Security fears, a lack of humanitarian actors on the ground and a perception that Nigeria's government can handle its crises without help, are leaving many of the thousands displaced by Boko Haram violence in the northeast short of food, with little to no access to health care or basics like clean water and blankets.
The Nigerian disaster authority is calling for international help to urgently boost the aid response.
"We can't cater to needs of all [the affected] - resources are not adequate. We are trying our best to meet people's needs but it's not easy," Manzo Ezekiel, spokesperson for the National Emergency Management Agency (NEMA), which is leading the disaster response, told IRIN. "We need the help of international NGOs. The government alone cannot do it." NEMA and the State Emergency Management Agencies, (SEMA) are leading on the humanitarian response.
According to the most recent assessment by NEMA, violence displaced 249,446 people in Yobe, Borno and Adamawa states between January and March 2014. Half of the population of 12 million living in these three states are directly affected by the ongoing violence.
Extremist group, Boko Haram, has been waging a campaign of indiscriminate violence for the past few years. In its latest attack it abducted 100 schoolchildren from their school hostel in Chibok in Borno State.
Many of the displaced face "horrendous" sanitation conditions, according to NEMA, with 500 people sharing a single latrine; the already crumbling healthcare system is in a state of "entire collapse" - 37 percent of primary health centres are closed; while civilians who have experienced brutal violence have no human rights commission to address their concerns.
Most people NEMA interviewed said they had reduced their meals from three to one per day. NEMA has delivered food to 200,000 people but 50,000 had not yet received distributions as of its March assessment.
Why aid slow
Assistance has been slow to gear up for a variety of reasons. Firstly, internally displaced persons (IDPs) are hard to find, as just a fraction of them live in camps - the vast majority are staying with family or friends in state capitals, or southern states.
"IDPs fear they will be attacked in camps. They prefer moving to urban areas trying to blend with the host families. But the capacity of host families to absorb has been stretched," said Choice Okoro, OCHA's representative in Nigeria. "We have to provide assistance to a population that is not in camps and that is constantly moving," she said. "The displaced populations from the three states under a state of emergency usually live with host families, and then the host families are attacked."
NEMA has since appointed a location in flood-affected Gombe State to host IDPs, and is currently setting up coordination and camp management systems.
Boko Haram's indiscriminate violence is also hampering aid access, and negotiating access has remained difficult for aid agencies who are attempting it.
"The problem in the northeast is a security problem - we have no idea what happens from one day to the next," NEMA's Ezekiel told IRIN.
Not many humanitarian agencies are present in northeastern Nigeria, mainly because of the insecurity, and also because the government is strong and has traditionally projected an image that it is capable of taking care of its own problems, despite consistently high malnutrition levels and a crumbling health infrastructure. Only a dozen or so aid agencies are present in the northeast and just a few of them are responding to the humanitarian situation, among them the Nigerian Red Cross, ICRC, International Rescue Committee, Action against Hunger, and the UN Population Fund. Most declined IRIN's requests of an interview.
"Taken by surprise"
"This is a country that has actually harboured distressed populations from neighbouring countries [such as Niger]. and it has been [traditionally] considered one of the stable countries in this region," said OCHA's Okoro. "This is the first time that we've had this level of displacement linked to conflict and it's taken the country as well as the international community by surprise," she said.
Humanitarians want to do more but they are having difficulty finding humanitarian "entry points" she said. "We cannot operate in Nigeria like it's a country of three million when it's almost 200 million [people]."
Discussions of how to respond are gaining momentum, partly because "actors recognize that Nigeria, in terms of its regional role, cannot fall apart," she said.
Thus far European Union aid body ECHO has allocated 7.5 million euros to help meet humanitarian needs in Nigeria, including those unrelated to Boko Haram violence; but the bulk of the IDP response has been funded by a government Presidential Flood Committee set up in 2012.
NEMA, ECHO, OCHA, the International Organization for Migration, and others met on 15 April to discuss how to step up the response, including how to open better communication channels with the military to ensure places are safe to access.
The best way forward "in a context that is so fluid and so insecure", will be to collaborate with national and community-based NGOs, said Okoro.
NEMA, OCHA and operating agencies are sharing information more openly now, and NEMA says it will try to facilitate access for agencies.
OCHA and the government are working on a joint humanitarian action plan which will be launched in May and will call for US$75 million to help the conflict-affected.