north-east

On a sunny morning in October 2025, 42-year-old Fatima Ibrahim walked into the outpatient department of the Adamawa Specialist Hospital in Yola, northeastern Nigeria. Fatima had been vomiting for days and felt increasingly weak. She said she believed going to the hospital was the safest option; however, her consultation with the doctor was brief. After asking a few questions and checking her vitals, the doctor gave her a handwritten prescription and asked her to collect her medication from the hospital pharmacy. Fatima moved from one pharmacy desk to another within the hospital, each pharmacist struggling to read the illegible handwriting.

Eventually, one pharmacist examined the prescription for a moment and told her, “This prescription is not clear. You will have to go back to the doctor.” Exhausted, Fatima turned back toward the consulting room. As she walked under the midday sun, she became unsteady. A few metres from the hospital entrance, she suddenly lost her balance and fell. A passerby rushed to help her up and guided her to a bench until she was stable.

“I felt very light-headed,” she recounted. “My body was already weak, and the back-and-forth movement made it worse.”

After resting briefly, she went back to see the doctor, who clarified the prescription he had written only minutes earlier. She then returned to the pharmacy for the second time. By 2:30 p.m., nearly four hours after she first arrived at the hospital, she finally received her medication.

Handwritten prescriptions are common in many Nigerian hospitals, especially in Adamawa State. Moses Mathew, a medical doctor at Specialist Hospital in Yola, told HumAngle that on busy days, prescriptions are often written hurriedly due to long patient queues. “All prescriptions are handwritten,” he noted. “After consulting with the patient, I write the diagnosis in the case file and then write the prescription on a card or prescription sheet for the patient to take to the pharmacy.”

Emmanuel Somtochukwu, a pharmacist, said he’s familiar with patients returning to consultation rooms because of illegible prescriptions. 

“Illegibility remains one of the most common challenges with handwritten prescriptions. In most cases, they are quite difficult to interpret and dispense,” Pharm. Emmanuel said, adding that prescriptions also frequently arrive with missing details on dosage, strength, duration, or frequency of medication intake. 

Dr Mathew acknowledged that while this does not happen often, it can occur on extremely busy days, and the patient may need to return for clarification. “Sometimes it is because the handwriting is not clear. It happens, but it is not usual,” he said.

Recent studies conducted separately in hospitals across northern and southern Nigeria have consistently identified illegible prescriptions as the leading prescriber-related error, leading to incorrect drug dispensing and, in some instances, death. 

Pharm. Emmanuel, however, reiterated that the back-and-forth due to illegible writing is common where he works. He claimed that “about one in every ten patients is sent back to the consulting room due to unclear handwriting or missing clinical information, though this often depends on the department or the attending clinician”. 

Patients, he noted, often carry handwritten prescriptions from one unit to another, dealing with unclear instructions, queues, and repeated walks within the same facility, even when they are already unwell. These interruptions, Dr Mathew noted, also affect clinical workflow. 

“When patients return for clarification, it interrupts consultations,” he said. “Time spent rewriting prescriptions or answering pharmacy queries reduces the number of new patients that can be seen in a day and adds to fatigue.”

A troubling system failure

In August 2025, Aisha Bello, who was pregnant, visited Cottage Hospital in the Girei area of Adamawa State for a routine check-up. She said that the pharmacist could not read the doctor’s instructions and could not dispense her tablets without confirmation.

“I was told I must go back,” she recalled. “I was tired. My legs were aching.”

When she returned, one of the prescribed medications was out of stock. She was asked to take the same handwritten note to a different pharmacy outside the hospital.

“When drugs are unavailable in one unit, patients may experience lost time, delayed commencement of therapy, or even abandon treatment altogether,” Pharm. Emmanuel explained.

What Fatima and Aisha experienced was a system failure; the problem was not the diagnosis but the process they had to follow to receive treatment. In many hospitals in Nigeria, medical care depends heavily on paper moving between disconnected units, forcing patients, many of them weak, pregnant, or elderly, to carry their own medical information. 

“Without easy access to a patient’s previous prescriptions, allergies, or medical history, decisions are made with incomplete information,” Dr Mathew noted. “You rely heavily on what the patient remembers or what is written in the paper file. This increases the risk of drug interactions, repeated medications, or prescribing something a patient may be allergic to.”

He suggested digital public infrastructure (DPI) as a solution, enabling health facilities to share information seamlessly with patients. He argued that a digital prescribing system could entirely change patients’ negative experience with handwritten prescriptions. 

“Prescriptions would be clear and instantly accessible to pharmacists,” he said. “Doctors would also be able to see past prescriptions, allergies, and drug availability. It would save time and ultimately make care safer and more efficient for patients.”

DPI refers to shared digital systems that enable governments, service providers, and institutions to securely share information and work together efficiently. In healthcare, the infrastructure enables prescriptions, medical histories, insurance status, and laboratory results to move electronically between units, without requiring patients to act as messengers.

The United Nations Development Programme (UNDP) defines DPI as “interoperable, reusable and privacy-respecting digital systems” that enable both public and private actors to deliver services at scale and with greater efficiency. According to UNDP, countries that invest in these shared digital foundations are better able to expand access to healthcare, social protection, and financial services without duplicating effort or excluding vulnerable populations.

Digital identity is often the starting point for effective DPI in healthcare, experts said, noting that when patients are reliably identified across systems, their records, insurance coverage, and entitlements are easily linked and verified instantly. In Nigeria, the National Identity Management Commission (NIMC) reports that over 120 million National Identity Numbers (NINs) have been issued as of 2024, serving as a major building block for integrated public services, including health insurance and electronic medical records. 

Lessons from other countries

Countries with interoperable digital health systems have demonstrated what is possible. Estonia’s health system allows doctors and pharmacists to access patient prescriptions and records through a shared digital platform, reducing prescription errors and wait times. In India, the Ayushman Bharat Digital Mission links digital health IDs, electronic prescriptions, and insurance claims across public and private facilities, enabling near-instant verification for millions of patients. 

