More than 400,000 people in northeastern Nigeria, who have been forced to flee their homes due to ongoing violence by militant Islamist group Boko Haram, are in "urgent need" of assistance, humanitarian agencies say. This number is likely to increase as attacks against civilians escalate.
"There's a major crisis going on in the northeast, and it's not being recognized for the crisis it is," said Sarah Ndikumana, country director for the International Rescue Committee (IRC) in Nigeria. "Since late August, the insurgency movement has been aggressively and progressively taking Adamawa State over and establishing their presence, and what this means is that hundreds of thousands have fled."
This has left "countless" people without access to food, water, shelter, medical care and other basic necessities, such as clothing and soap.
"You're talking about huge movements of populations and these people flee with nothing," Ndikumana said. "These are surprise attacks, so people literally come with only their shirts on their backs. They don't know anybody, they don't have anything and many aren't getting anything."
A double suicide bombing at a busy marketplace in Borno State's largest city, Maiduguri, on 25 November, which killed "dozens" of people, is the latest in a wave of terrorist attacks in the region.
A growing crisis
At least 1.5 million people have been internally displaced since May 2013, when the Nigerian government first declared a state of emergency in the northeastern states of Adamawa, Borno and Yobe, according to the government. At least 150,000 have taken refuge in neighbouring Chad, Niger and Cameroon, according to the UN Refugee Agency. The European Union aid body ECHO says this number could be as high as 180,000.
Nigeria's National Emergency Management Agency (NEMA) says they registered nearly 700,000 internally displaced persons (IDPs) between January and November. Most have appeared within the past six months.
Following the takeover of Mubi town (in Adamawa State) by Boko Haram on 29 October, more than 20,000 IDPs were registered by NEMA at formal camps in Yola, the capital of Adamawa State, during a single week.
Tens of thousands more are believed to have taken refuge in makeshift settlements within neighbouring host communities, and remain undocumented.
"As we speak, there is still an influx of displaced people fleeing from northeastern areas," said Fernando Arroyo, head of OCHA's operations in Nigeria. "The trend has continued unabated for a very long time now, but it has really accelerated in the last few weeks."
More camps needed
There are now 12 official IDP camps in Borno State and six in Adamawa, which are operated by the State Emergency Management Agency (SEMA) with the support of NEMA and other international partners. At least four of these have opened in the last few weeks to accommodate the recent influx of IDPs.
Those that arrive at the camps are registered and given access to necessities such as food, water, health care and shelter.
The majority of IDPs, however, never make it into a formal camp. Some are turned away because the camps are overcrowded. Others are too afraid to enter the camps, and hide out in remote villages. Many people end up sleeping under trees, in abandoned churches and school buildings, or in empty fields.
"The problem is, we know for a fact that only a minority are going into formal IDP camps and the majority are moving into host communities and so it's very difficult to know how many they are and to register them in order to provide assistance," Arroyo said.
Delivering aid to these IDPs has also been a challenge.
"The people living in host communities - it's not like in camps where you can do mass distributions," said the IRC's Ndikumana. "We have to go community to community to find these people, so that makes it more complex."
Most of the spontaneous informal camps have no water, sanitation and hygiene facilities, with sanitary conditions described by some aid workers as "deplorable". Many of the health centres in the neighbouring communities have been shut down or destroyed.
Such unhygienic conditions have led to an increase in cholera, diarrhoea and other preventable diseases among IDP populations, according to the International Federation of Red Cross and Red Crescent Societies (IFRC).
"One of the challenges we are facing is the difficulty to cope with the increasing humanitarian needs," said Dénes Benczédi, a communication coordinator for the International Committee of the Red Cross (ICRC) in Nigeria. "Our capacities are limited. Our assistance remains essential for the victims, but we are covering just part of the needs."
Food security concerns
More than five million people were estimated to be food insecure across 11 states in northern Nigeria in 2014, according to OCHA.
Adamawa State now faces a phase 2, or stressed acute food insecurity, and could enter a phase 3 crisis situation, OCHA has warned. In Borno and Yobe states, food security reached crisis levels before the normal lean season in July/August, ECHO says.
Many fear these numbers could go even higher, following disruptions to this year's agriculture and trade activities, including destroyed harvests, farmland taken over by rebels, and people abandoning their fields. The government says production is down this year by 26 percent in Borno State, 21 percent in Yobe State and 14 percent in Adamawa State.
"The crisis that is playing out in northeast Nigeria is always hitting the most vulnerable hardest," said Robert Piper, the UN regional humanitarian coordinator for the Sahel. "We've already seen an impact on children, with a big jump in numbers of moderate acute malnutrition in the last six months and there are early indications of big drops in agricultural production in the three states of emergency. And at the rate things are going at the moment, the situation could well get worse."
Food prices remain high across the three states and many people have lost their main sources of income, further reducing purchasing power.
NEMA, along with partners such as IRC, ICRC and the UN Population Fund (UNFPA), have been distributing food and non-food items to IDPs both in and outside the camps, but say more assistance is needed.
"The government is doing what they can, but they don't have enough resources," Ndikumana said. "No one has enough resources. and because it's a forgotten crisis, there is not enough money or materials coming in. We try to prioritize the most vulnerable, but when everyone is hungry, how do you prioritize one person over another?"
Limited international presence
Due to ongoing security concerns, there are only a dozen or so NGOs or UN agencies currently operating in the affected areas, according to OCHA.
"The northeast of Nigeria is [a] very dangerous region to operate in," Arroyo said. "Even in Madiguri - the capital of Borno State - there is only a small concentration of humanitarian workers. But the situation is extremely worrying and probably should deserve more of our concern, both in terms of how serious it is and that the problem is only growing."
In Adamawa, the most affected state, for example, only two NGOs - IRC and Oxfam - have a permanent operational presence. They have been working alongside NEMA/SEMA, the Nigerian Red Cross and UNFPA to help reach displaced populations. The World Health Organization, the Food and Agriculture Organization and UNICEF have a monitoring presence, and ECHO, the World Bank and the US Agency for International Development are the only donors for the area.
"So the humanitarian footprint in the northeast is really quite small," said Dominic Stolarow, the emergency manager for UNICEF in Nigeria.
Those agencies that are operating, face many challenges due to poor road networks, state of emergency curfews and checkpoints. Many have had to relocate or have bases far from the priority areas.
Stepping up aid
As of mid-November, the Strategic Response Plan (SRP) for Nigeria, which was launched in February, was just 14 percent funded.
"This has really made it quite difficult to work," Stolarow said.
To help meet the growing needs, IFRC requested an emergency appeal on 5 November for US$2.8 million to assist 150,000 people who have been both directly and indirectly affected by the conflict, over the next 12 months. They also plan to open two additional sub-offices in early 2015 in Adamawa and Gombe states.
ICRC says they also plan to expand their operations into Yola and Gombe in early 2015.
In response to the events in recent weeks, ECHO pledged $6.2 million on 25 November to help IDPs in Borno, Yobe and Adamawa states. This is in addition to the $9.4 million they gave earlier this year to the region.
"It's clear that the situation is getting worse and not improving for the time being," said Yassine Gaba, ECHO's head of office in Nigeria. "More and more people are fleeing and they have no support and no assistance, and so we are trying to change that."