Persistent attacks by Boko Haram (BH) militants in Nigeria's Borno State have forced dozens of clinics to shut down and hundreds of doctors to flee, leaving many residents to seek medical attention across the border in Cameroon, health professionals and residents told IRIN.
Musa Babakura, a surgeon at University of Maiduguri Teaching Hospital (UMTH) in Maiduguri, told IRIN: "There is a growing health crisis in northern Borno, where most doctors and medical personnel have left the area due to security threat[s] from Boko Haram, forcing thousands to seek medical services across the border into Cameroon."
"The whole healthcare system in northern Borno has collapsed," he said.
As a result of doctors fleeing, many health structures in Borno are run by community health extension workers, which could have a detrimental impact on the reliability of epidemiological surveillance systems as well as the quality of care, said aid agencies. NGOs are particularly concerned about the break in procurement chains for anti-malarial drugs and bed nets.
"All the medical workers fled for fear of being attacked or kidnapped by BH, leaving empty health centres and clinics with no one to attend to the sick," said Modou Faltaye, local chief of Wulgo, a village near the Cameroon border.
In January 2013, BH seized control of a wide area in northern Borno, including Marte, Mobbar, Gubio, Guzamala, Abadam, Kukawa, Kala-Balge and Gamboru Ngala local government areas, prompting residents, including medical personnel, to flee southward to Maiduguri and southern part of Borno, where BH activities are not currently as persistent.
Despite a sweeping military offensive against BH in the area, underway since May 2013, the militant group has stepped up its attacks on civilians.
Many doctors and nurses fled after the militants stormed several hospitals and clinics, taking medical personnel to hideouts in the bush, where they were called on to treat BH's sick and injured, said Babakura. This put medical staff at risk of attack by the military, he said.
Drug access hindered
Most of the private clinics in northern Borno State, where the BH insurgency is currently concentrating, are closed, while public hospitals in the area have been emptied of medical staff.
Pharmacies, which were largely owned and run by members of the Christian Igbo ethnic group, have largely closed down, as they were often targeted by BH, with frequent looting and killings, said Gamboru Ngala resident Idrissa Kaka.
Uchenna Okonkwo relocated his drug store from Gamboru Ngala to Jalingo, in northeastern Taraba State, hundreds of kilometres away, to escape BH looting and killings. "At first BH gunmen would storm our chemists and demand huge sums of money, up to 200,000 naira (US$1,228), which we would pay to avoid being killed," Okonkwo said.
"They later got crazier by opening fire on drug store owners and taking money and drugs. A number of my colleagues were killed in this way," he told IRIN.
Resident Kaka told IRIN that, as a result of these attacks, the price of medicines has gone up by at least a third.
Babakura, the surgeon, said the same was true in Maiduguri, as transporting drugs now requires paying off the military at the numerous checkpoints that have been set up en route from Kano and the eastern city of Onitsha, the two main drug sources for the city.
Fleeing to Cameroon
Inhabitants of villages and towns on the Nigeria-Cameroon border - among them Kala-Balge, Wulgo, Zannari, Kwalaram, Logomani, Musuni, Fuye, Ndufu, Gambo Ngala - are crossing over to the nearest Cameroonian towns and villages with a health post, said residents.
There they pay four times as much as they would pay for treatment back home, but they have no choice, said Jummai Sylvanus, a nurse who fled to Maiduguri from her post at Gamboru Ngala General Hospital.
Chief Modu Faltaye, a local chief in Wulgo, told IRIN: "Our people travel as far as Kusiri, 100km into Cameroon, to get medical care because all our health facilities have closed for the past one year."
Some villagers use donkeys to transport their sick residents across the Cameroon border; others use rickshaws up until the border, where the authorities ban them from crossing, so they organize moped taxis to ferry the sick to hospitals.
"By the time the sick reach the [Cameroonian] hospital, they are in worse health state, which is why we lose a lot of our sick," said Faltaye.
Though no studies have yet been completed, Babakura predicted the rate of maternal and infant mortality was bound to rise as a result of the complications.
Routine childhood immunizations in the region were already abysmally low, said a state immunization official who asked to remain anonymous in Maiduguri, but the BH violence has further worsened the "pathetic situation", he told IRIN.
Polio and deadly fever
Routine vaccinations are now limited to the Maiduguri metropolis. And polio campaigns have stopped in many parts of the state, especially northern Borno, as vaccinators are too terrified to work there, said the immunization official.
Borno State accounted for 14 of the 53 polio cases recorded in Nigeria in 2013, according to the Global Polio Eradication Initiative.
On 14 September 2013, Borno State health commissioner Salma Anas Kolo blamed BH violence for the spread of polio in the state.
"For the eradication of polio in Nigeria and the world, we cannot afford to miss Borno and Yobe states," Pryanka Khanna, UN Children's Fund (UNICEF) spokeswoman in Nigeria, told IRIN.
Since December 2013, the fishing town of Baga, near Lake Chad, has been gripped by what residents suspect is cerebral fever. Without medical intervention, scores have died.
"People keep dying like fowl. It is acute fever characterized by severe headache and very high temperature, which kills within a few hours of contracting it," Baga resident Husseini Goni told IRIN.
Attacks along Maiduguri
People living in villages near the capital, Maiduguri, say they constantly face highway attacks by BH en route.
"People with special ailments like HIV, diabetes and hypertension need to access drugs at regular intervals, and those drugs can only found here in Maiduguri," said Kaibur Ibrahim, a doctor at UMTH. "Many of them are denied their chance to come if BH carries out a highway attack," he said
Maiduguri hospitals, meanwhile, are straining under the surge in patients, just as their health staff has dropped said Babukura.
Two of the hospital's three orthopaedic surgeons have resigned, and a number of senior consultants have taken special leave due to the continuing insecurity, said Ibrahim.