Nigeria

It was early in the morning, and Yakubu Buba stood in front of his house in Gamboru, northeastern Nigeria, looking towards the horizon. He was not waiting for a vehicle. He was waiting for cattle.

From across the Cameroon border, they came in low, patient herds, hooves lifting dust into the air. Yakubu breathed in deeply and smiled.  He enjoys the smell of fresh animal droppings, he says. “It replenishes the soul.”

The herds come daily. “About ten of them,” the 57-year-old estimates. “They are guided into Kasuwan Shanu, where they are loaded onto trucks bound for Maiduguri.”

That same morning, he, too, was headed to Maiduguri. A bean merchant since he was 17, Yakubu began travelling the Maiduguri-Dikwa-Gamboru road in 1986, importing beans from Cameroon and selling them onward to traders at the Muna Market who supplied to markets across Nigeria.

Gamboru sits on the Nigerian-Cameroon border in the northeast. A few kilometres away is Ngala, which links Nigeria and Chad. Through these borders, traders export processed goods like flour into Cameroon and Chad, Yakubu says. And when crossing back, they would import beans, sesame, and groundnuts. Animals, in whole or in parts, like hides, are the most imported from these countries, he says.

At the Muna Motor Park in Maiduguri, where I met Yakubu, this pattern was once predictable. Vehicles arrived full and left fuller. Mustapha Hauwami, a 47-year-old driver who began plying the route in 1980, remembers when the park felt like a tide. “We transport traders and passengers to Gamboru and Dikwa daily,” he says. “Most of those coming from Gamboru are Chadian traders.” He drove twice a day, sometimes more.

The pattern got interrupted, slowly. Conflict came, and fear crept in. “It became too risky to travel,” Mustapha says. Checkpoints began to pop up, and movement became impossible without military escorts. “There are at least 20 checkpoints on the road,” Mustapha says. “Importing goods became difficult,” Yakubu adds.

Movements became restricted

The effects were uneven. While Maiduguri’s economy tightened under restricted access, border towns like Gamboru adapted in unexpected ways. Cut off from Maiduguri at the height of the Boko Haram conflict, traders there turned outward. “We relied entirely on Chad and Cameroon,” Yakubu recalls.

Over time, goods from Maiduguri began arriving again, but now as just one stream among many. “They became cheaper in Gamboru,” he said. “Goods were coming from both Maiduguri and the neighbouring countries.”

The movement did not stop. It rerouted. The road’s restriction reshaped the advantage, redistributing it. What Maiduguri lost in centrality, border towns gained in flexibility.

Elsewhere, the pattern repeated with variations. On the Maiduguri-Bama-Gwoza road, Muhammad Haruna remembers when nights were just nights. He began driving in 1981, commuting passengers to Bama, Gwoza, Pulka, Yola, and Mubi. “Driving to Bama took at least 40 minutes,” he recalls. “For Banki, Gwoza, and Kirawa, it was one hour and 30 minutes.” There were few checkpoints, he says. And these existed because of criminals. “And travelling to Mubi was three hours, while Yola was not more than five hours.” The roads were free, even at night. “On market days, as many as 200 fully loaded Gulf cars carried traders into these towns,” says Bamai Mustapha, Chairman of the Bama Park National Union of Road Transport Workers.

Here, too, the Boko Haram conflict affected the flow. Most of the roads became inaccessible, forcing drivers to take a long route passing through the forest into Dikwa, before reaching Bama, until it became totally impossible to travel. “After escaping abduction in 2015, I stopped driving,” Muhammad says. “I sold the car and went into trading.”

Some traders shifted focus to Yola, Muhammad says. They would import from Cameroon into Yola instead. “Others import to Jalingo.”

When calm slowly returned, the routes reopened, but with limited access. “In some of the towns, curfew starts early,” says Muhammad. “They close Bama and Konduga by 5 p.m.” “If you leave Maiduguri by 2 p.m. with Gwoza passengers, you must spend the night in Bama.”

Still, it is not totally safe. “There was a time we got stuck for about a week in Konduga, while going to Gwoza, waiting for military escorts,” Muhammad recalls.

