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Easy treatment, challenging response

Cholera in Nigeria

By MSF

November 4^th, 2021

Four hundred kilometers northeast of the Nigerian capital Abuja, two-year-old Mohammad Sheriff is on the road to recovery from cholera. The child sits with his father in MSF’s cholera treatment centre (CTC) in Bauchi, the capital of one of the states hit hardest by Nigeria’s worst cholera outbreak in a decade. "He vomited twice and later started having diarrhoea," says Mohammad’s father, who immediately recognised the symptoms as cholera. "I told his mother that I'd take him to the hospital as we are constantly being informed through the radio that one should immediately go to hospital when vomiting and diarrhoea starts."

Cholera is simple to treat in most cases, and people with mild to moderate forms of the disease usually recover through treatment with fluids and oral rehydration solution. Severely dehydrated patients may need to be admitted to a CTC and be given fluids intravenously.

Mohammed’s case was serious, but after two days receiving medical care in the CTC, he is now in the recovery ward – the last step before being discharged and returning home. “If we had not come when we did, the situation might be very bad,” his father says.

Two-year old Sheriff with his father Mohammed. Sheriff spent two days in MSF’s cholera treatment centre in Bauchi and is waiting to be discharged home. © Hussein Amri /MSF

Cholera is endemic in Nigeria, but the outbreak this year has been especially severe, with more than 90,000 people infected so far. While nearly all of Nigeria’s 35 states have reported cholera cases in 2021, the vast majority have been concentrated in the six northern states of Bauchi, Kano, Jigawa, Zamfara, Sokoto and Katsina. The population of this region is already extremely vulnerable; hundreds of thousands of people have been displaced from their homes by conflict and violence, and most live in conditions with poor sanitation and no safe drinking water.

MSF emergency teams are working alongside the Nigerian Ministry of Health to try and bring the spiralling outbreak under control, opening six cholera treatment centres across the region and treating more than 20,000 patients so far.

Easy treatment, challenging response

In many areas, security poses an additional challenge. In Zamfara state, many patients arrive in a serious or critical condition, having delayed seeking treatment for fear of encountering violence or danger on the roads. Despite this, MSF teams were still admitting more than 100 patients daily at some points in August, underscoring the severity of the outbreak and the determination of patients to get treatment, however risky.

Nurse Bilkisu at the MSF CTC in Kano checks the body temperature of a patient using the infrared thermometer while another nurse records the reading. © Hussein Amri /MSF

“Cholera has added to a complex web of medical and humanitarian vulnerabilities.” Dr Simba Tirima

An emergency response

A Nurse checks the vital signs of Abubakar Gali, a 10 year old patient who’s being treated of cholera at the MSF’s cholera treatment centre in the city of Kano, Nigeria. © Hussein Amri /MSF

Nurses, at the female observation ward in MSF CTC in Kano. © Hussein Amri /MSF

“Vulnerable populations in Nigeria were already in a dire situation,” says Dr Simba Tirima, MSF country representative in Nigeria. “Cholera has added to a complex web of medical and humanitarian vulnerabilities, coming on top of heightened insecurity, a chronic state of acute humanitarian and medical needs, and the direct and secondary impacts of COVID-19.” At the peak of the outbreak in July, the Nigerian Centre for Disease Control reported more than 7,500 new cases per week and many medical facilities were at risk of being overwhelmed.

“We had to admit 80 or 90 patients during a single work shift,” says Anas Al-Hassan, a nurse at MSF’s CTC in Kano, where the outbreak spread quickly throughout the community. “There was no time for rest because of the number of patients. The work at that time was overwhelming.”

“The patients would come devastated, their caregivers worried they might not make it,” says Philip Esenwa, MSF medical activity manager for the Nigeria Emergency Response Unit. “Some were so weak they that they couldn’t speak.”

“We used to have patients who were brought in dead,” says MSF nurse supervisor Mustapha Mahmud, who also works at Kano CTC.

Anas Al-Hassan, a nurse works at the MSF cholera treatment centre in Kano. Anas checks the IV fluid of a patient in the CTC triage. © Hussein Amri /MSF

Barira Usman, mother of a 10-year-old daughter, Hafsat Auwal, is waiting in MSF cholera treatment center (CTC) in Kano, as her daughter was recently admitted with cholera. “I don’t have an idea how or where she got the sickness from but one thing is certain is that it is now an epidemic” she says. “She first started with abdominal pain and she was taken to the hospital where some drugs were prescribed for her and yesterday night she started vomiting and acute watery diarrhoea”. She continues “I noticed that she got sick when she came back from school”. Hafsat suffered from abdominal pain, vomiting and acute watery diarrhoea. Barira has other eight children, Hafsat is the only one that has cholera. Barira and her family have been living in Kano for quite a while now, she knows about Kano Infectious Disease Hospital (IDH) where MSF CTC is located, because other people have come for similar health issues.

Easy treatment, challenging response

Easy treatment, challenging response

Easy treatment, challenging response

Maryam is the mother of a 20-month old child, who is being treated at the MSF’s treatment centre in Toro, some 100 km from the state capital in Nigeria’s Bauchi state. Maryam watches as an MSF nurse adjusts the flow of IV fluid being administered on her son at MSF’s cholera treatment centre in Toro. Later, she places her hand on the head of her son who is being treated at MSF’s treatment centre in Toro, Bauchi state.

Easy treatment, challenging response

Easy treatment, challenging response

Easy treatment, challenging response

But if cholera patients needs to be treated rapidly, the recovery is quite fast, like for Musa (name changed) who waits to be discharged from MSF’s cholera treatment centre in the city of Bauchi after his condition was stabilised. During the peak of the outbreak in Bauchi, there were such high numbers of patients that some had to lie on the floor while waiting for a bed to become free.