According to Asor Ahura, a Nigerian-based AI engineer and digital health expert, electronic medical record (EMR) systems, a digital version of a patient’s paper medical file used within a health facility, have become standard globally because of the efficiency they bring to health facilities and digital prescribing. Asor added that these systems improve speed, accuracy, and the integrity of clinical decisions in ways paper-based processes cannot match.

Across Nigeria and other parts of Africa, private health-tech startups are attempting to close the digital divide. One such company, Helium Health, says it has digitised operations for more than 500 healthcare providers in Nigeria and Kenya. However, these efforts remain fragmented, and the broader challenge of system-wide integration persists.

Why Nigeria’s health sector struggles with interoperability

Nigeria’s health sector is undergoing digital reform, but interoperability remains largely aspirational rather than operational. Most public hospitals still rely on paper records or isolated digital tools that do not communicate with one another. Handwritten prescriptions remain vulnerable to legibility errors, while paper records degrade over time. Digital records, by contrast, can be preserved, duplicated securely, and retrieved instantly.

“Physicians are not known for great penmanship, which leads to the legibility issues associated with paper-based prescriptions that often cause pharmacists to dispense wrong regimens to patients. Furthermore, paper is relatively more destructible than digital information; even with careful handling, the former erodes in quality while the latter can persist indefinitely,” Asor noted.

In 2024, the Federal Ministry of Health and Social Welfare launched the Nigeria Digital in Health Initiative (NDHI), which is designed to create a national digital health backbone that supports interoperable electronic medical records, shared data standards, and secure health information exchange across public and private providers. However, the initiative is still in its early stages. Many state hospitals, including those in Adamawa, are yet to benefit from the infrastructure, funding, training, and governance structures required to make interoperability routine in daily clinical practice.

According to NDHI, scaling digital health systems requires coordination across federal and state governments, regulators, technology vendors, and health workers. Asor argues that a key missing shift is the adoption of hospital-wide EMR systems, noting that digitising prescriptions alone, without integrating laboratories, radiology, and clinics, still results in poor patient experiences and care.

Another major barrier to interoperability is the slow development and enforcement of national standards and legal frameworks for digital health. While Nigeria has articulated a vision for digital health transformation, binding requirements for interoperable systems, electronic prescribing, and patient data portability are still evolving.

Ridwan Oloyede, a tech policy consultant and Co-founder of Tech Hive Advisory, said the digital health services bill seeks to address some of these gaps by defining rules around digital health platforms, data protection, system accreditation, and interoperability standards.  Corroborating, Asor noted that countries with seamless data sharing rely on Fast Healthcare Interoperability Resources (FHIR), a global standard for storing and exchanging medical data. He said Nigeria would need to adopt a national implementation guide and mandate FHIR compliance to avoid creating new digital silos. 

For patients like Fatima and Aisha, the absence of interoperability is not an abstract policy/implementation gap. It translates into longer waiting times, repeated walks across hospital compounds, delayed treatment, and increased physical strain, especially for pregnant women, the elderly, and those already unwell.

“Personnel training is key,” Asor added. “Basic digital skills are a must for all health facility personnel if the benefits of digitisation are to be realised. Government needs to implement recurrent training of its staff along with provision of infrastructure, including computers, internet and local network connectivity as a precursor to the implementation of the EMR.”

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

It was December 23, 2025. A group of young men mounted motorcycles and rode through the warring communities of Lamurde Local Government Area in Adamawa State, northeastern Nigeria, to deliver the governor’s message. A peace accord had been signed, they announced, and all hostilities between the Bachama and Tshobo tribes had ceased.  

“We don’t expect further damage. Enough is enough,” Ahmadu Fintiri, the state governor, said during the signing. “With this, I want to declare, there is no victor and no vanquish.”

In the days that followed, residents who had fled to neighbouring towns began returning home. Commercial farming, which had largely stopped after the July 2025 clashes between the two tribes, was slowly resuming after months of standstill.

Eager to resume work, Grace Joshua, a 35-year-old Tshobo woman based in Lamurde Town, and her group of friends secured a contract at a commercial rice farm on the outskirts of the town. On Jan. 3, they set out. But as they were about to commence work, a man appeared. 

“We were all frightened, and we immediately stood up,” Grace told HumAngle, taking laboured breaths over the phone.  The man, she said, was tall and dressed in black, wearing a mask. 

“Two of us started running [to the opposite direction] towards Tingo Village, and then we saw two other men in front of us. That was when we realised that it was an ambush,” she recalled.  

Gunshots broke out. Grace was hit in the thigh and fell to the ground, but the other woman reached the village unharmed. “I thought I was going to die until I saw people coming from my village, and that was how I was rescued,” she said. 

By the time a rescue team arrived on the farm, the attackers had fled, leaving the other three women dead in a pool of their own blood. The villagers rushed Grace to a clinic for treatment, while the other women were buried that same day. 

As Grace continues to receive treatment, the question echoes in her mind: when will the attacks cease?

The clashes 

For centuries, the Tshobo and Bachama tribes coexisted peacefully, living side by side, sharing schools, markets, water sources, health centres, and even marriages. Situated barely a kilometre apart, both tribes fall under the same local government council, with most of the shared social infrastructure located in Lamurde Town, the local government headquarters. 

However, this long-standing harmony was breached in July 2025, when a dispute over land ownership broke out. Locals say the farmland at the centre of the recent crisis is in Waduku and has been disputed for several years. The claimants — Mallam England Waduku, Afiniki Monday, and Engeti — are members of the same extended family, linked through intermarriage between the Tshobo and Bachama tribes. The violence reportedly began when members of the Engeti family, from the Tshobo tribe, went to work on the land, which they said was allocated to them through inheritance. Members of Mallam England’s family, from the Bachama tribe, confronted them and attempted to stop the farming, insisting that the land also belonged to them. What began as a family disagreement soon escalated into communal violence.

