Adamawa

Terrorists attacked the Garahamojili military camp in Garaha, Hong Local Government Area of Adamawa State, in northeastern Nigeria, on Saturday, Feb. 21. Alison Hassan, a resident of the community, told HumAngle that the attack, which began around 11 p.m., lasted about an hour, as the terrorists engaged the soldiers in a fierce gun battle.  

Although the Nigerian Army is yet to release an official statement regarding the attack or the number of casualties, residents say three soldiers were killed in the exchange, while several others were severely injured. HumAngle contacted Suleiman Yahaya Nguroje, the Adamawa State Police Command spokesperson, but he declined to comment on the situation.

Locals said that during the confrontation, a bullet landed inside a neighbouring house and struck a young woman. Chinapi Agara, a relative of the deceased, told HumAngle that she was the only civilian from the community to lose her life, as the terrorists were focused on the military base. “She was 20 years old. We buried her yesterday [Sunday, Feb. 22],” he said. 

Chinapi also noted that the camp was set ablaze, forcing some of the soldiers to flee. 

“The community wasn’t burnt, but the camp and three houses close to the camp were burnt, including two armoured tanks and their excavator,” Alison added. 

According to Musa Simeon, a local vigilante, several attacks had been launched against the military base in the past, but none had been successful until Saturday’s incident. While locals are unsure of the terrorists’ identities, Musa said several armed groups have terrorised the area over the past decade. “Boko Haram, Islamic State – West Africa Province (ISWAP), and kidnappers, so we don’t know which one is responsible for now,” Musa said. 

ISWAP reportedly released visual evidence and has claimed responsibility for the attack. 

Several locals have lost their lives in the insurgency since it began in 2014. “We are close to the Borno border. Lots of communities like Kopure, Gabba, Lar and others have been completely displaced,” Chinapi added. Similarly, communities within Garaha have experienced a surge in kidnappings within the area in the last few years, forcing many to flee. 

While calm has been restored in the area since Saturday’s incident, Alison noted that residents are deserting the area. “We are seriously in trouble because once it’s evening, people leave their houses to go and sleep somewhere. Some sleep in people’s houses inside town, and those of us who don’t have anywhere to go to sleep with our eyes open,” he said. 

Residents who spoke to HumAngle called on the government to tighten security around the area as people are currently living in fear. 

Hannatu Charles* carried her pregnancy to full term. She attended all antenatal sessions and was eager to meet her baby. 

In January, when she was due, she went into labour around 7 p.m. Unfortunately, the primary healthcare centre in Kirchinga, a community in Madagali local government area of Adamawa state in northeastern Nigeria, closes around 6 p.m. Her family immediately called one of the traditional birth attendants in the community.

Hannatu laboured for hours, yet her baby did not emerge despite the efforts of the traditional birth attendant. By 10 p.m., warning bells began to ring in her mind, as by that time, all doors in Kirchinga had been shut and all access routes deserted. 

“We decided to try to see if we could at least meet one person at the primary healthcare centre, so my husband and my neighbour took me there that night, but we didn’t meet any midwife or any healthcare staff,” she told HumAngle. 

The centre was closed. All the healthcare staff had gone and would only return the next morning. Night shifts no longer hold. These changes were made due to the scale of insecurity. 

Hannatu told HumAngle they returned home, where she continued to push, but despite her efforts, she was unable to deliver. The birth attendant noted that the baby was in breech position and, therefore, an experienced midwife or a gynaecologist was required. The only way they could access such care was by travelling to the Cottage Hospital in Gulak Local Government or the General Hospital in Michika Local Government, both many hours away. 

Hannatu said they would have made the journey that night on a regular day, but now,  it was too risky. Movement in Kirchinga was restricted after dark as Boko Haram terrorists roamed the area, especially at night. There was also no way to access vehicles or get a driver to take the,m as all routes were closed. 

She said she was willing to persevere until dawn when the roads would reopen, but by midnight, the pain intensified, and the midwife doubled her efforts. A stillborn was delivered. 

“I’m not the first to lose a child because of the security situation in this region,” Hannatu said as she talked about how insecurity destroys healthcare. “In fact, I’m lucky to be alive,” she added, stressing that several women and their babies had died.

According to Hannatu, the women who went into labour during the day in Kirchinga are considered lucky. 

The healthcare crisis 

Kyauta Ibrahim, a community health extension worker, spends her days at the primary school in Limankara, another community in the same Madagali that has, since the past decade, been repurposed as the community’s healthcare centre. Since residents began returning to Madagali in 2016 — two years after Boko Haram attacks displaced them — she and her colleagues have provided medical services from this makeshift facility.

“We are yet to move to the permanent site. We were asked to stay here to perform our duties,” she said. When the insurgents struck, they torched several structures, including the original primary healthcare centre where she worked.

For Limankara residents, this temporary facility remains the only nearby source of medical care. With few doctors remaining in the region, patients are often forced to travel long distances to better-equipped centres in Shuwa, Michika, or Gulak, particularly in emergencies.

