It was 11 p.m., and Aisha Usman and her husband had fallen into a deep sleep in a tent at the El-Miskin camp for internally displaced persons (IDP) on the shores of Jere Local Government Area in Borno, northeastern Nigeria. She suddenly woke up clutching her stomach, crying heavily. She was bleeding profusely. Her husband rushed out, calling for help.
At the camp, over 70 displaced people have struggled for a long time to get basic amenities. Families are crammed into small tents, trying to make do with the limited space. Each day, they walk long distances into the wilderness to fetch water from contaminated streams for drinking and other needs. There are no toilets, so privacy is nearly impossible. People have to go into the bushes to bathe or relieve themselves, often feeling unsafe. The children who can’t go to school wear tattered, dirty clothes because their parents, who are also displaced, can’t find jobs to support them.
Aisha, who fled from Konduga to Maiduguri amidst the Boko Haram insurgency, has lived at the camp for over 11 years. There, she suffers from pregnancy complications without access to maternal care. That night, she bled, sweated, and cried for three hours, her clothes soaked in blood.
The local birth attendant arrived to help, but when asked to push, Aisha had lost all strength and fainted until the next day. Her husband and others rushed her to a hospital 21 kilometres away. After tests, the doctor said she needed blood, and her baby had died in her womb.
Aisha had lost another child. Since their displacement in 2019, she has lost nine children during childbirth. She had nine chances to live again after four surgeries following the deaths of her children in the womb. The haunting memories of blood loss during childbirth still trouble her. At 36, she longs for children, believing they would ease the sadness brought on by the Boko Haram insurgency that displaced her and her family.
“It’s been 38 days since I lost my 9th child. I’m still sick, suffering from severe headaches; I’m not as strong as I used to be. The lack of a health centre here is causing us so much pain,” Aisha told Ripples Nigeria. “Every time I start bleeding during childbirth, get rushed to the hospital, the doctors scold me for not attending antenatal care. But we struggle to eat—where will I find money for transport, let alone medical bills?”
Aisha often cried in their small tent, recalling the traumatic childbirths that left her childless after marriage. She bitterly lamented the plight of women in the IDP camp, including herself, who have no access to antenatal care or proper maternal health services due to the lack of a healthcare centre.
“Every woman knows the risks of skipping antenatal care. In my case, I knew something was wrong because my last pregnancy lasted over 11 months. I should have seen a doctor; however, there was no access to one here in the IDP camp. I waited until the day I started bleeding, which wasn’t normal,” she explained. “When I was rushed to the hospital, the doctors told me the baby had died in my womb, so they had to induce labour. I didn’t think I would survive.”
Mohammad Hashir Abubakar, El-Miskin Camp’s leader, spoke of their daily struggles. “We have over two thousand households here. The camp has existed for over 12 years, yet the absence of a health centre is one of the biggest challenges for me as a leader.”
“As a leader, I can’t just stand by. Sometimes, a woman goes into labour in the middle of the night; we don’t have any vehicles. So we gather around her tent with our wives helping until dawn, when we can rush her to the hospital. There are times I even have to use my own money,” he added.
Nigeria’s child mortality crisis
Nigeria is facing a significant child mortality crisis, with the northeastern region, where Aisha’s IDP camp is based, being the most affected. According to the World Health Organization (WHO), the Northeast records 1,549 deaths per 100,000 live births, the highest in the country. The WHO report highlights that Nigeria sees roughly 58,000 maternal deaths annually, contributing to 19 per cent of the global total, with at least 800 women dying per 100,000 births.
Conditions are even worse in the displacement camps in the region. Pregnant women in these camps struggle to access proper healthcare, leading to frequent complications during childbirth. A report by the United Nations Children’s Fund (UNICEF) noted that, in some cases, newborns die during night deliveries, but their mothers often do not report these losses. The report emphasised that pregnant women need peace of mind and a calm environment for safe delivery, which is rarely available to displaced women in conflict areas.
Research by Clinical Epidemiology and Global Health, an international research group, found that the Boko Haram insurgency has worsened the maternal mortality issue, severely limiting child health services in the northeastern part of Nigeria.
According to Human Rights Watch, since 2009, the Boko Haram insurgency has displaced over 1.8 million people in Borno State. UNICEF stated that there are 32 displacement camps in the state, with 60 per cent of host communities occupying over 1 million internally displaced persons (IDPs).
In early 2021, the state government decided to shut down some displacement camps in the city, closing 13 out of the 32 camps and relocating over 200,000 internally displaced persons (IDPs) back to their original communities—a move that sparked controversy due to the ongoing insecurity in northern Borno.
A study from the National Institute of Health showed that in 2008, a year before the Boko Haram insurgency began, Borno recorded 166 maternal deaths per 100,000 live births. By 2023, with the humanitarian crisis deepening, Borno’s maternal death rate had climbed to 564 per 100,000 live births. The research also indicated that being closer to conflict zones directly impacts child survival rates and leads to higher maternal mortality in Borno State.
