Thirty years in Nigeria: responding to crises, standing with communities

A child struggling to breathe in a crowded emergency room. A mother walking for hours to find treatment for her malnourished child. A family forced from their home by conflict, losing access to healthcare along the way. A community confronting an outbreak of a disease that is preventable. 

For millions of people across Nigeria, these are not isolated stories. They are part of a complex reality in which conflict, poverty, displacement, disease, malnutrition and limited access to healthcare can collide, often leaving communities with few options for care. 

For 30 years, MSF has worked alongside people caught in these crises—responding to emergencies, treating disease, and continually adapting our medical humanitarian work to the changing needs of Nigeria's people. 

Nigeria's relationship with MSF began before we were established as a humanitarian organisation. In the wake of war and famine in Biafra, Nigeria, a group of doctors and journalists founded MSF in 1971. After witnessing the conflict’s devastating consequences, they faced a fundamental question: was providing medical care enough, or did humanitarian workers also have a responsibility to speak about what they were seeing? 

Their experiences in Biafra helped establish a defining principle of our organisation: providing medical care and bearing witness to human suffering must go hand in hand. Nigeria therefore occupies a unique place in MSF's history, both as a country where we witnessed a devastating humanitarian crisis and, decades later, as the home of one of our largest and longest-running medical humanitarian operations globally. 

MSF responded to a yellow fever outbreak in Nigeria in 1987, carrying out a vaccination campaign that reached more than 2.5 million people around Ibadan and in Anambra state. But the meningitis epidemic in northern Nigeria in 1996 marked the beginning of our continuous presence in the country. MSF teams vaccinated about 3.5 million people during the epidemic. 

People’s needs continued to change, and so did MSF’s response. We have increasingly worked in places where conflict, insecurity, displacement and natural hazards have disrupted access to healthcare since 1996. 

Today, MSF works across Anambra, Borno, Bauchi, Jigawa, Kaduna, Kano, Katsina, Kebbi, Sokoto and Zamfara states, combining longer-term healthcare programmes with emergency responses. Teams support children with severe malnutrition, provide maternal and neonatal care, respond to disease outbreaks, support victims and survivors of violence and sexual violence, and bring healthcare closer to communities facing barriers to access. MSF has also maintained capacity to respond to emergencies in other states across the country.  

Some of MSF's most significant responses have involved crises that might otherwise have remained invisible. In 2010, MSF was alerted to unusually high numbers of children dying in Zamfara state. The cause was eventually identified as lead poisoning. MSF treated affected children while supporting longer-term efforts to address the causes of the poisoning and advocating for environmental remediation and safer mining practices. 

In Sokoto, MSF has supported the Nigerian Ministry of Health's Noma hospital since 2014. Noma is a devastating but preventable disease associated with extreme poverty and malnutrition. For people who survive it, the consequences can extend far beyond physical injury, affecting their ability to eat, speak, attend school, work and participate in community life. Our support at the hospital includes reconstructive surgery, malnutrition and mental health care, community outreach, research, and advocacy. 

In 2023, the World Health Organization recognised noma as a neglected tropical disease, following an initiative spearheaded by the Nigerian government and supported by partners, including MSF. 

Thirty years of medical humanitarian work in Nigeria would not have been possible without the people delivering it. Today, more than 3,400 people work for MSF in Nigeria, more than 90 per cent being Nigerian nationals.  

“Nigerian staff have been central to our ability to understand local realities and adapt our response,” says Dr Ahmed Aldikhari, MSF country representative for Nigeria. “They are the doctors, nurses, midwives, counsellors, logisticians, health promoters, drivers, administrators and many others, people who know the roads, the languages, the communities and the health system.” 

MSF's work has also always depended on collaboration. For three decades, MSF has worked alongside federal and state health authorities, particularly ministries of health, as well as communities, other humanitarian organisations, academic institutions, professional bodies, and more partners. 

In many places, MSF's role has been to complement existing services, provide additional capacity during emergencies, strengthen approaches to care, and support health workers through training and mentoring. Through initiatives such as the MSF Academy for Healthcare, locally hired healthcare professionals can strengthen skills in patient assessment, clinical reasoning, and decision-making. 

Nigeria in 2026 is vastly different from the country of 1996. Its population has grown, cities have expanded, the economy and technological landscape have evolved, and Nigerian culture has gained remarkable global recognition. 

Healthcare has also evolved, with new institutions, technologies, expertise, and approaches. Yet, these advances have not translated into equal access to quality healthcare for all, especially in northern Nigeria, where millions continue to face barriers to timely and essential medical care. Malnutrition remains a major concern, while noma continues to affect people living in conditions of poverty and malnutrition. Disease outbreaks place additional pressure on already stretched health services, while maternal and child health challenges persist. Conflict and insecurity continue to displace communities and disrupt access to essential services. These realities are further compounded by climate shocks, food insecurity, and poverty, creating overlapping humanitarian and health emergencies in which families face multiple, interconnected challenges. 

Our 30 years of working in the country has shown that there is rarely a single solution. An outbreak may require an emergency response today, but preventing another outbreak tomorrow may depend on investment in water and sanitation services, disease surveillance, and stronger general healthcare. A child with malnutrition may need lifesaving treatment immediately, but preventing malnutrition requires food, livelihoods, functioning health services and social support. 

The funding landscape has also become increasingly challenging. Humanitarian needs have grown while funding for emergencies and longer-term programmes has come under increasing pressure, making it harder for many organisations to sustain operations where needs are greatest. MSF's model of funding — almost entirely supported by individual private donors rather than governments or institutional donors — has been central to our ability to remain independent and make decisions based on medical needs rather than political or funding priorities.  

“Our independence means that our decisions are driven by medical needs, not by where funding is available,” says Dr Aldikhari. “It allows us to stay when needs remain, even when the crisis is no longer attracting attention.” 

Adaptability, therefore, has been at the heart of MSF's work in Nigeria.  

We are increasingly looking not only at what care is delivered, but how it is delivered. Across our operations, we are investing in reducing reliance on fossil fuels and moving towards cleaner, more sustainable energy sources.  

In several states, MSF has introduced solar-powered energy solutions as part of our efforts to reduce our environmental footprint while maintaining reliable power for essential medical services.  

While thirty years is a moment to recognise the dedication of our teams and the resilience of the people and communities we serve, it is also a time for MSF to reflect on our experience and strengthen how we provide healthcare. It is an opportunity to learn, improve, and ensure that care is more accessible, effective, and responsive to future needs. 

As we look ahead to our future humanitarian action in Nigeria, we will continue to bring care closer to communities, strengthen local capacity, use innovation to improve the quality of care, and ensure that people affected by crises have a meaningful role in shaping the services intended for them. 

“No community in Nigeria should be left behind. Preventable disease must be prevented. Children must have access to adequate nutrition and quality healthcare,” adds Dr Aldikhari. “Women must be able to access safe maternal care. People affected by conflict and displacement must be able to access healthcare. Outbreaks must be detected and contained before they become disasters. And communities must be at the centre of decisions about the healthcare they receive.”