Before the insurgency, the primary healthcare centre in Limankara served the local population and neighbouring communities such as Sakur and Lakundi, providing antenatal care, deliveries, and basic medical services. After peace was gradually restored in 2016, the state government converted one of the primary schools into a modest healthcare facility to meet the community’s needs.

A decade later, the school still functions as the healthcare centre. The situation worsened as medical doctors and other professionals began withdrawing, leaving indigenous community health extension workers to manage the facility. In 2016, most health centres in Madagali and Michika were closed because many professionals had either been killed or fled permanently.

As of 2019, the World Health Organisation’s Health Resources Availability Monitoring System (HeRAMS) highlighted that only 45 per cent of health centres in Adamawa were fully functional after 12 per cent had been destroyed and 34 per cent severely damaged by Boko Haram attacks. 

Kyauta told HumAngle that, aside from staff shortages, inadequate healthcare equipment continues to affect healthcare delivery in the area. The temporary primary healthcare centre now closes by late evening due to recurring Boko Haram attacks, leaving pregnant women and children most vulnerable.

“When a woman starts labour at night, she can’t even go to the primary healthcare centre and has to give birth at home,” she said. Complicated cases are referred to Shuwa, and if necessary, to the General Hospital in Michika or the Gulak cottage hospital, all of which are some distance away. 

Esther Markus, a mother of six from Wagga, another community in Madagali, travels six hours for a round trip to Gulak for medical care. Emergencies are further complicated by a 6 p.m. curfew. Traditional birth attendants handle routine deliveries, but high-risk cases, like breech births or sudden illness at night, go untreated until morning.

“Once it’s 6 p.m., we can’t take sick people to the hospital, so we leave them till the next day in the hands of God, and if the person dies, then we accept it,” said Hamidu Ahmadu, Limankara’s community leader.

Residents said security remains precarious. “A few days ago, the soldiers guarding us were attacked, so since then, they leave once it is 5 p.m. and head back to their headquarters in town. Our youths guard us all through the night,” Esther added. 

Hamidu told HumAngle that the community has a population of about 3,000. He acknowledged the efforts of some humanitarian organisations that have visited the area in the past to treat malnourished children and provide basic healthcare services to residents, but the gap remains. 

In 2024, the International Committee of the Red Cross (ICRC) resumed operations in Madagali after being unable to operate since 2018. The following year, the organisation provided basic healthcare and nutrition services to residents and also renovated the existing healthcare facility in Madagali town, which has become a haven for displaced persons in villages around the area. This has helped mitigate how insecurity affects healthcare in Madagali. 

Despite these humanitarian efforts to restore healthcare access in conflict-prone communities in Madagali, however, factors like the curfew, abductions, and the absence of medical professionals continue to limit access to services. 

Medical professionals are fleeing 

Kirchinga, the community in Madagali where Halima had the stillbirth, faces a similar plight. Although it has a functional primary healthcare centre, the lack of medical professionals severely affects service delivery.  

“Since the insecurity started, the doctors have stopped staying. They no longer live in the community but only show up from time to time,” said Bitrus Kwada, a Kirchinga resident.

Boko Haram terrorists have abducted, killed, or threatened several health and humanitarian workers in the northeastern region. In 2018, some medical workers were kidnapped and later killed in Borno. The following year, Boko Haram attacked Kirchinga and Shuwa communities, burning houses, shops, and clinics after killing three people. 

By 2020, Bitrus explained, healthcare workers, including doctors, who once lived in Kirchinga had either been transferred or fled, leaving them only occasionally available and unable to respond to emergencies.

“We suffer when it comes to emergency treatment at night,” Bitrus stated.  

Over the years, several women with complicated pregnancies have died during childbirth, along with their babies, due to the absence of doctors and surgeons. 

Blessing Dingami, another resident of Kirchinga, told HumAngle that before the insurgency started in 2014, the primary healthcare centre in the community was staffed by a medical doctor, two nurses, and another healthcare provider who ran the facility round the clock, with support from community health extension workers.

Following the attacks, the centre collapsed, forcing the professionals to flee. Although the government has since renovated it, community health extension workers now manage the facility, and the quality of services has declined.

Even though movement in Kirchinga is unrestricted until 10 p.m., accessing medical care is increasingly difficult. “There was a time when people from our community were involved in a ghastly accident at night, and we rushed them to the centre, but there was no professional to handle their case,” Blessing recounted. 

She noted that the healthcare centre no longer provides scanning, surgery, and other services it previously offered. Residents now have to travel for over half an hour to Shuwa and sometimes to Gulak, where there is a cottage hospital.

In Wagga Lawan, another community in Madagali, the primary healthcare centre was destroyed during Boko Haram attacks in 2014 but was recently rebuilt and commissioned by the state government.

Despite the renovation, many Madagali residents remain unable or afraid to use the facility. People from Wagga Mongoro, Thidakwa, and even Limankara travel there, yet fear of kidnapping, its remote location, and the surrounding bushes keep many away, particularly at night.

“The centre is located on the outskirts of the town, and bushes surround it, so people are afraid to go there for services, especially at night, due to fear of kidnapping,” said Cyril Ezra, a resident. Travel to the facility takes over an hour by bike. 

