Cameroon

Five years in Maroua: Essential care in an ongoing crisis

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Since 2016, Médecins sans Frontières/Doctors Without Borders (MSF) medical teams have provided emergency surgical care and mental healthcare at Maroua regional hospital, in the Far North region of Cameroon, part of the Lake Chad Basin. The services provided by MSF teams here range from emergency trauma surgery for those caught up in conflict, to long-term surgical and rehabilitative care for people involved in car accidents, and psychological healthcare. MSF has performed more than 14,000 surgeries, and provided more than 8,000 mental health consultations in Maroua since 2016.

After completing the refurbishment of an intensive care unit and having trained new teams, MSF is now transitioning these services to the ministry of health. However, the health needs in the region remain significant. MSF has launched new projects in the nearby areas of Mora and Kolofata to meet these needs, and is preparing to launch more.

FIVE YEARS OF ESSENTIAL CARE

The Lake Chad crisis began in Nigeria in 2009, before spreading throughout the Lake Chad Basin, including the Far North region of Cameroon, western Chad and south-east Niger. The crisis further exacerbated the needs in a region with limited infrastructure, social inequalities, poverty and regular droughts. The crisis displaced thousands of people, who have been left at risk of extreme violence and with insufficient access to healthcare.

The Lake Chad crisis is a complex humanitarian emergency precipitated by climate change, extreme poverty and cross-border conflict. Lake Chad, once the largest lake in the Chad Basin, has been shrinking for decades. As it recedes, so too do grazing pastures, water supplies, livelihoods and the availability of fish. From this, protracted conflicts between armed groups and government forces have grown. This crisis continues to have serious repercussions for the 17 million people living in the region. While the effects of this crisis are profound and ongoing, few solutions are in sight.

According to UNHCR, the UN agency mandated to aid and protect refugees, 298,225 Nigerian refugees have fled to Chad, Cameroon and Niger. An estimated 2,832,939 people have been forced from their homes across Nigeria, Cameroon, Chad and Niger as a result of the crisis.

Since March 2015, MSF has been assisting refugees and people displaced by conflict in the Lake Chad region, as well as host communities made vulnerable by the violence. In 2021, the impact of the crisis is still visible both on the displaced populations and on host populations.

“At the start of the project, MSF’s main objective was to treat victims of armed groups who came from remote areas and were transferred to Maroua. That was the idea. But after a while, we started to receive a lot of injured people from the city of Maroua. People came with life-threatening emergencies that had to be managed. Immediately, MSF began to take care of these cases; both those who had been injured in conflict and other vital emergencies.”

- Gaëlle Ngacha, nurse

The Maroua regional hospital is the main specialist health centre in the region. Since 2016, MSF has provided support with complex surgical care and mental health support to people affected by the conflict and the local population more generally. MSF teams treat of patients suffering from complicated fractures, serious soft tissue and abdominal infections, severe burns, and those in need of emergency surgical care. These services are provided 24 hours a day, seven days a week.

Hawa is not the only patient to have spent so much time in the hospital. Some patients spend more than two years undergoing continuous treatment. Whether a serious car accident, burn or gunshot wound, options for complex surgery and medical care, including psychological care, in the Far North are scarce, which makes the treatment provided at Maroua even more valuable.

"Attacks were happening every day," says Ibrahim Abdulahi, 24. He fled Nigeria to escape armed groups. He lost several brothers and his mother in an attack. He was referred to MSF after showing signs of post-traumatic stress. “I'm constantly on edge; when someone shuts a door I think it's a weapon. I can't be with people; I can't sleep. I have lost many brothers, my mother too, all in attacks… It disturbed me, I couldn't even sleep. I was sent here to MSF. When I arrived I said I didn't know why I was still living on earth. But with the treatment that I have had since, I am better. In terms of health, I am managing to sleep more."

Although the subject of mental health is little discussed in Cameroon, the psychological impact of the crisis cannot be underestimated. Last year alone, our medical teams provided 2,400 mental health consultations to patients in Maroua and Mora. Psychosocial support is offered to all patients and carers to help them during their treatment.

“As soon as we started working here, we began receiving a wide variety of cases. There have been as many cases of moderate mental disorders as severe mental disorders. People were suffering from from mood disorders, anxiety disorders to psychotic or psychiatric disorders and substance abuse. We also treat people who have attempted suicide.”

- Raëlle Miamekongo, mental health supervisor, Maroua

BOUBA’S STORY

Ibrahim is a cotton farmer from Madaka in Bogo arrondissement in Cameroon’s Far North Region. When his son Bouba was badly burned in a fire, he took him to Maroua regional hospital, where he underwent treatment for more than two years. Ibrahim stayed with his son in hospital, despite the many challenges he faced. Today Bouba is nine, and can walk again and go to school.

