MSF in Borno, Nigeria: taking a critical look

Evaluation and Lessons Learned
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Food distribution in Borno state (2016) © Shaista Aziz/MSF

by Elba Rahmouni

In 2016, the Operations Department commissioned a review of Médecins Sans Frontières (MSF) France’s operations between 2015 and 2016 in Borno State in north-eastern Nigeria, in response to the consequences of the conflict between the government and Boko Haram. As part of the project, some of the directors and operations managers who had been involved reflected on their experience: were we late in responding to the catastrophic situation in IDP camps in rural areas and on the outskirts of Maiduguri, the state capital, in 2016? If so, why? What conclusions can be drawn about the operational choices made and the effectiveness of MSF’s intervention strategies? And what does this experience tell us about how MSF functions and how our teams work?

[_Interview with Isabelle Defourny, Operations Director at MSF-OCP_]

Why was the review commissioned?

When, in June 2016, our teams arrived in Bama – a town 70km away from Maiduguri, where 20,000 displaced people had gathered in the grounds of a hospital controlled by the Nigerian army – they were stunned to find a catastrophic health situation. Mortality rates were 10 per 10,000 per day, with 1,200 graves in the hospital grounds testifying to the scale and duration of the crisis.

Just a few months earlier, in January, the health situation in Maiduguri had appeared to be under control: a cholera outbreak had ended and mortality and malnutrition rates were back below emergency thresholds. We believed that, while the situation in the localities around Maiduguri controlled by the Nigerian government – like Bama – was probably not very good, we certainly weren’t expecting things to be as bad as they were. And yet other humanitarian actors, including UN agencies, the ICRC and ECHO, had known about the situation outside the city for some time. Back in September 2015, the ICRC had identified severe malnutrition rates of 25% in the camp in Dikwa.

Hence the question: how did we not know about the scale of the crisis when everyone else did? We knew there were large numbers of displaced people in Bama, but security problems made the town difficult to reach; the Nigerian government was hiding the gravity of the situation and the ICRC was not talking about it openly. These were real constraints – but even so, if we’d paid more attention to what other actors were documenting, we could have been in Bama by April, saving two months. Assessments produced by the UN and WFP should have rung the alarm if we’d been more open to what colleagues from the UN were saying – even if, for political reasons, the seriousness of the situation was not explicitly stated.

Another issue was the analysis of the context during the handover from the emergency cell to the regular cell, which wasn’t thorough enough. For example, it is revealing that there is no written analysis of the situation in north-eastern Nigeria during this period. This is a criticism that I also direct at myself because, as Operations Director, I could have asked the emergency cell to provide more detailed analysis of the context after spending a year working in Borno. If I had, we would probably have got an answer, perhaps along the lines of ‘the health situation in Maiduguri is under control but we don’t know what’s going on outside the city – we haven’t been out there’. I don’t know to what extent the high volume of activities carried out by MSF in Maiduguri contributed to the delay in responding to needs outside the city, particularly in Bama. Perhaps we could have scaled back activities in the town earlier, given that health indicators had improved significantly, and redirected our attention and resources to Bama.

In all large-scale emergency operations there are always management problems, which can create opportunities for misappropriation. This is neither surprising nor insurmountable. The real problem in Borno was not misappropriation as such, but the fact that it was never mentioned and, worse still, was not dealt with. During an emergency deployment, the case number curve and human resources curve are never in phase because it takes time to find the right people and then make sure they’re available, get visas and so on. So, during the initial phase, there are often not enough people to cope with the scale of an emergency, which can lead to management problems. There comes a point where more human resources are available but the situation has become less serious, with a decline in mortality rates and fewer cases of cholera and malnutrition. This is the time to sort out any management problems and deal with any incidents of misappropriation, for example.

Read the full report on ODI.