Displaced but Determined in Borno; Exclusive Breastfeeding in the midst of a humanitarian crisis
The Bakassi Internally Displaced Persons (IDP) Camp in Maiduguri is home to over 30,000 people. It is one of several IDP camps in Borno State where victims of the Boko Haram conflict, forced to abandon their homes, have taken refuge. As a result of this conflict, the longest (since 2009) and one of the deadliest Nigeria has ever witnessed, thousands have lost their lives and millions have been displaced, creating a large-scale humanitarian crisis reported to be one of the worst on the African continent in recent times.
Bakassi camp was originally an unfinished housing estate, with hundreds of partly completed houses spread over several hectares of land. At the peak of the insurgency, faced with a need to provide housing for the large number of people seeking refuge in the state capital, the state government converted this estate into a camp for displaced people. Besides the uncompleted buildings, there are also tents, many of which bear inscriptions of international humanitarian organisations working to provide relief in Borno State.
It is a wet August morning at the camp, due to the heavy rainfall. With the drainage system unable to cope with the rapid downpour on the non-permeable soil of the Lake Chad and Sahel region, there is surface water flooding. School is out, and children can be seen playing in different parts of the makeshift primary school, which has neither walls nor seats nor blackboard. Some women and girls have gathered to fetch water from the many taps mounted around the camp which are powered by a solar-powered borehole. Between the primary school and a cluster of settlements is a long line of pit toilets. Even though they have been walled with aluminum sheets, the smell is distinct and hard to miss.
Balkisu, a healthy and well-fed 19-month-old girl, lives in one of the tents with her mother, father and 12 other people. In a place where poverty is rife, where thousands of people compete for very scarce resources and most parents struggle to provide decent meals for themselves and their children and where the sight of malnourished children is common, Balkisu is a surprise find.
Balkisu’s mother, Binta Lawal, is a thirty-year-old mother of five from Bayan Dutse village in Gwoza Local Government Area. Gwoza town was once declared a caliphate by the Boko Haram terrorist group. Binta ran away from her village in 2013 when members of the group invaded and killed many people including her brother and husband, leaving her with four children of her own and some of her late brother’s children to care for. They found their way to this camp where she met and married Balkisu’s father. “The moment I suspected I was pregnant I rushed to the clinic and they told me I was, in fact, three months pregnant,” Binta says, as she hands Balkisu to her eldest son who wants to play with his sister. “From then, I never missed any antenatal appointment I was given”, she added. During her antenatal visits, she was diagnosed with pre-eclampsia which she said took a toll on her. It later developed into eclampsia and she said she had to be referred to a hospital outside the camp because she started having seizures. She was successfully treated and the camp clinic was kind enough to settle her bills.
Pregnancy, giving birth and raising a child comes with a specific set of challenges. Pregnancy comes with cravings, hormonal changes and the worry over whether the baby will survive to full term. Antenatal visits are an important part of ensuring both mum and the growing foetus are healthy. When it comes time to give birth, concerns about post-partum haemorrhage and the health of the mother arise. After birth, nutrition of both mum and child becomes paramount, and for the child especially, exclusive breastfeeding and then complementary feeding. The extent to which a woman is able to effectively handle each potential challenge depends on some specific factors, such as the quality and affordability of the healthcare delivery system, her own socioeconomic status and literacy level, and the level of access she has to skilled healthcare services.
It is widely agreed among experts that enabling women and girls to have access to education improves the prospects of the family, improving health outcomes, with reduced maternal and child deaths, lower fertility and the women are more knowledgeable about the nutritional value of different foods. In addition, the higher educational status of mothers increases the likelihood of the early initiation of breastfeeding. Also, a woman with a moderate to high economic status is better able to plan for pregnancy and childcare. Binta has never had any formal education, not even primary schooling, as a result her family has always struggled financially. However, this did not hinder her from accessing information about pregnancy and childcare and using it to ensure that she gave Balkisu a healthy start in life.