In 2025, Boko Haram attacked Wagga Mongoro, killing four people, injuring many others, and razing property—underscoring why many remain hesitant to use even the newly rebuilt facility.

Uncertainty 

Peace Ijanada Simon, a midwife at Shuwa’s primary healthcare centre, said the facility is overburdened with deliveries and emergencies from surrounding communities, as theirs lack night services. Although staff work night shifts, service is inconsistent due to recent kidnappings and a lack of reliable electricity. 

“There is no power supply. We use torchlights for most deliveries. If we can’t handle it, we refer immediately to Gulak or Michika,” she said.

In Kirchinga, locals have lost hope for the return of professional healthcare workers. “From 2014 to today, we’ve been facing security challenges because Boko Haram can attack at any time and destroy our things. Some of our people have been killed. Two years back, the situation changed into kidnappings,” he said. 

Bitrus explained that the terrorists mostly show up at night when locals are sleeping and carry out these abductions. “Ransoms have been paid, and some have been released. We have soldiers here, but I don’t think they are taking strong action,” he added.

Maradi, a community near Kirchinga, was attacked on Jan. 23. One resident who resisted capture was killed in his home, while a hunter who confronted the attackers that night was also killed, and another person was abducted that night. 

“We don’t sleep. From midnight, we stay awake till 3 a.m. because that’s the time they normally come. We have to stay conscious,” he said. 

A group of children gather on a Saturday morning in front of a three-block classroom at the Ekklesiyar Yan’uwa a Nigeria (EYN) displacement camp in Wurro-Jabbe, a community in Yola, Adamawa State, northeastern Nigeria. They run across the dusty fields, playing and chatting, but when a chessboard is laid in front of the closed classroom, the children fall silent and move closer to the scene. Their sudden silence and concentration do not come as a surprise because on the chessboard before them, new possibilities begin to unfold.

Seventeen-year-old Partsi David, one of the oldest players in the group, sets up the chessboard and gives instructions before the teachers arrive. She randomly selects the first team to play and urges the next group to be patient as each player is eager to demonstrate their moves first. 

It has been a decade since EYN established the camp to accommodate displaced persons from Mubi, Michika, Madagali, and other communities attacked by Boko Haram. While most residents from Mubi have returned home following the restoration of peace in their communities, those from Madagali and other parts of Michika remain in the camp. Apart from relying on donations from EYN and other humanitarian organisations over the past decade, the displaced persons have also taken up farming and menial work to survive. 

Survival became a priority over the years, pushing education down the list, and many children relied on the camp’s only primary school, run by older displaced persons who taught the younger ones basic English and numeracy. With barely enough chairs and tables inside the three-block classroom, the pupils bring mats from home to sit on. 

According to the United Nations International Organisation for Migration, Boko Haram has displaced over 200,000 people in Adamawa State so far, with residents of Michika and Madagali being among the most affected populations. As of 2025, 69 per cent of children living in internally displaced persons (IDP) camps across Adamawa, Borno, and Yobe were said to lack access to education services. 

However, through the Chess in IDP Camp Initiative, displaced children at the EYN camp are now being relocated to formal schools in Yola, where they have been receiving structured education over the past few years. The change came after a young woman, Vivian Ibrahim, introduced chess to the displaced children in 2023. 

After establishing the initiative in the EYN camp, Vivian replicated it in Malkohi, another Yola community where a displacement camp is situated. It was in this environment that chess began to take root.

The game of chess 

The displaced persons in Malkhohi are from Askira Uba, Gwoza, Damboa, and other parts of Borno State. Having developed a passion for chess during her junior secondary school years, Vivian’s experience enabled her to teach the game to the children.

She recounted that barely a few minutes after she introduced the game to them, the children began to catch up. “The kind of moves and the thinking ahead that I saw some of them doing left me amazed, and I was like, these kids are very intelligent,” Vivian said. 

On social media, she showcased how the children had embraced chess and how well they played. 

People began reaching out with tokens of support for the initiative, and soon, more chessboards were acquired. As monetary donations kept flowing, Vivian conceived the idea to direct every penny donated to the campaign toward the educational development of children from the various camps. The initiative’s goal is to use chess as a tool to help displaced children access opportunities in life. 

That same year, the initiative secured secondary school admission for five children at the Malkhohi IDP camp, and after she shared the success story on Facebook, the President of the Gift of Chess, an international chess club, reached out to her. 

“He donated $500, so I used it to get more of them back to school. And we got books, school uniforms, sandals, school bags, and all of those things,” she said. 

From the Malkhohi camp, Vivian began expanding her work to displacement camps in Yola alongside her younger brother, who was also skilled at the game and her only volunteer at the time. They held weekly chess lessons for the children after establishing chess clubs at Malkhohi and EYN camps. “We recently enrolled three-year-olds,” Vivian said with a smile. 

As the years rolled by, the children’s skills steadily improved. She noticed a shift in their mindset, particularly in their career aspirations. She explained that many of them believed their future was limited to manual labour since they were displaced children, but after several chess lessons, many of them felt they were really good at something. Vivian believed that participating in tournaments outside the camp would help the children realise not only that they were capable, but also that they were deserving and worthy of every opportunity. 

