By Dr. Simba Tirima
MSF’s outgoing country representative in Nigeria, Dr Simba Tirima, reflects on how the disruption of aid will impact the long-term response to combating malnutrition, maternal mortality, and infectious diseases.
For the last (almost) eight years, I have had the privilege of calling Nigeria home. First as a deputy head of mission and now as the country representative, I have seen first-hand how my organization, Doctors Without Borders/Médecins Sans Frontières (MSF), has responded with compassion in the face of disease outbreaks, natural disasters, and recurring crises. I have also seen how other organisations – both international and local – have stepped up to support authorities in tackling many of these same issues. We at MSF know we can’t fix every global medical issue by ourselves; partnerships are critical.
In many ways, MSF remains as stable as ever. Because 99 percent of our funding comes from individual donors, our decisions are dictated by patients’ needs and not political priorities. But with the dramatic draw-down of funding from the US and other rich countries, we will all feel those impacts.
Nigeria is about to enter the peak season of malnutrition, which continues to afflict more Nigerian children than when I first moved here. It’s a serious condition that is not only dangerous or deadly in the short term but can also lead to long term developmental issues; stunting can occur even from moderate malnutrition. Investing in the reduction of malnutrition isn’t just humane – it’s an investment in Nigeria’s future prosperity.
In 2024, more than 250,000 children with severe acute malnutrition (SAM) were admitted to MSF- supported outpatient facilities (Out-Patient Therapeutic Program, OTP) and 76,000 acutely malnourished children with medical complications to inpatient facilities (Stabilization Centers, SC), representing an increase of 38 percent and 53 percent respectively compared to 2023.
In many of our hospitals last year, our teams saw so many children that we had to increase bed capacity, open every emergency tent we had, put mattresses in corridors and every available space, and treat two or three children per bed. Just in the case of one hospital – Katsina Hospital, the largest of our hospitals focused on malnutrition – we struggled to support the more than 25,000 children admitted to hospital over the course of the year. During the malnutrition peak, we often admitted a child every 5 minutes at the hospital because of complications of acute malnutrition. Overall, the Katsina ITFC admissions were 35 percent higher than in 2024.
Late last year, a food insecurity and malnutrition analysis – led by the Nigerian government – projected that 33.1 million people will face high levels of acute food insecurity during the 2025 lean season (June to August) — seven million more people affected than in 2024.
As we near the lean season this year, these projections are already tracking. Many of our hospitals are already seeing higher numbers than last year. In the most northwestern state of Kebbi for example, just in the month of April we admitted 41.8 percent more patients than in April 2024. In Kano State, one MSF-supported Ministry of Health primary inpatient therapeutic feeding centre (ITFC) – Unguwa Uku Primary Health Centre – is at full capacity; we are projecting that the other one we support – ITFC at Murtala Mohamed Hospital – will also soon hit capacity. MSF-supported facilities across northern Nigeria are likely to face an influx of patients, as in many areas—such as Shinkafi and Zurmi in Zamfara State—MSF is the sole provider of inpatient care for malnourished children.
While we are making the necessary arrangements to treat these projected number of patients by expanding bed capacity, recruiting more health care workers, and starting mobile clinic activities, the cuts and changes in logistics around USAID will inevitably have an impact on the northern region, where we treat people. UNICEF, for example, receives most of its funding from USAID and is a leading distributor of life-saving ready-to-use therapeutic food (RUTF) to international, national, and local organizations. Many questions and concerns remain about how these drastic changes will disrupt the flow of food to those who need it most. As more children than ever are projected to suffer from malnutrition, we need more resources – not fewer – to ensure they survive the lean season.
There are no shortages of factors contributing to this crisis. A devastating mix of rising food prices, displacement, insecurity, climate-induced crop failures, low immunisation coverage, and a lack of drinkable water and sanitation leave more children susceptible to developing malnutrition. Sustainable strategies to mitigate these factors must continue to be developed – including by MSF. But having worked on this issue for years, I know that aid funding for food alone will not solve the problem. Without it, Nigerian children will continue to die.
For decades, the humanitarian sector has operated under the assumption that if one donor withdrew, another would step in. That assumption no longer holds. New donors and solutions are critically needed at this moment to analyze RUTF needs and treatment gaps, invest in vaccination and primary health care, and tackle malnutrition in northern Nigeria.
Make no mistake, this seismic structural collapse will produce ripple effects for generations, the scale as big as pandemics. Some of those ripples will be more obvious than others, but we will all feel the impacts in one way or another. It’s up to all of us to correct the course today.
