Seven years of war waged by Boko Haram in northern Nigeria has left 5 million people "in urgent need of food assistance" and 250,000 children severely malnourished, the International Rescue Committee announced this week.
As aid workers reached areas in recent months that had been inaccessible for years due to the presence of Boko Haram fighters, they have scaled up their efforts in light of the suffering they've encountered.
"What is most upsetting is that this looming famine is entirely man-made," said Sarah Ndikumana, the organization's country director in Nigeria. "We are seeing countless children under 5 on the verge of death because they were given no other option than to be caught in the middle of this war."
The call for international action from the organization follows United Nations Assistant Secretary-General Toby Lanzer's recent effort to raise concern about looming starvation in the region.
"We will see, I think, a famine unlike any we have ever seen anywhere," Lanzer said in Brussels last week.
About 15 percent of children under 5 years old in northern NIgeria are reportedly malnourished, and the United Nations estimates an average of 184 children will die each day as a result of starvation and other health problems linked to the food emergency.
"It's probably one of the biggest health crises in the world right now, possibly the biggest in terms of number of people affected," said Natalie Roberts, an emergency doctor who has been managing the response for international medical charity Doctors Without Borders. "It's kind of astonishing in this day and age to see the levels of malnourishment and death in Nigeria."
Over the summer, it became increasingly clear that northern Nigeria was on the brink after humanitarian organizations finally gained access to areas previously blocked off by fighting, particularly in Borno State, the birthplace of Boko Haram.
Doctors Without Borders received military approval in June to access the once-besieged town of Bama. Flanked by a military convoy, they found 24,000 people living in a camp, 200 people dead from starvation, and hundreds of children suffering severe malnutrition. At the time, the group called the situation a "catastrophic humanitarian emergency."
Boko Haram's violent insurgency exploded in 2009 as the militants captured swathes of land in Borno and surrounding areas before moving into bordering countries like Chad and Niger. Nigeria ramped up its military campaign in the north in 2015, further isolating millions of residents from the rest of the country, food, healthcare, and trade. The fact that there was resultant suffering wasn't a surprise to aid organizations — but the scope was.
"I don't think any of us thought it would be quite as bad as it was," Roberts said.
Since June, Roberts said, Doctors Without Borders has been able to access Bama about once a month by helicopter. There is still an active frontline near the town, and the homes in Bama have been emptied out, with residents isolated in a guarded displacement camp. Relief workers are able to stay for no more than a few days at a time, Roberts explained.
The World Health Organization has since announced it would scale up its response in the region, one of the most dangerous places in the world to provide humanitarian aid. In addition to malnutrition, the UN health agency found a recent polio outbreak and a devastated local medical system.
According to Doctors Without Borders, there is even rampant malnourishment in the Borno State capital of Maiduguri, a comparativel safe city where relief efforts have been underway for several years. Hundreds of thousands of displaced person live in camps and informal shelters in and around the capital.
Roberts said there is not enough food arriving to feed the population. Relief workers can treat malnourishment and other health conditions in the meantime, but without food it's a losing battle.
"It's not a long-term solution," she said. "If the food crisis continues, they're just going to become malnourished again. The situation is getting worse and worse."
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