New opportunities 

As the children’s confidence grew, the initiative organised a tournament between the two camps and later expanded it across the state, so the young players could showcase their skills. They competed in the state chess tournaments and emerged as champions. The children said their confidence was boosted, and their learning efforts doubled.

For twelve-year-old Timothy Hassan, it was an opportunity to shine. 

“I love to calculate. I love mathematics,” he stated. 

However, he never thought his dreams could come true, since he didn’t have access to secondary education; education at the EYN camp stops at the primary level. So when the game was introduced to his camp in 2024, Timothy was among the first group to show interest. 

“I’ve participated in local tournaments within Adamawa and even travelled to Lagos and Delta states to compete,” he told HumAngle with a bright smile. 

Timothy says the feeling he gets anytime he’s set to travel for a competition is indescribable because he never thought it would be possible for him to leave the camp or even travel outside the state. Now, he gets to compete with other chess players, and the initiative has enrolled him in a secondary school where he is continuing his education. 

“The game has made me a more focused person. It has reduced the rate at which I play around the camp unnecessarily as I spend my free time practising with the chessboard,” Timothy said.  “I want to be an engineer,” he added. 

When preparations were underway for the National Sports Festival in 2025, the Chess in IDP Camp initiative seized the opportunity, as there was no group to represent Adamawa State in the chess section. 

“I made contact with the Adamawa State Sports Council, and I presented the kids to them. They played a match. The people at the sports council were impressed,” Vivian told HumAngle. 

The children were then selected to represent the state during the chess tournaments in Delta State. They competed against teams from other states in Nigeria and finished fourth.

Partsi, one of the chess players who represented the state at the National Sports Festival, says she’s getting better at the game with each passing day. She also participated in a secondary school tournament in Adamawa, where she emerged as the female winner. 

While she wants to become a doctor, Partsi aspires to be a famous chess player. 

“I want to be seen on TV, and I also want to be the winner in every competition. I want to win for Nigeria,”  she said. 

In 2024, Vivian noted that the Commander of the 105 Composite Group, Nigerian Air Force (NAF), who is a patron of the NAF Chess Club in Maiduguri, Borno State, reached out to the Chess in IDP Camp Initiative in Yola, requesting that the programme be introduced to some displaced camps in Borno. Led by Vivian and Tunde Onakoya, a Nigerian chess master and founder of Chess in Slums Africa, the initiative reached Maiduguri, with Tunde directly engaging players at the Muna and Shuwari IDP camps. 

Tunde’s visit was said to have brought further media and public attention to the role that chess can play in healing, learning, and reimagining futures for children affected by conflict.

“This game makes me calm whenever I’m playing because chess doesn’t want your attention to be divided. It wants your full attention,” Partsi said. 

After Tunde became affiliated with the initiative, Vivian explained that several chess players in the state, mostly young people, volunteered to teach the children. This increase in human resources helped the initiative to reach more children in the camps.

Vivian highlighted that the initiative teaches chess to over 200 IDP children from both camps, ranging from ages four to 18. The chess clubs operate on Saturdays for two hours during the school term, but during the holidays, volunteers visit two to three times a week to tutor the children. 

Fifteen-year-old Emmanuel Paul, one of the players who joined the club in 2024, said he needed no persuasion to join. 

“The game itself impresses me. The game requires a lot of calculation,” he told HumAngle. 

The boy explained that the game makes him feel confident, and anytime there is a forthcoming tournament, he feels ready to play. Emmanuel said the hardest part of the game is the endgame when a tournament is drawing to a close. 

“If you don’t strategise well during the endgame, your opponent will win,” he said. 

Like many other chess players in the camp, Emmanuel has been enrolled in a secondary school by the Chess in IDP Camp Initiative. 

Mary Zira, a renowned chess player from the EYN IDP camp, secured a scholarship for secondary education at a private school in Yola. This came shortly after she returned from an international competition in Georgia in 2025. There, she competed in the Chess Community Games, won a silver medal, and earned a chance to speak at the United Nations. 

Impressed by her performance, an individual reached out to the initiative and offered to sponsor her secondary education. While Mary is currently in a private boarding school, her mother, Hannatu Victor, spoke to HumAngle about the achievement. 

“I am a very proud mother,” Mary’s mother stated. 

She explained that she had never imagined her daughter’s life would change overnight because of a game. “This game is helping us, especially our kids, in furthering their education. It also exposes them because they go out to meet other children when they play in different places,” she said. 

From chessboards to classrooms 

Following several tournament victories by the displaced children, the Chess in IDP Camp Initiative has gained widespread recognition. Although the initiative has not yet partnered with any local or international humanitarian organisation, Vivian remains grateful to individuals who have given the children the opportunity for a better life. 

According to Vivian, about 70 young chess players from both the Malkhohi and EYN IDP camps have been enrolled in various private and public secondary schools in Yola, with the initiative covering their fees. The oldest student has recently completed secondary school and is now ready to pursue a university education. Scholarships have also been secured for some of the children.