The Tshobo people primarily inhabit the mountainous areas of Lamurde Local Government Area, including communities such as Wammi, Lakan, and Sikori, which stretch toward the border with Gombe State. The Bachama, on the other hand, are largely settled in Rigange, Waduku, and other lowland communities. In towns such as Waduku and Lamurde, members of both tribes live side by side and often speak one another’s languages.

The violent land dispute has shattered daily life in these communities. Two months after the violence, HumAngle extensively documented the impact: some locals had fled to stay with relatives in other towns, while those who remained lamented being trapped within their communities, unable to move freely. Access to healthcare and other social services became difficult, especially for Tshobo communities, which had long depended on clinics in Lamurde town, a Bachama stronghold. 

The crisis deepened communal divisions, as both tribes began avoiding routes and activities that previously brought them together, such as trading. By September 2025, social and economic ties were being severed. Despite several peace talks and reconciliation efforts by the government and stakeholders, both communities continued to clash. 

In early December, both communities violently clashed again, prompting the intervention of the Nigerian Army. Tragically, the intervention resulted in casualties when the military allegedly opened fire on a group of Bachama women who had come out in Lamurde Town to protest the violence. Seven women and a man were killed, while many others sustained injuries. The Nigerian Army denied shooting protesters, but locals insist otherwise.

Hensley Audu, whose wife was killed in the protest, said his mind will never be at peace until justice is served. “Our house was burnt to the ground in Rigange, so we moved to Lamurde Town for safety, but then another incident broke out in the township in December, and my wife joined a group of women to protest peacefully on that day,” he said.

Hensley told HumAngle that he wasn’t at the protest ground, but eyewitnesses said it was the military who shot at his wife and the other women. “She was 63 years old. She left behind five children and two grandchildren,” he added. 

While calm seems to have been restored in Lamurde Town, Hensley said locals no longer trust the military officials patrolling the area. “They were the ones who shot our women,” he stated. 

He said his family has relied on support from relatives since his wife’s death. 

“The government also came to check on us. They offered a token, but until the military takes responsibility and my wife gets justice, my mind will never be at rest,” he said. 

The accords that keep failing 

Since the conflict began, community leaders and residents have told HumAngle that the warring sides have signed three peace agreements, yet new clashes continue to erupt. 

Hyginus Mangu, the leader of the Tshobo tribe, said that the first accord was signed in the office of the state’s Commissioner of Police when the clashes first broke out around July 2025, in the presence of all the state’s security heads. The other two, he said, were signed in the state governor’s office in September and December 2025. 

“It was agreed that there would be interactions between the two communities. And it was unanimously signed like that without any argument,” Hyginus said. 

Simon Kade, a Bachama stakeholder, corroborated the account. He noted that the accords were meant to bring a definitive end to the recurring clashes. However, with the recent attack on the Tshobo women, Hyginus said, the accord has been breached yet again.

To Hensley, the peace accord is just a piece of paper: “The government is not tackling the main issue. They need to arrest those who incite the conflict despite agreements to maintain peace.” 

HumAngle learned that two suspects linked to the attack were arrested by security operatives and are now in custody. 

Trading blames

Hensley accused some Tshobo youths of using social media to provoke hostility against the Bachama. Hyginus, on the other hand, blamed the Bachama for instilling fear among his people. He said Tshobo farmers who own land in Lamurde Town, Tingo, and other Bachama-dominated areas have yet to resume dry-season farming. Civil servants from Tshobo communities have also stayed away from the Lamurde secretariat, fearing attack.

Simon disputed this, claiming Tshobo residents around Tingo provoke Bachama people with insults, which he fears could spark renewed clashes. He added that Bachama residents living in Tshobo-dominated areas do not feel safe.

At night, Simon said, locals do not sleep despite the presence of security officials in the area. He explained that the community has set up its vigilante to patrol the area every night. Hyginus said the same situation exists in the communities where his subjects live. 

Ready to embrace peace?

Wilson Ezra, who lost his wife in the Jan. 3 attack, said he feels hopeless without his wife, who left behind six young children. The last of them, he said, is barely a year old. “Even the other two women who died were breastfeeding mothers,” he told HumAngle. 

While he grapples with the loss of his wife, he prays that more attacks do not happen in the future. “There is nothing I want in this life more than peace,” Wilson said. 

The recent incident has sparked a new wave of displacement among both tribes. Residents are leaving communities such as Rigange and Waduku, which were significantly affected in previous clashes. 

“We have left our home in Rigange and moved into Lamurde Town because we don’t know what might come next,” said Azurfa Morisson, a Bachama native from Rigange who lost her son in the December clash. Since the town houses the local government secretariat, she feels safer. 

This displacement comes at a high cost for families like Azurfa’s, as they have abandoned their farmlands and businesses. But she is willing to do anything to stay alive. 

Lamurde LGA is known for its rich cultural heritage, agricultural productivity, and trade. Before the violent conflict, locals across Adamawa and neighbouring states flocked to Tingo, home to one of the state’s largest markets. Recently, however, the area has become increasingly inaccessible. Roads leading to Lamurde Town, the Tingo market, and nearby villages are largely deserted. Business in Tingo is gradually coming to a standstill. 

Simon, a commercial farmer who lost his home in one of the clashes, said economic activity has collapsed. “This situation has changed the market in Tingo. A  lot of people used to bring their farm produce here, but as a result of this conflict, even the big trucks that come to buy and pack our goods and take them to other states have stopped coming,” he noted. 

Hyginus, the leader of the Tshobo tribe, said they are ready to embrace peace. “There will be peace if today the Bachama’s will stop harassing, attacking, or provoking us, so that there’s a peaceful movement of people from my area, wherever they want to go,” he said. 

He called on the government and the leadership of the Bwatiye Traditional Council, which comprises leaders of both tribes, to investigate the recurring incidents. 

Simon argues that the Bachama tribe also want peace, but the Tshobo doesn’t want to let their guard down. “Everyone should hold on to what they own and stop trying to take over other people’s lands or property,” he said.

HumAngle reached out to the Adamawa State government for comments, but no response had been provided at the time of filing this report. 

As both parties fail to maintain the fragile peace, many lives are strained. 