Ripples Nigeria conducted an investigation at three of the 19 remaining IDP centres in Borno State, uncovering severe maternal health challenges faced by displaced women due to the lack of healthcare facilities. Through interviews with victims, local camp leaders, and healthcare professionals, the report highlights the grim realities of women losing their children and suffering deteriorating health due to inadequate maternal care.
The struggles of pregnant women
In Ajiri IDP camp, located two to three hours from El-Miskin camp, women are experiencing similar maternal health crises, facing the same lack of access to proper healthcare, leading to tragic consequences.
Apart from healthcare challenges, residents of the displaced persons camp face many other hardships. They find themselves praying for strong winds to ease the severe heat waves, yet they also plead for rain to stay away because of the fragile state of their makeshift shelters. When heavy rains and winds do hit, their flimsy tents made of sacks and thin plywood often get torn apart, forcing many to sleep outside in the open. Even during the dry season, when the river they rely on for water two kilometres away dries up, they are left scrubbing the ground for any remaining moisture.
The available tents are too small to house all the people displaced to the camp, leaving many to sleep outside, even during the rainy season, making their situation even more difficult.
Muhammadu Sahradeen, the 62-year-old camp leader, explained that beyond the lack of water, floods, food, and toilets, child mortality is alarmingly high due to the absence of a healthcare centre.
“Women here suffer from losing their babies during and after pregnancy. We have no choice but to endure because, after nearly 13 years in this place, we’ve never had a healthcare centre. It’s heartbreaking. To me, it’s one thing to lack food and shelter, but what our wives and children are going through is much worse,” he said.
He urged the government to address their desperate need for healthcare and to take their suffering seriously.
In March 2021, Falmata Muhammed celebrated her wedding to Usmanu at Ajiri IDP camp, surrounded by other displaced residents. It was one of the few happy moments she’d had in the seven years since Boko Haram destroyed her parents’ homes and looted their belongings, forcing them to live in the camp in Jere LGA.
Just two years into her marriage, Falmata’s joy turned to sorrow because she struggled to conceive. Then, in January of last year, an elder in the camp noticed that she was three weeks pregnant, bringing excitement to her family. But the absence of healthcare at the camp quickly shattered their happiness.
In the middle of the night in September 2023, Falmata woke up in severe pain, realising it was time for her to give birth. She hadn’t gone for any check-ups or antenatal care because she couldn’t afford it. “That night, people called my grandmother, who helps deliver babies at the camp, but I couldn’t deliver. I was in pain for three days without any medicine or help,” Falmata shared with Ripples Nigeria. “Eventually, I was taken to Jiddari clinic, far from the camp, but they sent me to Umaru Shehu Hospital. I almost died, but the doctors saved me. Sadly, I lost my baby.”
Falmata’s tears flowed as she spoke of the agony of losing her first pregnancy after waiting so long. She had a tough recovery, spending six weeks in the hospital. “They had to use a tube to remove urine from my body. I had a blood transfusion and was on medication the whole time. That’s when I developed VVF. It’s been over nine months, and I’m still dealing with this problem,” she added.
To this day, Falmata is still suffering from Vesicovaginal Fistula (VVF) after being in labour for too long without proper care. VVF is a condition where an abnormal connection between the bladder and vagina causes urine leakage, usually due to prolonged labour.
Mohammed Mohammed, the head of Ajiri camp, voiced his concern over the lack of healthcare.
“Women suffer so much during and after pregnancy,” he said. “We’ve been here for 13 years, and we’ve never had a health centre. It’s hard to watch what our wives and children go through. I’d rather we didn’t have toilets than see this.” He urged the government to address their healthcare needs.
More IDP women in woes
At Gwazari camp, residents face the same struggles as other displaced people. There aren’t enough tents to shelter everyone, and many are forced to dig holes in search of water while they struggle to find enough food. The tents are too small to hold all the people, so it’s often difficult for residents to sleep. The camp is always eerily quiet.
The camp head, Amsami Bulama, urged the government to step in and address these issues, with a focus on the urgent need for healthcare. “Even if we cannot get other support from the government, we are pleading with them to consider the health challenges our wives and children are facing in this place. We are their people, and we believe they haven’t forgotten us,” Amsami said.
Hajjah Mustapha, a 40-year-old displaced woman living in Gwazari IDP camp in Jere Local Government, shared the painful reality many women face during childbirth due to the lack of healthcare. She explained how women often cry and endure terrible moments while giving birth because of the absence of proper medical care.