Apart from chess, a group of young volunteers from the Modibbo Adama University, Yola, who recently joined the initiative, are incorporating AI and tech sessions into several chess classes. Their goal is to equip the children for a rapidly changing world. 

Elisha Samson, one of the volunteers at the camp, told HumAngle that the children have shown noticeable improvement in STEM subjects integrated into their sessions. The volunteers have been teaching the children how to use Arduino, an open-source platform used for building electronics projects. 

“I feel that, going further in the future, maybe we could have a lot of them build very cool tech on their own without us guiding them to do it,” Elisha said. 

Elisha noted that the major challenges they face as volunteers are the lack of electricity in the camp, as some of the tech and AI concepts they are introducing to the children require electricity. 

“Sometimes we have to come with a backup power supply from home, and then we use it for them. We also need more Arduino kits to be able to handle more students or show more students what we’re talking about and have lots of practicals because our practicals are limited, as the kits we have are very limited,” he added.

Jerry Sunday, another volunteer with the initiative, explained that sessions are more interaction-based. 

“When we notice that a student is trying to lose interest or is not doing well, we break the concepts down into basic everyday examples, and they quickly understand and relate to it,” he said, adding that students who don’t do very well are often paired with better-performing colleagues who serve as their tutors. 

Despite these efforts, sessions are sometimes disrupted.  

“There is no consistency in attendance, especially during the rainy season, because most of them go to help their parents on the farm,” the volunteer said. 

A 2024 fact sheet on Nigeria’s education, developed by the United Nations Children’s Fund (UNICEF), shows that rural and poor children across all levels have lower school completion rates than urban and wealthier children, whose completion rates are above average. The report further states that while 90 per cent of children from the wealthiest quintile complete senior secondary education, less than 16 per cent of children from the poorest quintile do so.

Against all odds, the children continue to excel. 

Rebecca David, a displaced woman from Madagali whose daughters participate in the chess programme, noted that their confidence has improved since they enrolled. 

“They are now smarter and more critical in doing regular things at home,” she said. 

With a focus on long-term sustainability, the initiative aims to partner with local and international organisations to enrol more children in school, expand opportunities for the children, and ensure that displaced children have the chance to dream beyond the confines of their camps. 

For years, 64-year-old Ibrahim Zira lived with high blood pressure, managing the condition at Jigalambu Primary Healthcare Centre (PHC) in the Michika area of Adamawa State, northeastern Nigeria. When his condition worsened, he was referred to the Michika General Hospital, where he faced a familiar struggle: incomplete medical records and repeated tests.

“When I got there, they asked for my records, and the file I had contained very little information. I was asked questions and told to repeat tests I had already done. I had to pay again. It was painful because I don’t have a steady income,” Ibrahim complained.

In Nigeria, about 77 per cent of health spending is paid out of pocket, so each additional test adds a financial burden that many patients can barely afford. But the challenge is not only financial. Without digital medical records, patients like Ibrahim are often made to reconstruct their medical histories whenever they move between facilities, relying on memory of dates, drug names, and test results. 

“Sometimes I forget dates or drug names,” he said. “When that happens, the health workers think I’m not serious. It’s stressful explaining the same sickness again and again, especially when you’re not feeling well.”

The same experience surfaced for Pwavira Akami during her first pregnancy. She began antenatal care (ANC) at Gweda Mallam PHC in her hometown of Numan but later relocated to Jimeta, Yola—more than an hour’s journey away—to stay with her sister. There, she registered for antenatal care at Damilu PHC. 

The transition exposed the same fault line in the absence of digital patient records.

“They asked me many questions that were already written in my ANC card, but some pages were missing,” she recalled. As a result, Pwavira was asked to repeat basic lab tests. “I had to spend more money. It’s tiring; you keep answering the same questions about your last period, past illnesses, and tests. Sometimes you’re not even sure if you’re saying it correctly.” 

In both cases, the problem was not medical knowledge or staff competence. It was the absence of a shared system that allowed patient information to follow people as they moved between facilities.

Frontline workers show concerns

This gap, healthcare workers say, affects patients across Adamawa every day.

Mercy Dakko, a midwife at General Hospital, Michika, said she works almost every month without patient files and that internally displaced persons (IDPs) and pregnant women often arrive with incomplete or fragmented medical histories. 

“It slows everything down,” she told HumAngle. “In emergencies, lack of history can be risky. You may not know past complications or drug reactions.” 

Mercy recalled the case of a woman who came into labour, only for the staff to later learn that she was diagnosed with high blood pressure in a previous clinic. “We found out late, and it almost caused serious complications,” the midwife explained.

Sam Alex, another medical practitioner, agreed that due to a lack of well-documented medical history, they rely only on what the patient remembers, which is not always accurate. “Very often we repeat tests. It’s not ideal, but sometimes it’s the only safe option,” Sam said, noting that the stakes are even higher for chronic diseases.  “It increases the risk of wrong medication, delayed care and poor outcomes, especially for conditions like diabetes or hypertension.” 

He acknowledged that patients often bear additional burdens, spending more time and money, and some even refuse to come to the hospital because they are tired of having to repeat medical procedures. 