Jimmy John had been battling a severe toothache for days. The pain made eating and sleeping almost impossible. Early in the morning on Monday, July 7, 2025, he walked into New Boshang Hospital in Jimeta-Yola, northeastern Nigeria, hoping for relief. He queued, was registered, and eventually called in to see a clinician.

After an examination and scans, he was told that he needed a root canal, a dental procedure that removes infected or inflamed pulp from inside a tooth. Jimmy didn’t bother about the cost; the procedure is covered by his insurance under Adamawa State’s health insurance scheme. 

However, he was asked to wait. 

The hospital needed to confirm his insurance details. A desk officer explained that an authorisation code would be sent from his Health Maintenance Organisation (HMO). It would not take long, he was told. Two days at most.

Jimmy left the facility with painkillers and a promise, but the aches kept getting worse. 

“It was a terrible toothache,” he said. 

Two days passed. Then a week. “It took about three weeks,” Jimmy told HumAngle. “I had to be constantly calling and asking if it had been sent.” Each time, the answer was the same: they were still waiting for the code.

By the third week of waiting, Jimmy made a decision he had hoped to avoid. “I ended up paying ₦35,000 for something my insurance should have covered,” he said. “The money I planned to use for food was what I used for treatment.”

Growing coverage, inconsistent access 

Launched in 2020, Adamawa State’s contributory health insurance scheme has expanded in recent years. The Adamawa State Contributory Health Management Agency (ASCHMA) now covers the formal sector, informal sector, equity, retirees’, and tertiary students’ health plans. Official figures show that more than 170,000 people are enrolled across the state, a significant increase from its early years. 

Yet, Jimmy’s experience showed that being insured does not always mean being able to access care when it is needed.

Under ASCHMA’s design, access to healthcare operates at two levels. At the primary care level, enrollees are entitled to services such as malaria treatment, antenatal care, immunisation, and basic diagnostics by simply presenting their insurance ID card at their chosen facility.

According to ASCHMA’s Executive Secretary, Ujulu Amos, this process does not require involvement from HMOs. “Verification at that point only requires an ID card,” he explained. “Once the hospital cross-checks the enrollee’s number with the list sent to them, the person is entitled to access all primary care. The HMO is not involved.”

The process changes once a patient needs secondary or specialised care, such as surgery or a root canal procedure. At that stage, hospitals must request an authorisation code from the patient’s HMO before treatment can proceed. The code allows the hospital to later claim payment for the service.

Ujulu emphasised that this authorisation step is meant to be fast and tightly regulated.

“In our operational guideline, requesting a code should not take more than one hour,” he said. “Three hours is the maximum. If it takes three days, that is a problem.”

In Jimmy’s case, that process stretched into three weeks.

Where the system breaks down

At the heart of these delays is a lack of interoperable digital health infrastructure. While hospitals can confirm that a patient is enrolled, they cannot proceed with secondary care without explicit approval from the HMO, even when coverage is obvious. 

This multi-step process, often reliant on emails, phone calls, and individual responsiveness, leaves patients stuck in the middle.

Ujulu said patients are not powerless in such situations. According to him, ASCHMA operates a 24-hour toll-free call centre that enrollees can contact if authorisation delays exceed the allowed timeframe. In such cases, the agency can intervene, issue the authorisation, and later deduct the cost from the HMO. HumAngle attempted to reach the agency through the toll-free line, and the line was active at the time of reporting.

Beyond awareness gaps, however, fundamental system weaknesses are a factor. Many health facilities still rely on manual processes, and digital literacy among healthcare workers remains low, slowing down requests.

“We discovered low digital literacy among healthcare workers as one of the bottlenecks,” Ujulu admitted. “A good number of them either are not willing or don’t know how to log into the platform to request the code.”

In practice, this means insurance verification is hardly real-time or reliable. 

At New Boshang Hospital, staff say such delays are common once care goes beyond the primary level. Godiya James, a technician at the dental unit, explained that authorisation requests often stall.

“We send the diagnosis and treatment plan for authorisation,” she said. Sometimes it takes a day or two for us to get a response. Sometimes it takes longer. Sometimes there won’t be a response until we resend it.” 

Some patients, she added, can’t wait longer. 

For patients like Jimmy, long wait periods mean prolonged pain. 

What’s the issue?

Health insurance schemes like ASCHMA are designed to reduce out-of-pocket spending, which dominates healthcare expenditure in Nigeria, yet the systems that support them are not well-connected. Many facilities and HMOs rely on emails, phone calls, paper records or ad-hoc networks to verify coverage. 

Without digital interoperability, the ability for different software and data systems to talk to one another, each verification becomes a manual transaction, dependent on network stability, personal responsiveness, or manual cross-checking.

Farida Abalis Paul, Chief Operating Officer of A&M Healthcare, one of the HMOs working with ASCHMA, said verification depends largely on monthly enrolment lists. 

“Once a facility requests verification, we check the list. If the person’s name is there, they can go ahead with treatment,” she explained. However, the process is delayed when a patient’s name is missing from the list, even if they hold a valid insurance card. 

This can result from delayed updates, data entry errors, or changes in facility selection.

“You may have an ID card, but when we check the list, your name is not there,” she said. “Today you’re on the list, tomorrow you’re not. Along the line, something happened.”

When this happens, HMOs cannot approve care until ASCHMA corrects the records. 

For patients, the consequences are immediate. 

Aishatu Haliru, a lecturer at Adamawa State Polytechnic, Yola, was turned away from the Specialist Hospital despite presenting her insurance card.

“They told me my name was not on the list,” she said. “I couldn’t understand how that happens when nothing has changed.”

She was referred to ASCHMA, where an official confirmed that her record had been omitted during a routine database update. Although the issue was corrected the same day, Aishatu missed the clinic schedule and had to wait several more days for care.

“But the question is, why did it disappear in the first place?” she asked.

Ujulu, ASCHMA’s Executive Secretary, argued that such disappearances could result from platform migration, noting that data loss also slows down authorisation processes for patients like Jimmy.

