intersection

When Mariam* first started thinking of deserting Boko Haram’s settlement at Sambisa Forest, where she had been living for a decade, she was not entirely sure that it was the best idea. She still believed in the cause, for starters. But there was the matter of her body starting to fail her. 

Her husband had just died of HIV/AIDS, and she had unfortunately contracted the disease from him before he passed. Although the doctor in the forest tried to provide her with medication, it was not consistent. In addition, she had kids she feared infecting. Then, she started to hear that access to antiretroviral drugs was free in Maiduguri, the Borno State capital in northeastern Nigeria. So, she began to tinker with the idea, for the first time, of leaving the group behind. 

The group was all she had known for the past decade. She had even been prepared, at some point, to give her life for the cause by volunteering for a suicide bombing. She had been approved for it and had begun to undergo training and preparations when she realised she was pregnant. Her husband, previously supportive of what they collectively thought of as her noble martyrdom, then decided she could not blow herself up while carrying their child. She was heavily disappointed. That’s how far she was willing to go for the Boko Haram cause.

And so to leave it all behind seemed impossible. 

She had joined when the group first declared war on the Nigerian state over a decade ago, leaving state-controlled territories for the Sambisa Forest. They sought to establish what they believed to be an Islamic state, declaring formal education, democracy, and elections forbidden. Their campaign has killed over 35,000 people violently, displaced over two million others, and caused over 25,000 others to go missing. Mariam had been attending their sermons right from the early, non-violent days. 

Eventually, after nearly a decade, she left with her children in 2017. Since coming back to Maiduguri, she has had uninterrupted access to free medications for her condition, reducing her viral load and making her no longer infectious. And so, even though she considered the economic prospects and living conditions in Maiduguri to be worse than in Sambisa, she stayed because she could remain alive.

She keeps the truth of her condition from her children and everyone she knows. 

Earlier this year, however, the United States President Donald Trump announced the suspension of USAID, which was primarily responsible for the accessibility of antiretroviral drugs for people like Mariam. Without the USAID subsidy, the drugs are estimated to be unaffordably expensive for low-income earners like Mariam.

Word started to go around that the availability of the drugs would falter. When Mariam ran out of her six-month stash of medications, she returned to the Borno State Specialist Hospital to get a refill, as she has done for years now. There, she met a surprise that scared her. 

“They only gave me one small can of pills, not the usual two. They seemed to have changed the ratio. They didn’t say why, only that they had changed the ratio. The bottle will only last me three months,” she recounted.

It worried her. When she got home from the hospital, she poured the pills into a thin white plastic bag and hid it, as usual. That way, it is inconspicuous, and anyone who knew the kind of bottles the drugs came in would not be able to recognise hers. This is so that she would avoid stigma.

“Nobody knows I have HIV to date. Even my children. And they are HIV-free. I had them tested at the hospital. Even the eldest among them doesn’t know.”

Around the same time, NGO-run health facilities were also starting to shut down in many rural communities in Borno. For example, in Konduga, a primary healthcare centre run by Family Health International (FHI360) was shut down. The facility had been receiving hundreds of patients daily until its abrupt suspension, leaving many in need and others unemployed. 

For Mariam, this has made her begin to consider going back to the terror group, especially after she lost everything during the tragic Maiduguri floods last year. She and her children barely escaped with their lives. The flood had swept through Maiduguri and neighbouring areas, affecting over one million people in total. Her daughter had initially been swept away until a neighbour dove into the waves and rescued her.

“It was a young man who came to help. I was at the verge of diving into the water myself when he came and said not to worry, that he would get her back, and he did. We could not salvage anything else from the flood. We were displaced to the Bakassi IDP camp.” 

When Mariam ran out of the three-month stash and went back to the hospital for a refill, she was only handed a one-month stash this time. The two times she has gone back for more refills after she had exhausted each, she only received one month’s stash, further scaring her.

Though she is no longer as committed to the Boko Haram ideology as she used to be, the realisation that she and her children’s lives are not safe has made her seriously reconsider the prospect of returning

A medical doctor working in Borno State, who pleaded anonymity, confirmed that the drugs had become difficult to access after the USAID suspension. “Patients who showed up at the hospitals were being told that the drugs were not available,” the doctor told HumAngle. “But if you knew your way around and gave some pharmacists some money, they would then give you the drugs, but keep in mind that the drugs are meant to be free. The situation has mildly improved.”

The availability of healthcare among terror groups is traceable to many sources. They are notorious for abducting healthcare workers and forcing them to work for them. But they also took medical training very seriously during the early days when the group first started to tactically come together over a decade ago, according to a former member of the group. 

Now, as many people are coming back to state-controlled territories, the rewards for recidivism have reportedly become higher, as the groups struggle to maintain their followers. Mariam hears these whispers from many of her associates.

“In addition to the drugs they were giving me in Sambisa, they would also give me a litre of honey and some black seed,” she said, adding that the honey and black seed were to help build her immune system.

In northwestern Nigeria, children who escaped or were rescued from terror groups have reported similar experiences. Some boys told HumAngle in an investigation that they joined the groups for things like food and healthcare. They said these were some of the incentives that made staying easy, and why they were not so keen on returning to state-controlled territories.

“I collected the last batch exactly a week ago today,” Mariam said of her access to the drugs. “The flow has never stopped. They always give me on schedule; it is just that I now only get one-month refills.” 

“The life over there is way better,” she said of Sambisa. “If I were there, I would have received a lot of support, especially with my husband dead. Here, who will help me? Everyone is focused on themselves. There is peace of mind there.”

When asked how there could be peace of mind there, with the threat of military bombardment ever present, she said the military would not harm women and children, and so she still would have been safe. “They will only ‘rescue’ us and bring us back to Borno… Even recently, I said to myself that life over there would be better for me. There were so many things weighing down on me at that time. It was even before the flood.”

On whether her children’s lives would be better in Maiduguri, she said it would only be so if her children had access to formal education here, which they don’t. Now, they spend all their time either at home with her or roaming the streets.

When we first spoke in June 2023, she had told me that her children were opposed to the Nigerian army and would throw rocks at them on the road, chanting war songs. When I asked her if things had improved now, she said yes.

“They don’t do that anymore,” she laughed. “They have forgotten. They don’t even want to hear anything related to Boko Haram anymore.”

If she could make an appeal for help to the government, it would be for three things. “Healthcare, school for my children, and a means of livelihood.”

This work was produced as a result of a grant provided by the Wits Centre for Journalism’s African Investigative Journalism Conference.

*Mariam is a pseudonym used to protect her anonymity.