There have been recurring attacks and abductions on these routes for about a decade. The Boko Haram terror group has turned to the kidnapping economy as one of its revenue windows. “The most dangerous route is between Gwoza and Limankara,” Muhammad reveals. “The terrorists would plant mines on the roads. You cannot follow the route without a military escort.”

Despite that, they must travel the route. “It leads into Cameroon. We often transport traders and goods imported from Cameroon through Banki, Kirawa, and Pulka into Maiduguri.” At least seven trucks filled with grains enter Maiduguri from Pulka daily, he says. “It used to be around 30.” “This is the same for Gwoza, Madagali, and other towns.” 

The goods coming in, especially grains and animals, are transported onwards to Lagos in southwestern Nigeria and other cities, Bamai says. “They pass the Maiduguri-Damaturu road.”

The fish stopped coming

The story is the same on the Maiduguri-Baga-Monguno road. This is the backbone of Maiduguri’s fish trade. Audu Gambo began plying this route in 1990, transporting passengers, including traders and farmers, to Baga daily. “Driving to Baga used to take only two hours and 30 minutes,” the 54-year-old recalls. “There were few customs and immigration checkpoints, and the roads were good,” he adds. This enabled him to make a full trip twice, he says, until the conflict interrupted this frequency.

“Travelling has become difficult and restricted,” Audu says. “The entrance to Baga closes at 2 p.m.” So, they must leave Maiduguri as early as 8 a.m. “There are at least 30 checkpoints before reaching Baga,” he says. “Most of the drivers here are from Baga. Those of us from Maiduguri rarely travel the route.”

This affected the city’s source of protein. “I stopped going to Baga in 2017,” Abubakar Mustapha, a fish trader, recalls. It was 10 a.m. when I met him at his stall at the Baga Road Fish Market. “If it were before [the insurgency], we would have finished trading by this time,” he says. The influx of fish into the market has reduced. “They were cheaper and in abundance in the past. We used to offload at least five trucks of fish daily in the market.”

When the insurgency peaked, Abubakar recalls, it became one truck in days, until it became too risky to travel. The road became totally inaccessible.

Then the focus shifted to neighbouring countries. “We began importing from Cameroon, Chad, and Niger,” Abubakar recalls. “Fish from Cameroon and Chad are imported through the Maiduguri-Gamboru road. Those from Niger are brought in through Geidam in Yobe State,” and are transported through the Maiduguri-Damaturu road. “At least four trucks from these countries are offloaded daily,” he estimates. However, transporting to Maiduguri became costly. “Each cartoon costs 4,000 to import,” he says. So, traders relocated to Hadejia and Yola. “More than 50 per cent left.”

In the past two years, however, there has been cautious improvement. The market’s population has increased as previously closed roads are now accessible, Abubakar says. “Some traders have returned and they can now directly import from Baga and Monguno. Yesterday, we offloaded four vans. And the day before, it was three. It doesn’t go below or beyond this number.”

Yet, consignments from neighbouring countries make up the majority. “Fishers cannot freely access the water from the shores of Baga and Monguno,” he says. The shore there is one of the strongholds of the Islamic State West Africa Province (ISWAP) terror group. To fish in the water, fishers must pay.

That afternoon, Yakubu Buba boarded a vehicle at the Muna Park back to Gamboru. His beans had been delivered. He has learned to accept delays as the new rules of the road. Still, he remembers it used to be free.

Kurmin Wali, Nigeria – Like most Sundays in Kurmin Wali, the morning of January 18 began with early preparations for church and, later on, shopping at the weekly market.

But by 9:30am, it became clear to residents of the village in the Kajuru local government area of Nigeria’s Kaduna State that this Sunday would not be a normal one.

Gunmen known locally as bandits arrived in the village in numbers, armed with AK47 rifles.

They broke down doors and ordered people out of their homes and the village’s three churches.

They blocked the village exits before taking people and marching dozens into the forest at gunpoint.

Some captives were taken from church, while others were forcibly kidnapped as gunmen moved from house to house.

In one house, more than 30 members of an extended family were abducted.