Balkisu was born safely at one of the three clinics at the Bakassi camp, where Binta had been attending antenatal care. The clinic is managed by the International Rescue Committee (IRC). During antenatal days, when women are being given the routine ‘health talk’, Binta said she always carried one message with her; ‘exlusive breastfeeding’. Though not entirely new to her, she had never fully practiced exclusive breastfeeding with her older children when she gave birth to them in her village. “I heard it would make a child stronger and more intelligent,” she says. Balkisu is all that as well as being a smiling and playful child. Binta breastfed her daughter exclusively for the first six months of her life and made sure she took her to every immunization appointment.
Unfortunately, not many Nigerian children have had this privilege. According to a recent Multiple Indicator Cluster Surveys (MICS), only 23.7% of babies in Nigeria are breastfed exclusively. This is as a result of many compounding issues, some including cultural practices. The belief in many communities is that if an adult needs water and food to survive, so does a baby, not realising that about 80% of breastmilk is water; so they give water to infants under 6 months. Many people also do not know that breast milk contains many nutrients and vitamins that aid in a child’s brain development and helps protect the child from common infections. Lower educational status plays a significant role in the low rates of exclusive breastfeeding.
With limited formal education, Binta however knows exactly what she needs to eat to enable her and her daughter to stay healthy. “I like fish a lot”, she said jokingly. Her husband does not have a regular job, so some days he goes out of the camp into Maiduguri town to do menial jobs. On her part, Binta goes to the farms outside the camp to work for money and gets paid between N600 to N800 per day. “I bring what I get and add to what my husband gets and buy food for all of us”, she explained before adding, “We make sure we eat something decent at least once a day”. Besides fish, Binta said that she puts some money aside from time to time to buy eggs and fruit, especially watermelon.
Binta’s efforts are aided by a local NGO in Maiduguri, the Social Welfare Network Initiative’s (SWNI) intervention. The NGO works in the areas of food security and nutrition, ensuring that those fleeing conflict are able to access nutritious food, especially vulnerable members in a community, such as pregnant women, the aged and families with many children to feed. Binta said she has on several occasions received large amounts of food items including cooking oil, onions and okra that lasted for several days. She was also given guinea corn and N6,300 on two occasions. These interventions have helped Binta use more of the money she earns from working on farmlands to buy more fish and eggs to supplement the nutrition of her family.
Looking at some of her other children, it is safe to say that Binta is doing what many parents even outside the camp have not been able to do; providing decent nutritious meals for their children. However, her greatest pride lies in the fact that Balkisu has never fallen sick since she was born; this can definitely be linked to the fact that she has been exclusively breastfed and immunized. Experts agree that children who have been breastfed and immunised are better able to withstand childhood illnesses better than children who have not been exclusively breastfed or completed their immunisation schedule.
Binta has shown great courage and conviction in taking care of Balkisu in spite of the odds, but in the process, she has forgotten another very important thing; following up on her own care, especially in regards to her blood pressure levels. Eclampsia is a condition that usually occurs in women even after pregnancy and in some, it becomes lifelong hypertension. Since giving birth to Balkisu, Binta said she has never gone back to the clinic to check her blood pressure. This is because she takes her daughter to a different camp clinic run by UNICEF for immunisation. She mentioned that she has not had any symptoms, but hypertension can sometimes be symptom-free. More awareness is needed from healthcare providers to pregnant women who develop eclampsia on the need to keep checking their blood pressure even after delivery.
Humanitarian crises such as war and natural disasters are almost always accompanied by damaging health emergencies, top of which are malnutrition and infectious diseases. Managing such situations is a complex task that governments cannot handle alone. In a country like Nigeria where the entire healthcare budget is less than a billion dollars, interventions of international humanitarian organisations such as the ones International Rescue Committee and UNICEF are providing in Bakassi camp are very critical. Without their clinics, Binta would probably have not been able to attend antenatal sessions and learn about exclusive breastfeeding and Balkissu would probably have not enjoyed the benefits of immunization. Also, what would have happened to Binta as a result of her high blood pressure is unimaginable. These organisations work all over the world giving hope and providing succour to vulnerable people and humanity cannot thank them enough. Governments and philanthropists around the world must continue to support them in the work they are doing.
We are proud of parents like Binta who have followed through with the decision to practise what their health care providers preach. Her actions have given Balkisu the opportunity to start life on a healthy footing. If more mothers, whatever their economic or educational status may be, make the small but powerful changes that Binta made, children like Balkisu will no longer be the exception but the norm in Nigeria.