‘Everything is paper-based’

At the root of the problem is a paper-based system that requires patients to carry physical files. Emmanuel Somotochukwu, a Nigerian pharmacist, told HumAngle that in his hospital, about one in ten patients are sent back simply because a prescription is illegible or an old lab result is missing. 

Studies in Nigeria have found that illegible or incomplete prescriptions are a leading cause of medical error. In most hospitals across Adamawa, record officers are overwhelmed by paperwork. Bewo Gisilanbe, a record officer at the General Hospital in Michika, described how patient histories are stored. 

“Everything is paper-based. Files are created manually and stored in cabinets,” he said, admitting that old files or files from busy clinic days could get torn, misplaced, and slow to retrieve. “Once a patient leaves, their record ends here. There’s no connection to other facilities.”

Bewo stressed that searching for a lost history wastes time and distorts continuity of care. “We don’t know what happened to a patient’s prior care after they leave,” he said. If systems were linked, he argued, everything would change. “It would reduce workload, improve accuracy, and make record tracking easier.”

Why digitalised medical records matter

Experts say the solution to the flawed health system in Adamawa lies in Digital Public Infrastructure (DPI). In the health sector, DPI refers to shared, secure information systems that allow “medical histories, prescriptions, insurance status, and laboratory results to move electronically between units, without requiring patients to act as messengers”. 

The cornerstone of this system is a dependable digital identity. By mid-2025, Nigeria’s National Identity Management Commission (NIMC) had issued 123.5 million National Identity Numbers (NIN). These IDs, if utilised, can act as a digital passport, enabling the connection of patient records across various healthcare facilities.

Recently, the National Health Insurance Authority (NHIA) and NIMC signed an MoU to establish a unified framework linking citizens’ national identity data with health insurance records. This integration is meant to streamline verification, reduce fraud, and expand access to healthcare, especially for underserved communities.

Beyond identity, DPI seems to require an interoperable health information record system. In 2024, the government launched the Nigeria Digital in Health Initiative (NDHI) to build a national health information exchange and patient registry. The goal is for health facilities to securely and seamlessly share information. 

Nzadon David, a digital innovations specialist working with the African Union, and Asor Ahura, a Nigerian-based AI engineer and digital health expert, highlighted several key requirements for success in digital health systems. Nzadon emphasised that “every system needs a way to recognise each person. In Nigeria, this means using the NIN or similar IDs in health records.” Asor also stated that “clinics must agree on data formats and coding systems to ensure that one hospital’s notes can be understood at another. He stressed that privacy laws, such as Nigeria’s 2023 Data Protection Act and clear guidelines about who can access information are essential for building trust. 

Across Africa, early DPI projects show what’s possible. Rwanda has an integrated e-health platform (Irembo) that links digital IDs to patient records and lab results. Kenya’s Afya Kenya initiative likewise allows a clinic in Kisumu to retrieve the same information as a clinic in Nairobi, eliminating duplicate efforts. The payoff is clear: fewer medical errors, faster diagnosis, and better continuity of care, according to the DPI Africa platform. Even India’s Aadhaar ID system now covers 1.4 billion people and is tied into programs including health insurance.

Nzadon noted that these countries didn’t digitise everything at once. They started small, created shared standards, scaling gradually. “States that succeed focus on shared standards and simple, open systems more than expensive software,” he added.

The road map

In 2025, Nigeria joined the UN’s Digital Public Goods Alliance, pledging that government systems, including health, should be open, inclusive, and interoperable. These moves seem to reflect lessons from around the world. Rwanda, Kenya and other countries show that with a national ID, electronic medical records, and a clear privacy framework, health services can become seamless. In Nigeria’s case, there is no shortage of data on why it matters. Aside from the human toll of broken care, inefficiency has economic consequences. According to McKinsey Global Institute’s digital identification report, scaling digital ID systems worldwide could add $5 trillion to global GDP. 

Frontline healthcare workers, seeing the impact firsthand, have a clear wish list. 

With connected records, Mercy said, “we can focus more on care instead of paperwork.” Bewo admitted that a shared system would “reduce mistakes” and free up resources for patients. Perhaps most pointedly, patients themselves feel the difference. Reflecting on his own experience, Ibrahim says a digitalised health system would make life easier. 

This report is produced under the DPI Africa Journalism Fellowship Programme of the Media Foundation for West Africa and Co-Develop.

Fatima Abdullahi stands beside a group of children with a bowl balanced in her hands. As the children rally around her, she tries to give them instructions. “The pap is small, so you must be patient and take turns,” she tells the children, who are each holding a plastic spoon. 

The 30-year-old mother of five then places the bowl on the ground, and the children swing into action, scooping and scraping. Inside is pap made of corn flour and plain water.

“It was never this bad,” Fatima tells HumAngle, glancing at the children whose spoons were colliding in the wooden bowl. “There was a time when each child had their own bowl, and the pap had sugar in it, but things got worse.”

In 2015, Fatima and her family fled the Boko Haram insurgency that ravaged her hometown in Gwoza Local Government Area, Borno State, in northeastern Nigeria, and claimed the lives of over 350,000 people and displaced millions of others. They were transported by the Nigerian Army to Malkhohi, a displacement camp in Yola, the Adamawa State capital. 