These gaps highlight a broader challenge within Nigeria’s evolving digital health system. 

Nigeria’s push toward efficient digital healthcare systems

At the national level, Nigeria has begun laying policy foundations for digital transformation in healthcare, although implementation remains uneven. 

One of the key efforts is the Nigeria Digital in Health Initiative (NDHI), which aims to build a national digital health architecture that supports interoperable electronic medical records and efficient data exchange between healthcare facilities, insurers, and government systems. In practical terms, such a system would allow clinics to instantly confirm a patient’s insurance coverage, treatment entitlements, and provider claims eligibility, eliminating the kind of long delays Jimmy experienced.

Alongside this, the National Digital Public Infrastructure (DPI) Framework and the emerging Nigerian Data Exchange standards, coordinated by the National Information Technology Development Agency (NITDA), seek to promote shared digital rails for public services. These include interoperability, data security, and service integration. 

Applied to healthcare, these principles mean that insurance verification, patient identity, and claims processing should function as shared public infrastructure: secure, privacy-preserving, and accessible across institutions. In practice, a hospital should be able to instantly confirm a patient’s coverage without manual escalation.

NITDA’s ongoing strategic roadmap also emphasises inclusive access to digital infrastructure across the country and equitable digital literacy, both of which are foundational to reliable nationwide digital service delivery. 

The goal of such policies is straightforward: when systems can talk to each other securely and immediately, services like insurance verification become almost instant, reducing delays and unnecessary costs.

“Interoperability sounds like a technical word, but in reality, it’s about time, trust, and dignity,” said Muhammed Bello Buhari, a Nigerian-based digital rights activist. 

In a state like Adamawa, where insecurity and economic pressure already shape access to care, the ability of systems to speak to one another determines whether insurance works in practice or remains theoretical, leaving people insured on paper but uninsured in practice. 

Muhammed argues that without shared, real-time systems, patients are pushed into delays and out-of-pocket payments not because they lack coverage, but because institutions cannot confirm what they already know. 

“Interoperability is less about cutting-edge innovation and more about treating health information as essential public infrastructure that respects patients’ vulnerability and ensures care moves quickly, reliably, and with dignity,” he added. “When a patient arrives sick or in pain, insurance must work immediately, or it loses its value.”

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

It was almost 6 p.m. on the evening of Wednesday, Dec. 24. 

Makinta Bukar had finished attending to a customer when he heard the Islamic call for prayer from a nearby mosque, signalling the closure of business for the day. He performed ablution, picked up the food items he had bought earlier, locked his shop, and headed to the Al-Adum Jummat Mosque in Gamboru Market, Maiduguri, northeastern Nigeria.

It was a routine he had followed for years.

A few shops away, Suleiman Zakariya was also closing up. Alongside a friend known simply as Manager, he walked towards the same mosque. 

The three men met outside the mosque and chatted briefly. Makinta and Suleiman went in through the front door and occupied the front row, while Manager followed through the back door and stayed a few rows behind them. 

Then prayer began. 

Moments later, a sudden loud sound exploded in the middle of the mosque.

“I thought it was an electric spark,” Makinta recalled. “I ran out immediately as I was close to the exit.” After a few steps, he collapsed. “That was when I noticed the blood on my trousers. I tried standing up but felt a sharp pain.”

Suleiman, standing just behind the Imam, could not escape as quickly. 

“The blast threw me forward,” he recalled. “I sustained injuries on my legs and waist. The debris pierced through my two legs. There was dust everywhere. You could not see anything. The sound was so loud that it deafened my right ear. I still cannot hear with it.”

Manager, who was praying close to the centre of the mosque where the explosion occurred, did not survive.

“He was blown apart,” Suleiman said. “It was only his right arm that was identified this morning through his wristwatch.”

A familiar violence returns

The explosion triggered panic across the area and people ran in all directions. 

As the confusion spread and the sound of the blast quietened, residents rushed towards the scene. Some tried to help the wounded; others searched desperately for friends and relatives. Security operatives and ambulances soon arrived.

“They put me and other victims into their vehicle and drove us to the hospital,” Makinta recalled. Some were taken to the Maiduguri Specialist Hospital, others to the University of Maiduguri Teaching Hospital.

Police authorities later said five people were killed and at least 35 were injured. But survivors dispute that number.

“None of those praying in the middle survived,” Salisu Tahir, another survivor, who prayed in the last row, said. He had prayed regularly at the mosque for nearly two years. “The mosque can take more than 100 people,” he added. “That day, it was full,” Salisu noted that about 15 worshippers could make up a row. 

Others who were praying outside, on the verandah and in the open air, were also struck by debris. “The blast reached them, too,” Suleiman noted. 

When HumAngle visited the mosque, blood stains still marked the walls. Footwear and caps, left behind in the rush to escape, lay scattered across the floor.

The explosion reopened old wounds in a city still trying to heal.

At press time, no terrorist organisation operating in the region has claimed responsibility, and authorities say investigations are ongoing. However, the pattern resembles previous attacks attributed to the Jama’atu Ahlis Sunna Lidda’awati wal-Jihad (JAS) faction of the Boko Haram terror group.

For more than a decade, Maiduguri stood at the centre of Boko Haram’s insurgency. What began in 2009 as an uprising against the state evolved into a brutal campaign targeting civilians, markets, schools, and places of worship. Tens of thousands were killed, and millions displaced across Borno State and neighbouring regions.

At the height of the violence, bombings were frequent. In 2015, coordinated suicide attacks tore through parts of Maiduguri, including markets and busy roads. Two years later, explosions struck the University of Maiduguri, claiming several lives and heightening fear among residents.

The violence devastated livelihoods. Farming collapsed in many areas. Trade slowed as roads became unsafe. Markets emptied, and families who once relied on daily commerce slipped deeper into poverty.

Gradually, the attacks receded. Counterterrorism and community-led efforts, particularly the rise of the Civilian Joint Task Force, helped push terror groups out of the city. Checkpoints became less visible. Shops reopened. Life, cautiously, began to return.