Jummai Idris, a relative of the family that was taken, remains inconsolable.

She was home the day of the attack and did not go out.

“When I heard shouting, I took two children and we hid behind a house. That was how they [the bandits] missed us,” she told Al Jazeera.

“But I heard every shout, every cry and footstep as they picked up people from our house and surrounding houses,” she added, between sobs.

With tears streaming down her face, Idris recounts how she kept calling out the names of her missing family members – men, women and children.

Her house sits on the edge of the village, close to a bandits’ crossing point.

“I don’t know what they are doing to them now. I don’t know if they’ve eaten or not,” she said.

A total of 177 people were abducted that day. Eleven escaped their captors, but about a quarter of Kurmin Wali’s population remains captive.

Initially, state officials denied the attack had taken place.

In the immediate aftermath, Kaduna’s police commissioner called reports a “falsehood peddled by conflict entrepreneurs”.

Finally, two days later, Nigeria’s national police spokesman, Benjamin Hundeyin, admitted an “abduction” had indeed occurred on Sunday. He said police had launched security operations with the aim of “locating and safely rescuing the victims and restoring calm to the area”.

Uba Sani, Kaduna state’s governor, added that more than just rescuing the abductees, the government was committed to ensuring “that we establish permanent protection for them”.

There has been a police presence in Kurmin Wali since then. But it is not enough to reassure villagers.

Locals say the police are not there to protect the village, but merely to compile the names of victims they for days denied existed.

At the premises of Haske Cherubim and Seraphim Movement Church, the largest church in the village, days after the attack, a rust-coloured door lay on the floor, pulled off its hinges. Inside the mud-brick building, the site was chaotic.

Plastic chairs overturned in panic were strewn around the room – just as the kidnappers had left them.

‘Only the recklessly bold can stay’

The church building was where the captors brought everyone before marching them into the forest surrounding the village.

Residents said the gunmen divided themselves into different groups, targeting homes and churches in the village.

Maigirma Shekarau was among those taken before he managed to escape.

“They tied us, beat us up, before arriving us into the bush. We trekked a long distance before taking a break,” he said of his journey with his captors.

Shekarau, a father of five, was holding his three-year-old daughter when he and others were taken.

“When we reached an abandoned village, I ducked inside a room with my little daughter when the attackers weren’t looking. I closed the door and waited. After what seemed like eternity, and sure they were gone, I opened the door and walked back home, avoiding the bush path,” he said, now back in the village.

But on returning home, his heart sank. He and his three-year-old were the only ones who made it home. The rest of the family is still held by the kidnappers.

Standing in a parched field of long dried grass, Shekarau says the village no longer feels like home.

The village chief was also taken, but managed to escape. He now presides over a community hopeful for the return of the missing – but too scared to stay.

“Everyone is on edge. People are confused and don’t know what to do. Some haven’t eaten. There are entire families that are missing,” said Ishaku Danazumi, the village chief.

Danazumi says the kidnappers regularly visit and loot the village grain stores and the villagers’ possessions, including mobile phones.

Two days after the attack, residents said the bandits rode through their village again.

On that day, the community also received a ransom demand.

“They accused us of taking 10 motorcycles they hid in the bush to evade soldiers who operated here the week before,” Danazumi said. “But we didn’t see those bikes.”

The chief said the captors told him the return of the 10 bikes was a precondition for the return of his people.

But deep inside, he knows, more demands will follow.

In the village, residents wait in their thatch and mud-brick houses, hoping for their loved ones to return.

But because of fear and the tense situation, many are leaving the farming community.

“Anyone thinking about remaining in this village needs to reconsider,” said Panchan Madami, a resident who also survived the attack.

“Only the recklessly bold can stay with the current state of security here.”

Villagers said that before the January 18 attack, 21 people kidnapped by the bandits were returned to them after a ransom was paid. But just two days later, a quarter of the village was taken.

“It will be stupid to stay here, hoping things will be OK,” added Madami.

The government says it will establish a military post to protect the community from further attacks. But that is not comforting enough for Idris, who has also made up her mind to leave.