Like Fatima and her family, most of the over 360 people living in the camp were displaced from communities in Borno State, such as Gwoza, Askira Uba, and Damboa.

Back at home, she was an entrepreneur who sold akara and chin-chin, earning money to support her family. Fatima’s husband was an accomplished farmer. Their displacement halted all of these efforts, but things were better when they arrived in Malkhohi. At first, many structures were put in place to make life easier for residents. 

Each family was provided with a tent, mosquito nets, blankets, and sufficient food. Donations in cash and kind were made regularly. Fatima said there was a United Nations Children’s Fund (UNICEF)-run clinic, and the Red Cross was always on the ground to address emergency health needs. Local civil society organisations were also available to offer support. 

“There were organisations that came from time to time with food,” she recounts. “Some of them came and taught us different skills.” 

However, things eventually began to change. 

When the aid stopped

UNICEF was the first agency to exit the Malkhohi IDP camp in 2023, a move that led to the closure of the camp’s clinic. A few months later, the Red Cross also withdrew. In 2024, the International Organisation for Migration (IOM) closed its office at the camp. 

It was at this point that residents began to realise the gravity of their situation. 

The departure of these agencies that had provided healthcare and other essential services to the IDPs significantly affected the community, with conditions worsening steadily over time. 

That decline deepened in 2025, when other local organisations providing aid in the camp, particularly those dependent on USAID funding, also began to leave, shortly after the US government suspended foreign aid.

For families in the camp, the impact has been tough. 

“Before, my children had regular three square meals, but now they eat depending on how available food is. Sometimes, it’s breakfast and nothing till the next day. Other times, we go to bed like that,” Fatima said. She noted that starvation has made her children aggressive. “Whenever they see food lately, they start fighting over it, each wanting the largest share.”

As food became scarcer, meals grew more basic.

“These days, I mostly make pap for them with just plain water and corn flour, and sometimes, we make tuwo with the corn flour and eat without soup,” she added. 

The withdrawal of aid also disrupted services beyond food. In addition to basic healthcare, UNICEF had played a key role in education, with about 285,000 Borno children reportedly trained in numeracy and literacy after being orphaned by the Boko Haram insurgency.

With the clinic closed, access to medical care has become increasingly difficult.

“We used to access free medicines and other healthcare services until the camp’s clinic closed,” Fatima told HumAngle. “If our children get sick these days, we go to the nearest clinic inside Malkhohi village. They charge a lot.” 

She explained that private clinics require an upfront deposit of about ₦6000 before examining a sick child, a sum many families cannot afford. “If we are paying for malaria drugs, then it’s ₦6000, but if the child requires a drip, then it is ₦9000 and above,” she added. 

Although there is a primary healthcare centre in Malkhohi, IDPs say it is far from the camp and difficult to access during emergencies, often taking hours to reach on foot.

“So when there is a health emergency, we just go to the private clinic closer to us,”  Fatima said. 

Living conditions in the camp have also worsened. Salome Ijarafu, the women’s leader at Malkhohi IDP Camp, told HumAngle that there are only a few standard toilet facilities in the camp. 

“Sometimes, we have to wait till it is dark so that we can go and take our bath outside in the bushes because the bathrooms are not in good condition. Even then, we have to queue up and wait for others to get out before we make use of the good ones,” she said. 

Following a rise in vaginal infections at the camp, some women don’t use the toilets; they now relieve themselves in nearby bushes. 

“Our toilets and bathrooms are all worn out. We rely on the few in better condition, but there are a lot of us relying on them, so it gets messy all the time. Before, we used to receive soaps, detergents, and Izal from the organisations, but since the aid stopped, we just clean the floors with water,” Fatima said. 

The women’s leader also noted that pregnant women in the camp have become increasingly vulnerable since the closure of the UNICEF clinic, as access to antenatal care and delivery services is no longer readily available. 

“When women want to give birth, there is no way it can be done here, so they have to be rushed to the distant primary health care, and sometimes when the primary healthcare centre can’t handle it, we have to look for a means to transport them to Yola town,” Salome said. 

Beyond healthcare, women in the camp are also grappling with rising costs of sanitary materials.

“Sanitary pads are expensive now, so we use rags during our period. Before, we used to receive donations of sanitary pads, but we no longer get them,” she said.

‘We hustle to survive’

Buba Ware, Chairperson of the residents at Malkhohi displacement camp, told HumAngle that the Adamawa State government ceased communication with the camp five years ago, bringing an end to the donations from the State Emergency Management Agency (ADSEMA), but the IDPs didn’t feel much of that impact until the international agencies began to exit, followed by local humanitarian organisations. By the end of 2025, no organisation remained in the camp.

It has made it difficult for residents to renovate their tents, a responsibility that was carried out by IOM. “They fixed the leakages on our tents and replaced old structures, but now that they are gone, our tents are collapsing,” Buba said. “Even the local NGOs that came before no longer come, and that is why we go out and hustle so we can take care of ourselves.”

For many parents, that hustle has become a daily struggle to feed their children.