For years, Maiduguri experienced a fragile calm.

Until now.

Lives interrupted

Wednesday’s bombing has put many lives on hold.

Makinta now lies on a hospital bed, his legs wrapped in bandages. A maize flour trader, he earns his living selling goods that belong to his employer. “I make at least ₦7,000 daily,” he said. “I have a wife and two daughters. I provide for them from what I make at the market.”

Now, he worries about survival.

“With this injury, I cannot go out.” Shrapnel tore into both his legs, damaging the bone in his left leg. 

As he spoke, a relative came to visit. Before leaving, she handed him ₦1,000, which he immediately passed on to his wife.

“I had just finished ablution and was preparing to pray when I heard the news,” said Yagana Bukar, Makinta’s wife. “I had already made stew and put water on the fire. I was waiting for him to return with rice so I could cook.” When she learnt about her husband, she rushed to the hospital, leaving her children with her sister.

Unlike Makinta, Suleiman owns his shop, where he sells provisions supplied on credit. “I collect items from wholesalers at Monday Market, sell them, and then return their money,” he explained. “What remains is my profit. I make about ₦20,000 daily. That is my only source of income.”

He also buys food for his household daily. “This incident will affect me badly,” he said. “I cannot go to the market until I recover. I worry about how my family will survive during this time. I am the sole breadwinner.”

At the entrance of the ward, Abatcha Mohammed waited anxiously. His younger brother was among the injured. “My shop is next to his,” he said. “I also pray in that mosque. But that day, I had gone home early because my son was sick. When the explosion happened, I rushed back. My uncle and some friends were also affected.”

The market falls quiet

At Gamboru Market, HumAngle observed a scene far removed from its usual bustle. Many shops, especially those closest to the mosque, were locked. Stalls stood empty. The area was unusually quiet, with security operatives patrolling the streets.

Gamboru Market is one of Maiduguri’s busiest commercial centres, drawing traders and buyers from across Borno State and neighbouring countries, including Chad, Cameroon, and Niger. It hosts a wide range of businesses, from fresh produce and clothing to household goods, and supports countless small-scale traders, tailors, and food vendors. Activity often continues into the night, sometimes until 9 p.m., long after the main market closes.

Now, that routine has been broken.

Still, the survivors speak with resolve. 

“I will be careful going forward,” Makinta said. “Nothing happens without the will of Allah.” Suleiman echoed him. “I will return to the mosque,” he said. “Crowded or not, I will pray again. Allah has already written what will happen. I survived this because it was not my time. Those who died, it was their appointed time.”

A suicide explosion occurred at Al-Adum Jummat Mosque in Gamboru Market area of Maiduguri, northeastern Nigeria, on Wednesday, Dec. 24. 

The bomb went off around 6:00 p.m., shortly after residents and traders began observing the evening prayers.

The Borno State Police Command confirmed that 5 persons lost their lives while 35 others sustained varying degrees of injuries. 

“Preliminary investigations further suggest that the incident may have been a suicide bombing, based on the recovery of fragments of a suspected suicide vest and witness statements recorded, while investigations are ongoing to establish the exact cause and circumstances,” said ASP Nahum Kenneth Daso, Police Public Relations Officer of the Borno State Police Command.

People praying outside the mosque were also wounded after debris and shattered glass were scattered across the area.

Security personnel and emergency responders arrived to evacuate victims and sealed off the site.

The explosion marks the most serious incident reported in Maiduguri in recent times. Since the Boko Haram insurgency began over a decade ago in the city, suicide bombings like this one have been recorded across major cities in public places like worship areas and motor parks. The insurgency has killed over 35,000 people directly so far. 

HumAngle observed several ambulances transporting the injured and the deceased to hospitals, while the police and military personnel maintained guard around the site of the explosion.

While some of the victims were taken to the Maiduguri Specialist Hospital, others were taken to the University of Maiduguri Teaching Hospital. At the Specialist Hospital, HumAngle counted 17 victims, with injuries on the arms and legs, admitted at the Weapon Wound Ward.

A trader at Gamboru Market said, “I was performing ablution when the blast occurred, and I ran away.” He confirmed that the explosion came from inside the mosque.

Gamboru Market is one of Maiduguri’s busiest commercial hubs, drawing traders and shoppers from Borno State and neighbouring countries like Chad, Cameroon, and Niger. The market hosts a variety of businesses, including stalls for fresh produce, textiles, clothing, household goods, and other everyday commodities. 

It also serves as a centre for small-scale services like tailoring, food vending, and transport, making it a key economic lifeline for the local market, operating long into the night, sometimes until 9:00 p.m., even after the main market closes at 6:00 p.m.

ASP Nahum Kenneth Daso also stated that “Police EOD personnel have cordoned off the area to ensure public safety, while investigations are ongoing.”

He urged members to remain calm and vigilant as security operations are ongoing.

Saturday, Dec. 13, 2025, was meant to be a pivotal civic exercise across Borno State, northeastern Nigeria, as residents were expected to elect chairpersons and councillors responsible for local development, basic services, and community representation. Instead, what unfolded across parts of the state bore little resemblance to a functioning democratic process.

Umar Ali, a resident of Gamboru in Maiduguri, stepped out that morning expecting to vote, but could not locate any polling unit nearby. “We thought it was just a delay, but there was no election activity at all,” he said. 

His experience was replicated across the city and other neighbouring council wards. HumAngle observed that many polling units listed by the Borno State Independent Electoral Commission (BOSIEC) were deserted, with neither officials nor voters in sight. In locations where officials were present, there was only a handful of voters, often confined to near-empty compounds.

An exception was Ajari II polling unit in Mafa Ward, where Borno State Governor Babagana Zulum cast his vote, which recorded a higher turnout than most other locations observed.

In several neighbourhoods, residents watched the day pass from outside their homes or went about their chores. Conversations revealed frustration, distrust, and a widespread perception that the outcome had already been predetermined.

“This is not an election. It is a selection,” said Musa Ali, who declined to approach the polling unit closest to his house. He accused the government of determining the results in advance. “They already know what they are doing,” he argued. 