“I’m not coming back here,” she said, gathering her belongings to leave the village where she grew up and married. “I just hope the rest of my family gets back.”

A bowl of leftover pap saved Audu Gimba* from being abducted, but his wife, children, and relatives were not as fortunate. 

On Jan. 18, Audu’s family found their way to the Cherubim & Seraphim (C&S) Movement Church, Number 2, Kurmin Wali, Kaduna State, northwestern Nigeria, like they do every Sunday morning. Around 10:30 a.m., warning cries interrupted their service.

Terrorists had surrounded Kurmin Wali from all angles, unleashing their horrors on the worshippers of C & S 1 and 2 and the Evangelical Church Winning All (ECWA) Church in the same community. They would later make away with 177 people in total, according to Audu and some media reports. 

“We tried to run out but discovered we were surrounded. Even if you run, they chase you down,” he recalled the horrors of that morning. He said the terrorists were also collecting phones and cash from the victims. Before they got to him, he threw his phone into the bushes, planning to retrieve it after he escaped. 

The terrorists divided the captives into batches, with Audu and four others placed at the front. 

“As we were walking, I saw one of my brothers being beaten by the terrorists. They demanded that he get them food from his house. He told them he only had leftover pap, and when he brought it to them, their attention shifted to it, including the terrorists holding us hostage. When I noticed that, I used that opportunity to run and hide, but the rest were taken into the forest,” he told HumAngle. 

From his hiding spot, Audu watched as the terrorists brought out the remaining church members who had been hiding, made them lie on the ground, and then herded them into the forest. 

“The terrorists were holding guns, which were similar to the ones soldiers use,” he told HumAngle. “All of them had weapons. They came out through three angles; even if you run, you will run into them from all angles.” Although no one was shot, the presence of the firearms and the terrorists’ known ruthlessness were enough to force the villagers into submission. They wore no masks, and the survivors who spoke to HumAngle said they did not recognise them as familiar faces.

They came in through the forest and returned through the same path, this time with unwilling villagers, leaving behind a trail of fear and heartbreak. 

“My in-laws and two other women were heavily pregnant. My second wife and another in-law had daughters under two years old. My daughter was one year and two months old, and my three sons and their wives were all taken away into the forest. The children are not even old enough to walk on their own,” his voice cracked as he named his losses. 

He admitted that revisiting the events of that day makes him want to break down and cry.

It wasn’t just his losses, he said, but also the reaction of the military, those meant to protect them, that further pushed him into despair.

“The day the soldiers arrived, we told them the path they followed. When one of my brothers insisted on showing them the way, one of the soldiers even threatened to slap him. I don’t think any soldiers walked for 10 minutes between the village and the forest. They just stood there watching us,” he lamented. 

Security officials first dismissed the attack as a falsehood spread to cause chaos, only to later confirm it. The Kaduna State Governor, Uba Sani, said the reason for the denial was “to confirm details first before making any statements”. 

“We need help,” Audu cried. “We don’t have anything to do unless the government helps us. What can I possibly do to help them come out? It’s just my wife and me; they have taken everyone else away.”

A recurring problem 

For the people of Kurmin Wali, this is not the first of such attacks. Eight days earlier, on Jan. 11, another mass abduction of about 21 people occurred. The people were released four days later, only after a ransom of ₦2.6 million was paid, according to another villager, Moses Noma*. 

Attacks on the village remain largely underreported. Online searches for Kurmin Wali mostly return reports of the most recent abduction, belatedly drawing attention to yet another community Nigeria has failed to protect. 

Moses escaped the latest attack, but his family had been directly affected by the previous one. The incident occurred at night. 

“They entered my house and my brother’s house,” he recounted. “Twelve people from my family were kidnapped. I barely escaped with my wife. When I returned, I heard my mum crying. She had been badly beaten with metal and was injured. I picked her up along with my injured uncle and took them to the hospital.”

When Moses arrived, his mother was in a pool of her blood. He thinks the kidnappers must have assumed she died due to how badly she was bleeding. Even when he heard her cries, he hid until he was sure the terrorists had gone before he went to her side. Fortunately, her injuries were treatable, and she was able to return to her family. 