Hajjah herself went through this heartache when she lost her child. Her story is different in that she survived childbirth with the help of a local birth attendant, but her baby was not so lucky. After the delivery, her child contracted an infection and passed away two months later. “I lost the baby two months after giving birth. It’s been over a year now, and I still think about it. I didn’t go to the hospital during my pregnancy, so there were many complications,” she said. “I went into labour after Maghrib prayers around 6:30 p.m., and the pain eased a bit, so I stayed home. I didn’t go to the hospital until the next morning at 8:00 a.m.”
Hajjah was eventually taken to Jiddari Clinic. “I became unconscious and was too weak to push the baby out. They had to give me eight drips. God saved me, but my baby was born with pneumonia. We stayed in the hospital for a month while they monitored him. After two weeks at home, he got very sick again, and that’s when I lost him,” she explained, tears in her eyes.
Hajjah is not alone in her grief. Mustapha Haruna, 45, lost his sister a week after she gave birth to her fourth child at Gwazari camp. The lack of proper maternal care led to the tragedy. “We couldn’t afford antenatal care while she was pregnant. Our older relative helped with the delivery, but when she struggled to give birth, her husband rushed her to the hospital. Unfortunately, the baby was stillborn, and my sister’s health continued to decline. Despite receiving three blood transfusions, we lost her,” Mustapha shared.
Life has been tough for Mustapha since his sister’s death. “I’m now taking care of her children because their father is alone. My wife is doing her best to care for them, but things have become harder for us,” he said.
Fatima Ali, a 28-year-old woman from the same camp, also shared her tragic experience. She suffered a miscarriage and couldn’t seek medical help. “I was three months pregnant when I started noticing unusual symptoms. I saw blood from time to time, and by the fifth month, I woke up one day with severe stomach pain and more bleeding. I lost the pregnancy,” she recounted. “My neighbour helped me by giving me boiled water with neem leaves to drink and bathe with for two weeks, and I gradually recovered.”
Amsami Bulama, the head of Gwazari camp, urged the government to address the health challenges in the camp. “Even if we don’t receive other forms of support, we plead with the government to help with the health issues our wives and children are facing. We are their people, and we know we haven’t been forgotten,” he said, appealing for help.
Health expert’s reaction
Abdullahi Usman, Senior Registrar and Obstetrician at the University of Maiduguri Teaching Hospital highlighted the impact of inadequate maternal healthcare on women in IDP camps in Borno. He explained that poor antenatal care significantly increases the risk of maternal complications and mortality, especially in conflict-ridden areas where access to healthcare is limited.
“Pregnant women need regular check-ups so health professionals can assess their risk levels and plan their care accordingly,” he said. “Through these visits, we conduct basic investigations, monitor blood volume, check genotypes, and provide nutritional support. Ultrasound scans help us assess the baby’s gestational age, weight, and the mother’s pelvic cavity, all of which reduce the chances of complications during delivery.”
Dr Abdullahi also pointed out that women in IDP camps are especially vulnerable due to poor nutrition and anaemia. “These women often face malnutrition and anaemia, which increases the risk of complications like postpartum haemorrhage, a leading cause of maternal mortality,” he explained.
He emphasised the need for accessible and affordable healthcare for displaced women and children, noting that the lack of healthcare facilities in IDP camps has drastically increased the rates of maternal complications and mortality. “These women need special care and supervision, but without proper facilities, the risks are much higher,” he added.
NGO Perspective
Mohamed Mohamed Alhaji, the co-founder of Cohort for Existential Emergency Relief (CEER), a nonprofit organisation focused on humanitarian aid for displaced people in Borno State, said they know that child mortality is common at the IDP centres. He mentioned that while they have been helping some of the affected people, they weren’t aware of the issues at the specific camps visited.
“Over the years, I’ve seen how women struggle with poor healthcare, especially pregnant women in the camp,” he said. “They face so many challenges during antenatal care because there are no facilities. Although it’s not really our job to step in, we’ve helped some of the victims at the IDP camps in the past.”
“During the height of the insurgency, there were international groups like the WHO, MFF, and IRC that were offering healthcare services,” he continued. “But even back then, there was a big issue with a lack of skilled birth attendants. Now, the situation is even worse without that kind of support.”
He stressed that the government needs to do more to create a system where they can work alongside NGOs in a coordinated way. “National NGOs understand the local communities and know where the problems are. They can help make sure that everyone has access to healthcare.”
Government Accountability
The Borno State Government has not been active in helping to improve the situation at unofficial IDP centres. When Ripples Nigeria contacted Abdullahi Aliyu, Secretary at the Ministry of Health, he said he got our request and would get back to us. After a week of follow-up messages and calls, he didn’t respond.
Mr Umar Sidi, another official at the Borno State Contributory Health Management Agency, also didn’t reply to calls or messages.
This story was produced with support from the Tiger Eye Foundation under the “On Nigeria Programme”, funded by the MacArthur Foundation.