Musa (name changed) in MSF’s cholera treatment centre in the city of Bauchi, Nigeria. © Hussein Amri /MSF

A wider assitance

The challenges were immense in cities such as Kano and Bauchi, where many people live in overcrowded conditions, with dilapidated or non-existent sewage systems and no access to clean drinking water. Water sources can easily become contaminated with sewage, especially in the rainy season, causing waterborne diseases such as cholera to spread quickly.

“The areas with high numbers of cholera cases are congested, with no adequate ventilation or proper drainage,” says Mustapha Mahmud. “The sources of water are usually from shallow wells and boreholes; with rainfall, they become contaminated, and that is the water people here drink.”

MSF team members meet with community leaders in Magama village of Toro LGA of Bauchi state. The team usually visits the leaders of the community affected by cholera. © Hussein Amri /MSF

Many medical facilities in these areas are also poorly equipped and were unable to deal with the surge in patients. Some medical facilities charge for their services, which put treatment out of reach of those who could not afford to pay.

To grapple with these complex challenges, MSF adopted a community-based approach, taking healthcare, hygiene measures and public health information directly to the affected communities. MSF health promotion teams worked with Ministry of Health staff to conduct door-to-door contact tracing to find people with symptoms and help them get medical care quickly, while outreach teams chlorinated wells and disinfected patients’ homes.

MSF’s health promoters going into households in Magama village in Toro LGA, in Bauchi state, Nigeria, sensitizing residents about cholera and how they can help stop the disease from spreading. © Hussein Amri /MSF

Working with community leaders, MSF teams also identified neighbourhoods with high concentrations of cases to set up oral rehydration points, where patients with milder symptoms could receive treatment. In some states, a one-dose oral vaccine is available to help reduce the spread of the disease. However, global supply is limited and the vaccine is not available in all states.

In the areas where MSF is responding, these and other efforts have made a difference. In Bauchi state, where MSF set up 19 oral rehydration points and a cholera treatment unit, and carried out health promotion and hygiene activities, the mortality rate has been reduced by a factor of ten, from 5% to less than 0.5%, and the number of new patients being admitted for treatment continues to decline.

The MSF Health Promotion team consults amongst themselves before moving into Toro community in Bauchi state, Nigeria.© Hussein Amri /MSF

MSF’s health promoter giving aqua tabs to a housewife in Magama village of Toro LGA of Bauchi state. The Health promoter sensitises the woman on how to use the aqua tabs in purifying their water. © Hussein Amri /MSF

The Health promoter sensitises the woman on on how to use the aqua tabs in purifying their water. © Hussein Amri /MSF

An MSF health promoter chlorinates a well in Magama village, in Toro, in Nigeria’s Bauchi state. © Hussein Amri /MSF

An MSF health promoter disinfecting local people’s houses as a measure to prevent the further spread of cholera in the community. © Hussein Amri /MSF

The trend of declining cases holds true for the country overall, with new cases in recent weeks falling to below 1,000 per week from a peak of 7,500. In many areas, this has brought a sense of palpable relief for communities and medical teams alike.

“Thankfully, there has finally been a significant decline in the number of new cases in most areas,” says Dr Tirima. Elsewhere in the country, however, the outbreak rages on. “Other areas continue to be affected and the response is not over yet,” he warns.

Nurses sits in an empty ward at the Bauchi CTC after the peak period of the cholera outbreak , this was in September. © Hussein Amri /MSF

Spraying the feet of anybody coming into the CTC is a measure adopted to ensure sanitation so that the spread of the disease is prevented within into or out of the facility. © Hussein Amri /MSF

Some nurses inside the triage at the Bauchi CTC. The triage is the point where patients who arrive for treatment are assessed by MSF’s medical team. © Hussein Amri /MSF

An MSF staff disinfects the premises of the cholera treatment centre in Bauchi, this is to ensure that the spread of the disease is reduced or prevented. © Hussein Amri /MSF

One of those areas is Borno state, where hundreds of thousands of people have been displaced from their homes by clashes between government forces and armed insurgent groups. Years of conflict, displacement and underdevelopment have left the population struggling to access clean water and decent sanitation. In the state capital, Maiduguri, the MSF team continues to treat nearly 200 patients per week for cholera and acute watery diarrhoea.

In March 2021, MSF launched a cholera response in Gusua, in northwest Nigeria’s Zamfara state, setting up a 30-bed cholera treatment unit (CTU), which closed in late-July. In May 2021, MSF set up three cholera treatment centres (CTCs) in Kano and Bauchi states: a 130-bed CTC in Kano and a 40-bed CTC in Tambaruwa, both in Kano state; and an 80-bed CTC in Bauchi state; all are now closed. As the epidemic continued to spread in August, MSF opened four more CTCs in Zamfara and Borno states: a 72-bed CTC in Anka, a 30-bed CTC in Shinkafi and a 68-bed CTC in Zurmi, all in Zamfara state; and a 40-bed CTC in Maiduguri, Borno state; these CTCs remain open. MSF also managed eight CTUs and 25 oral rehydration points (ORPs) across northern Nigeria; most of these are now closed.

MSF cholera response in detail and in pictures:

Footnotes

Working in Nigeria since 1996, MSF observes neutrality and impartiality in the name of universal medical ethics and the right to humanitarian assistance.

FootNotes

Working in Nigeria since 1996, MSF observes neutrality and impartiality in the name of universal medical ethics and the right to humanitarian assistance.

© 2026 MSF

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