Usually, when attacks like this occur, residents say they report them to military personnel stationed along nearby roads. However, soldiers often arrive late, if at all, and little is done until kidnappers demand ransom and eventually release victims on their own. In some cases, soldiers show up a day after the attack, claiming they did not receive permission to respond earlier, residents said. 

“Even as we speak, we are currently patrolling the streets because no security forces have been dispatched,” the 30-year-old man explained a week after the attack, despite the governor’s visit four days earlier. 

According to Moses, the village has been under constant threats and attacks for about three years. “Even in February last year, they came and kidnapped people,” he noted.

After such attacks, some residents flee to other parts of Kaduna, such as Marraraban Kajuru, Kasuwan Magani, and neighbouring towns, and return after some time. Moses, like others, usually finds his way back home, but the terror never stops. 

Government intervention? 

James Kura* says it was the stars that guided him home that night. 

“We were in church. We stationed some people outside to ensure security. When they saw them coming, they raised an alarm. We ran out, but soon discovered they had circled us. They put us together and collected all our money and phones in front of the church. Then they started to march us into the forest,” he narrated. 

At one point, the terrorists stopped and started to beat them heavily with sticks before continuing with the march. James was injured during the assault. 

They later arrived at Sabon Gida, a nearby village that has been deserted due to the constant terror attacks, one of the many ghost communities in Kaduna State. Some captives managed to escape there. But it was much later that James found the chance. 

“I noticed I was lagging behind and the kidnappers were distracted, so I used that opportunity to hide somewhere in the bushes until they left. I started to walk into the forest and eventually found my way home by following the stars,” he recalled. James got home around 9 p.m. that night. 

Despite his escape, many of his relatives and friends remain in captivity.

James and ten other escapees were taken to Barau Dikko Teaching Hospital in Kaduna town on Jan. 23, following the governor’s visit. Before then, James had tried to treat his injuries at a chemist’s shop in the village.

The hospital’s Chief Medical Director, Abdulqadir Musa, said the victims would receive maximum care and attention and would “leave the hospital smiling”.

Even so, this was not the first time James had been kidnapped. In 2021, he was abducted from his home and held captive for days, and the horrors of that experience fueled his determination to escape repeating it. 

“They demanded a ransom of ₦1 million then, and they demanded other items like phones, which amounted to almost ₦200,000 extra,” he recalled. 

Although the current ransom demand has not been formally communicated, James told HumAngle that the kidnappers are demanding 17 motorcycles, which they claimed were left behind after the attack. Residents say only three were found, some of them already stripped of parts such as headlights. 

A separate report corroborates James’ account, adding that ₦250 million and three more motorcycles, bringing the total to 20, have been demanded by the terrorists. 

For a community already struggling to survive, residents say such demands are difficult to meet. The  Kaduna State government has said it will work with security operatives to ensure the victims are rescued unhurt. 

“We have been collaborating with the relevant security agencies, both the military, the DSS, the police, and the Office of National Security Adviser, to ensure the quick return and recovery of our people that were abducted in this very important community,’’ Uba Sani said during his visit to Kurmin Wali. 

The fear of the future 

Survivors like James are worried and concerned about their future security, the fate of their loved ones who are still in captivity, and the ransoms they may be forced to pay. 

Nigeria has criminalised ransom payments, with violators facing at least 15 years in prison. Yet kidnapping continues to surge nationwide, with few successful rescue operations, leaving families with little choice. 

On social media, people, including former top government officials, have crowdfunded for ransom. About ₦2.23 trillion in ransom payments was made between May 2023 and April 2024 in Nigeria, according to the National Bureau of Statistics. 

“When the governor visited, he promised he would bring us security. The government is taking care of our hospital bills and feeding. But in addition to that, the most important thing we need now is financial support because we know we would have to pay ransom,” he added. 

As for tightened security in the village, Audu said some military officials were stationed in front of their church during their morning service on Jan. 25. However, they are unaware of any action or movement to retrieve their loved ones, whose situation remains unknown. 

*Names marked with an asterisk are pseudonyms we’ve used to protect the identities of those interviewed.

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.