Forty-five-year-old Jummai Ali, a displaced person from Gwoza, has lived at the camp for the past decade. With seven children to care for, she has intensified her efforts to find food, especially now that aid is no longer forthcoming. 

Every morning, Jummai joins other women in the camp to search for leftover grains on harvested farms. The women leave the camp at 6 a.m.. Each of them carries a basin, a broom, a sack, a hoe, and a small gallon of water. 

“We don’t have a destination or specific location,” she said. “We just keep walking, scouting for farms where work has already been done. We pluck out grains that farmers have mostly overlooked during harvest. Some of them are bad, and sometimes it’s just husk, but we sieve out and try to gather the ones that are edible.”

The women, Jummai said, walk in groups and stop at certain fields. When work at one site is done, they move to the next field until they have gathered enough. They mostly labour on rice farms because that’s where they can collect more grains. 

“When we return, we sieve out the grain, work on it and cook. It’s not easy. There are times we walk for three hours to get to certain communities where there are large farms and then walk back to the camp when we are done,”  she added, stressing that the search for food has become increasingly exhausting. 

In addition to foraging, some women in the Malkhohi IDP camp prepare local foods such as akara, groundnuts, and moi moi, which they hawk in neighbouring communities to earn an income. According to Salome, the women’s leader, most of what the women earn from petty trading goes into buying medicines, especially during the harmattan season, when many children in the camp suffer from colds.

“We catch colds all the time. Our blankets are worn out. We’ve been using the same ones for the last ten years. Since the tent floor is not plastered, it’s easier for the sand to get cold and penetrate our mats,” Fatima said. 

As women struggle to cope, many men in the camp have also turned to risky forms of labour.

HumAngle learned that a growing number of men have taken up logging. With the Malkhohi IDP camp located on the outskirts of Yola and surrounded by dense forest, the men venture into the bush to cut down trees, chop them into pieces, and sell the wood to survive.

Adam Agalade, one of the loggers, said hardship in the camp pushed him into the trade.  Formerly a businessman and farmer back home in Gwoza, Adam said he had never swung an axe until last year. 

“Sometimes, we spend days in the bush, trying to gather enough timber for sale,” he said. “We stopped during the rainy season but resumed in December.” 

Once the trees are chopped, the men transport the wood in wheelbarrows into Malkhohi, where it is stacked along the roadside and sold to households and local food vendors. 

“We sell some batches for ₦1000 while some for ₦2000,” Adam said. 

While the trade has helped him support his family of ten, he noted that the income is uncertain. “There are days when we spend the whole day without selling anything,” he said. 

Adam is currently injured after a log fell on his leg while he was cutting a tree in the forest. With his leg swollen, he said his life has come to a standstill as he is unable to join other loggers in the forest. 

The rain will come

Beyond daily survival, residents say they fear what lies ahead.

Some IDPs told HumAngle they are particularly anxious about the approaching rainy season, given the deteriorating condition of their tents. “All these planks supporting our tent have stayed for 10 years and have been eaten by termites. When the wind blows, the tents start to shake because the planks supporting them are worn out,” Adam said.

According to Buba, the camp chairman, most tents are leaking and require urgent repairs or replacement. IOM used to handle the maintenance, but they have left. While IDPs have made temporary fixes using sandbags to stabilise the structures, they say these measures are unsustainable.

“Once it is the rainy season, we get scared because of the condition of the rooms,” he said. 

Buba added that heavy rains often cause tents to flood, forcing families to vacate them and seek shelter under trees until the storms subside. He recalled instances where tents collapsed on families, causing injuries, though no deaths were recorded. 

Waiting for a way out

For years, residents of the Malkhohi displacement camp have waited for clarity on what comes next. 

While the Borno State Government began closing displacement camps across Maiduguri in 2021, a move aimed at reducing long-term aid dependency, restoring dignity, and reviving local economies, those efforts have not reached displaced persons from Borno living outside the state. 

Some IDPs within Borno were relocated to homes around their ancestral towns, but families in Malkhohi say they have been left behind. Still, even those in Borno who have been resettled complain of insecurity in their new location, lack of government support, and an absence of basic amenities.

However, for displaced persons from Borno living outside the state, such as those in Malkhohi, talks of resettlement have not reached them. The residents of the camp told HumAngle they no longer wish to remain there, but the lack of alternative shelter holds them back. 

According to the camp chairperson, the IDPs have had no contact with the Borno State Government since their evacuation from the state over a decade ago. “They have never checked up on us. Our closest means to the government is the ADSEMA, but we have lost touch with them for more than five years now,” he said. 

He added that the displaced persons had written several times to the Adamawa State government about the prevailing hardship in the camp, particularly the dilapidated condition of their tents, but had received no response to date. 

“If the government will carry us back to where they took us from, then we are ready, because it’s not our wish to live here,” the camp chairperson added. “Alternatively, if the government can give us a place outside the camp or maybe build houses for us, we would prefer that, because once we have our homes, our struggles will reduce, and we will focus on providing food and other basic needs for our families.”

HumAngle reached out to the Adamawa and Borno Ministries of Humanitarian Affairs for comments, but received no response at the time of filing this report.