of Humanitarian Affairs (OCHA) in Nigeria.
"Initially there was a sense that it could be handled by the state authorities," said another U.N. official, who spoke on the condition of anonymity for diplomatic reasons. "It was only in April when we realised the magnitude, and the fact the government couldn't handle this alone."
When aid groups did start to get access to some cities in Borno this past summer, they were shocked by what they found. People were eating grass and locusts. The rates of severe acute malnutrition - a life-threatening lack of food - were among the highest in the world. About half of all children were malnourished. In August, two children were found paralyzed by polio after eradication campaigns were cut back because of insecurity. They were the first recorded polio cases in Africa in almost two years.
Yet even now, after the crisis has been acknowledged, many people in "accessible" areas where food aid is meant to be arriving are going hungry. In some cases, humanitarian groups say they are still trying to determine where the needs are.
A camp on the outskirts of Monguno, Nigeria, on September 27. The town, which has 60,000 people, is hosting more than 140,000 internally displaced people. Photo / Jane Hahn for The Washington Post
"Every time I think I know how bad it is, we get more data and it's worse," said Arjan de Wagt, the head of nutrition at UNICEF in Nigeria.
In parts of Maiduguri, the relatively safe capital of Borno, where more than a million people fled and where aid groups have been working for two years, many are still dying of malnutrition. There is not enough food being distributed in enough places to sustain them. The mortality rate in some camps and informal settlements is five times what is considered an emergency, according to Doctors Without Borders.
"Each time we hear of these [gaps in aid] we try and verify and, if we can, begin a distribution," said Mutinta Chimuka, the head of field operations for the World Food Program in northeastern Nigeria.
The government still does not publicly acknowledge how dangerous the state remains. Last month, President Muhammadu Buhari said in a speech that residents in Borno and neighboring Yobe and Adamawa states lived in relative safety. "Commuters can travel between cities, towns and villages without fear," he said.
But in July, a UN convoy was attacked by Boko Haram gunmen outside the city of Bama, which is east of Maiduguri. The vehicles were armoured and no one was injured.
In August, the United Nations sent two helicopters to Maiduguri, to fly humanitarian workers to reclaimed cities across Borno. Late last month, a Washington Post reporter and photographer traveled with aid workers to three newly accessible cities across the state.
But a huge portion of the state is still off-limits, too dangerous for the helicopters to land.
"You look out the window and you wonder: How bad are things down there? We just don't know," said Carmen Yip, an emergency health coordinator with the International Rescue Committee.
The city of Gwoza, the former headquarters of Boko Haram, is still scarred by the years insurgents ran it. Hundreds of buildings are charred, missing roofs and crumbling from rocket-inflicted damage.
Now, the city is controlled by Nigerian forces. Days after they seized the town in March 2015, Gen. Chris Olukolade, a military spokesman, visited from the capital with a group of journalists, telling residents, "Everything you have gone through is very bad, but this is the end."
But more than a year later, many of those living here are barely surviving.
Ramatu Musa, 22, and her extended family live in a bombed-out house near the center of the city. They fled from nearby Hambada village over a year ago, after Boko Haram fighters overran it.
They have enough food to eat only one meal a day, and Musa has struggled to feed her baby daughter.
In many cases across Borno, mothers are eating so little that they are unable to breast-feed - a major cause of child malnutrition. At a UNICEF clinic in Gwoza, one doctor reported seeing as many as 70 malnourished children a day.
"We need more food, oxygen, a blood bank, IVs, an ultrasound," said Ernest Okoli, a doctor, standing outside his clinic in a former courthouse, where patients were being treated on the floor. "Should I go on?
Many of the hungry are hidden away in war-ravaged neighbourhoods and haven't been included in any rough population count. The United Nations estimates that there are about 36,000 displaced people in Gwoza. But the top military commander there put the figure at 80,000.
Hamadu Husseiny, 28, keeps an eye out for beans that had fallen during food distribution last month at a camp in Monguno, Nigeria. Photo / Jane Hahn for The Washington Post
More are coming every day.
When they arrive here, escapees tell of villages under Boko Haram control, some of them taken recently.
"They destroyed everything," said Alima Auza, 30, who escaped as her village of Bura Manga was attacked by insurgents last month.
The Nigerian military has formulated its own strategy to end the war: starve the enemy. It is now blocking all food, including from regional markets, from entering parts of Borno where Boko Haram might be lurking.
That has contributed to the possibility that hundreds of thousands of civilians held or isolated by insurgents could starve alongside fighters.
"We know when we get there, we are going to see some scenes that will disturb us greatly," Taylor said.
Kevin Sieff has been The Washington Post's Africa bureau chief since 2014.