For many residents, the only indication that an election was taking place was the restriction of movement imposed across the state. “If not for the ban, you would not even know voting is going on,” said 22-year-old Fatima Alai. 

On some of the empty streets, children and even young adults turned it into football fields. 

Borno State has over 2.5 million registered voters, with about 2.4 million Permanent Voter Cards collected, as of February 2023. Yet participation in local government elections remains low. It is unclear how many people voted in the Dec. 13 elections. However, this trend is not unique to Borno or even to the current election cycle.

Across Nigeria, turnout in local government elections is consistently lower than in national polls. Analysts and residents alike attribute this to weak service delivery at the council level, the routine imposition of candidates by political parties, and the limited credibility of state-run electoral commissions. For many citizens, local elections appear disconnected from accountability or tangible improvements in daily life.

Malpractice in plain sight

Beyond voter apathy, HumAngle observed troubling procedural violations at multiple polling units. At a polling unit in Bulama Kachallah II, in Maiduguri, HumAngle observed electoral officials stamping ballot papers and depositing them into the ballot box in the absence of voters. This continued between 9:00 a.m. and 1:00 p.m., when we left the unit. 

A similar scene played out at another polling unit in nearby Bulama Kachallah I. BOSIEC officials wearing identification tags, alongside unidentified individuals, openly filled out ballot papers and inserted them into the boxes. 

When approached, a party agent who was present at the scene told HumAngle, “Ba ruwan ka,” meaning, “It is none of your business.”

Despite these irregularities, BOSIEC Chairperson Tahiru Shettima maintained that the process met democratic standards. “I think the commission has done its best and the election was free, fair, inclusive, and transparent,” he said. 

Two days after the exercise, BOSIEC announced that the ruling APC won all 27 chairpersonship seats in the state. The election was contested by six political parties, including the New Nigeria People’s Party, Social Democratic Party, Labour Party, and People’s Redemption Party.

Notably absent was the Peoples’ Democratic Party (PDP), the state’s leading opposition force. In the days leading up to the election, the PDP formally boycotted the process, citing concerns about the legitimacy and fairness of the electoral process, the high costs associated with the expression-of-interest and nomination forms, and a lack of trust in BOSIEC’s capacity to conduct credible elections.

The African Democratic Congress (ADC), a national opposition coalition, was also missing from the ballot. A member of the party, who asked not to be named, claimed that “the state government had been a big challenge”. He said that when the party attempted to launch its Borno State chapter in November, security operatives disrupted the event, alleging that the government had not been notified. According to him, this interference contributed to the ADC’s absence from the December local council election.

The electoral commission rejected these criticisms. Shettima said BOSIEC had consulted with stakeholders, including political parties, on logistics and nomination fees, and insisted that participation was voluntary. “We cannot force any political party to take part in the election,” he told journalists.

Public reactions on social media, meanwhile, suggested a contrasting reality to official claims. Tanko Wabba, a Facebook user, wrote: “We didn’t see the election [ballot] box in our street,” reflecting frustration over missing polling units and highlighting a gap between official claims and citizens’ experiences.

Weakened local governance 

For more than a decade, local council elections were not held in Borno State due to the Boko Haram insurgency. During that period, councils were administered by caretaker committees appointed by the state government. Elections resumed in 2020, with another round held in January 2024. 

While those elections were described by the media as largely peaceful, turnout was characterised as average at best. Analysts cited voter fatigue, lingering security concerns, and persistent doubts about the relevance and autonomy of local councils.

Under Nigeria’s Constitution, local governments constitute the third tier of government, operating under the state’s supervision. Democratically elected councils are mandated to manage basic services such as roads, markets, sanitation, health clinics, business and vehicle licensing, local fees, education, and support for agriculture and health in coordination with the state.

Executive authority at the local level rests with the chairperson and vice chairperson, who implement council policies through supervisory councillors and the civil service. In practice, however, councils often have limited autonomy. State governments frequently override their authority by appointing caretaker committees—often ruling party loyalists—and retaining control of local government finances through joint state–local government accounts.

Autonomy debates and unresolved tensions

In July 2024, Nigeria’s Supreme Court ordered that allocations from the federation account meant for lo­cal governments must be disbursed to them directly, rather than the joint account created by the state government. The court restrained governors from collecting, withholding, or tampering with these funds, declaring such actions unconstitutional, null, and void.

The Minister of State for Defence, Bello Mohammed Matawalle, welcomed the ruling, saying it would allow local governments to manage their own finances, strengthen accountability to voters, and improve service delivery and development.

However, the Nigerian Governors’ Forum opposed the decision. The governors argued that full local government autonomy does not align with Nigeria’s federal structure and said the ruling failed to address longstanding issues of weak administration and executive excesses at the council level.

“The desire for decentralisation must be backed by a commitment to delegate resources, power, and tasks to local-level governance structures that are democratic and largely independent of central government,” said Victor Adetula, a Professor of Political Science at the University of Jos.

Against this backdrop of contested authority and fragile credibility, the conduct of Borno’s local government elections raises deeper questions—not just about electoral integrity, but about whether local democracy in the state can meaningfully deliver the governance and development it promises.

Kolo Askumto sits on a small mat outside her makeshift shelter, a shawl draped around her shoulders for warmth. Her eyes remain fixed on the farmland ahead, not out of desire but necessity. Rows of guinea corn and beans stretch into the darkness. While she scans the fields, careful not to blink for too long, her ears strain at every unfamiliar rustling of leaves. 

It is midnight, and Kolo is at the Lainde fields in Mayo-Ine, a community in Fufore Local Government Area of Adamawa State, in North East Nigeria.

The 55-year-old has been living on her farm during every harvest season for the past three years. Before 2022, guarding her ripe beans or guinea corn was never a concern. That changed when thieves began invading their fields at night, carting away crops — sometimes even those already harvested and packed, waiting to be transported home. 