My name is Ibrahim, Bouba is my son. It was a Tuesday when Bouba was injured. We had harvested two cases of cotton and Bouba went to collect it when the cotton burst into flames. We still don’t know how it happened, but Bouba’s clothes caught fire too and he ran. People chased him to put out the fire but nobody could catch up with him. We had to peel the clothes off him and his skin was coming off with them. We took him to the neighbourhood hospital but they said they couldn’t treat him and they advised us to go to the regional hospital in Maroua where the MSF doctors would meet us.

When we arrived we were made to feel welcome. But first we couldn't sleep, because Bouba was crying, he called out to me, he called for everyone, I was so worried about him. They took care of us though, and little by little his condition was improving. Finally he was able to sleep, and that meant I could go and rest while someone else came to stay by Bouba’s bedside. Gradually he began talking to people in the hospital, he got to know the doctors and nurses.

Because I left the house alone to be with Bouba, I returned home to find it destroyed. The rainy season had arrived and the floods had totally wrecked the house. Bouba spent two years in hospital being treated, and when we went home, I needed to rebuild the house. That was not the only difficulty we faced in those two years: my crops burned too, so the next year I couldn't cultivate new crops. With nothing to sell, I had no source of income. We were counting on any help we could get. My wife and my other children were still living at home, and needed. It was three years after Bouba’s accident that I was able to return to work.

I grew cotton and millet, and today we rely on the income from cotton to rebuild the house. It’s still a work in progress. There were people who told me that MSF could do nothing for us and told me to go and look elsewhere, but I refused. I was ready to stay for five years if necessary. I waited patiently and there were people who also asked me if I paid for the treatment, how many millions I had spent and said Bouba’s treatment was free. There were people who asked me how MSF managed to treat him, I told them that if he needed blood, I would donate mine for him or I would find someone else who could.

In the operating theatre, the doctors would explain to me what they were doing and I would agree to the treatment, and I would ask them to do what they thought was right for him and that I was only going to go home after he was healed.

When the dressings were finished, he was able to give up his crutches and walk again. Today he can pedal his bike, he has gone back to school, he has gone back to Koranic school. He can harvest cotton, millet, he can draw water, he can do all the shopping without difficulties.

The chief of our village came to visit us too. He gave me 10,000 Francs, he kept coming to visit us to see if we needed more support until Bouba was discharged from the hospital. This is how he helped us.

During Bouba’s treatment, I was having a lot of trouble. When I had concerns, I received psychosocial support, which helps reduce my worries. Often when I was sad I thought that Bouba would never heal. Sometimes I wanted to give up. When I heard the stories of the patients who had been here and recovered it reassured me. After Bouba’s stay in hospital we came back for him to receive massages and physiotherapy.

“When my son started to walk again, my hope returned. But it was when he really started to recover that I felt relief. People told me I was very patient and I said that when you accompany someone in hospital you have to be patient.”

CONTINUING CARE FOR CONTINUING NEEDS

MSF teams have also responded to various epidemics of diseases in the Far North region, including measles, cholera and COVID-19. In 2018, the Lake Chad region was hit by several cholera epidemics. MSF teams treated more than 30,000 patients and vaccinated more than 550,000 people. Over the same period, more than 3,000 measles patients were also treated.

Enormous needs are still present in Cameroon’s Far North. For this reason, MSF is launching new activities in Kolofata and Mora, close to the border with Borno state, Nigeria. In Kolofata, MSF teams will provide basic healthcare, including treatment for child malnutrition, malaria and diarrhoea. In Mora, where MSF has worked since 2016, our teams will continue to provide basic healthcare. In 2020 alone, MSF treated more than 50,000 patients in Mora; more than 17,000 for malaria. In Mora, MSF will soon be providing emergency surgery for complex childbirths and patients with trauma injuries, including gunshot wounds. These new services reflect the need not only for continuous care, but for more specialist services in an area that sees frequent violence. The addition of surgical treatment in Mora is particularly relevant, as it is increasingly the point from which many patients in need of emergency surgery are referred to Maroua.

“With the increased medical capacity in the general hospital in Maroua, and the addition of surgical services in Mora and primary medical care in Kolofata, our goal is to expand the availability of healthcare for the population at a time when armed conflict, a changing climate, and food and water insecurity continue to impose hardships on those in the Far North.”

- Dr Modeste Tamakloe, MSF head of mission in Cameroon

Doctors Without Borders is an international, independent, medical humanitarian organisation that delivers emergency aid to people affected by armed conflict, epidemics, pandemics, natural disasters and exclusion from healthcare. We offer assistance to people based on need and irrespective of race, religion, gender or political affiliation. Doctors Without Borders has been working in Cameroon since 1984. Today we run medical humanitarian projects in the Far North, and in the South-West regions of the country. We work in each of these regions based on our assessment of people’s need.