Kolo lives with her family at the Malkhohi displacement camp in Yola, the state capital. She managed to secure farmland in Lainde after fleeing Madagali in Borno State due to Boko Haram attacks. Since 2016, subsistence farming has helped her support her husband in providing for their family. 

This year, Kolo has slept on her farm for more than two weeks. Every night, she spreads her blanket on her mat, switches on her torch, and scans her surroundings like an owl. When the night deepens, she retreats to her thatched tent but barely blinks while she’s there. 

She is not the only one keeping watch. The isolation of the area adds to the danger. Located on the outskirts of the Mayo-Ine area, Lainde lie far from residential settlements, with only a few people living there permanently. There is no police station nearby, farmers said, except in the main village several kilometres away, leaving those who sleep on the fields largely on their own through the night.

The vigil

Every night, several farmers keep watch across open fields. Some sit in small groups, whispering as they stay awake until dawn. At sunrise, some resume their harvest, while others head home to return by evening for the night shift. The women mostly stick together. 

To stay awake, the farmers told HumAngle that they drink herbal concoctions believed to chase sleep from their eyes. Sometimes, they light a fire and huddle around it for warmth. 

“We pray that God should protect us before we sleep, but we wake up to every sound we hear,” Kolo said. 

Though the vigil has helped keep her farm safe this year, fear still lingers. Two years ago, criminals struck in the dead of night and stole all the grains she had packed in sacks. She was not physically harmed, but the memory of that night has never left her. Since then, she sleeps with a machete by her side.

Unlike some women who return home during the day to rest, Kolo plans to remain on the farm for nearly a month — until the crops are fully harvested. The journey from the IDP camp is long and exhausting. “If we are to trek before we get here, we will be tired, and we will not have enough strength to work,” Kolo said. It takes about an hour to reach Lainde from Yola by tricycle, and much longer on foot.

While she has not encountered any security problems this year, she fears she might encounter the same group that robbed her the last time. However, Kolo says she is willing to go to any length to protect her farm. “If we don’t sleep here, we can lose everything,” she said.

“We can’t afford to pay”

Not every farmer in Lainde stays on the field all night. Some pay guards, mostly young men, to keep watch on their behalf. It costs around ₦60,000 to ₦70,000 monthly. In some cases, the guards are paid with a bag or two of harvested crops.  

For many women, that option is simply out of reach. “We have to buy fertilisers, herbicides, and other inputs,” Kolo explained. “There is nothing left to pay guards.”

Elizabeth Joseph has farmed maize, groundnuts, and beans in the Lainde fields for three years. Every harvest season, she says, comes with anxiety. Once, she harvested several bags of beans and left them in the field while she went to find transport. When she returned, everything was gone. Not even a single grain remained.

In 2024, a bag of beans sold for between ₦110,000 and ₦130,000, while a bag of maize cost about ₦60,000; losing even a few bags can undo months of back-breaking work for these small-scale farmers. That loss left her with little choice but to keep watch herself.

But the vigil is exhausting.

“If I have money, I won’t have to come to the farm. I will just assign labourers to do the work for me, and I will just come during the harvest season. I will even pay those who will harvest, and there won’t be any stress, but since I don’t have the money, I have to come and guard myself,” Elizabeth added. 

Although her husband could sleep on the farm while she managed the household, they switched roles. According to Elizabeth, men are more likely to be attacked or killed by thieves at night.  Her fear is not unfounded.

Recently, in Bare, another community in Adamawa State, twelve young men working on a farm at night were attacked; three of them were killed. Even on the Lainde fields, such attacks that claimed lives have occurred. 

Such thefts are not isolated to Lainde or Bare. Across the BAY states — Borno, Adamawa, and Yobe — farmers have repeatedly reported nighttime farm thefts and attacks during harvest seasons. Communities continue to call on authorities to address the insecurity, saying the losses threaten their livelihoods and food supply.

These threats compound the vulnerability of rural communities to hunger and poverty. Nearly 35 million people in Nigeria, particularly in the BAY states, are facing acute food insecurity, according to the World Food Programme. Displacement, rising food prices, and ongoing violence have further worsened the risk of malnutrition in the region.

Living with danger

However, the robbers are not the only thing farmers are afraid of; they face other threats such as snakes, scorpions, cold weather, and isolation. 

Zara Abba, who began farming in Lainde in 2023, said the environment becomes frightening after sunset. “By 7 p.m., everywhere looks like it is midnight; the whole place gets dark,” she stated. 

Like Kolo and Elizabeth, Zara cannot afford night guards. A mother of four, she brings her children to the farm and lives with them in a thatched tent. At night, the children sleep while she stays awake, watching the fields.

Zara said the women had once raised their concerns with the community leader, hoping for intervention or improved security. But nothing changed.

“If I could afford guards, I would stay home with my children,” she said. “But I don’t have a choice.” She carries gallons of water, cooking utensils, and clothes, staying on the farm for nearly a month until the harvest is complete.

“The other women, too, have been sleeping here for a long time,” she said. “We decided to come here because if we don’t, we will lose our harvest.”

As someone who has lost her ripened crops to thieves in the past, Zara says she does not mind living on the open field with her four children, where she can keep an eye on all of them. 

While they continue to find ways to adapt, the women who spoke to HumAngle said staying on the fields has impacted their other responsibilities, especially for those who can’t bring their children to the open fields. “When coming to sleep here, we leave the children at home and make sure we give them food that would sustain them with the older ones who take care of them before we get back,” Kolo said. 

Though the routine has become familiar, it remains exhausting. 

“The nights are harsh, and sometimes we feel like not selling our farm produce because of the suffering, but we end up selling it at a cheaper price sometimes,” Elizabeth lamented. The exposure often leaves them with flu. “Every harvest season comes with its stress.”

Elizabeth is also frightened by snakes and scorpions; people have been bitten in the fields in the past. To protect herself, she keeps a machete by her side.

As the harvest season draws to a close, the women of Lainde fields look forward to when they can return home, carrying the fruits of both their labour and sleepless nights. Yet even as they prepare to leave, another harvest season will come, and they will be forced to face long nights under open skies again.