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Accessing healthcare: An arduous journey for pregnant women in northwest Nigeria

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Accessing healthcare: An arduous journey for pregnant women in northwest Nigeria

By: Michael Mike

In the bustling emergency ward of Jahun General Hospital’s maternity department, the rhythm of activity beats with urgency and determination, like a pulse in the air. In this hospital, Médecins Sans Frontières (MSF) collaborates with the Jigawa state Ministry of Health to provide comprehensive emergency obstetrics and newborn care and fistula care. Since commencing services in 2008, MSF teams have assisted 90,000 deliveries.
Nigeria is the third country in the world, after South Sudan and Chad, where a woman is most likely to die giving birth, according to the World Health Organisation. With an average of more than 1,000 maternal deaths per 100,000 live births each year, Nigeria is far from the global target for 2030 of less than 70 maternal deaths per 100,000 live births, as set under the UN Sustainable Development Goals.
Maternal mortality rates far exceed the country average in northern Nigeria, where more than half of the country’s estimated 200 million people live. In Jigawa state, the most significant factor is the limited access pregnant women have to antenatal care and delivery care for complications in childbirth, which frequently occur.
Unity Enuebuke, MSF Nursing Activity Manager, has been working in Jahun General Hospital for more than 10 years. “We see a lot of women with serious complications, with the most common ones being anaemia, haemorrhage and eclampsia,” she explains. The high number of patients means the maternity wards are often fully occupied, if not over capacity. Unity says, “We regularly have up to two women sharing a bed, and depending on the type of complications we see, things can escalate very quickly.”
Ramatu
Ramatu, a mother of two, suffered life-threatening eclampsia—seizures due to high blood pressure—when she delivered her first baby in Jahun hospital. This is her second time here, overcoming the considerable distance from home. “I live five hours away from Jahun General Hospital. There is no hospital where I live, and the closest one does not open at night,” she explains. In Jigawa state, many of the estimated 749 primary healthcare centres do not have the drugs, healthcare workers and medical equipment to serve the thousands of women of childbearing age, despite efforts from public health authorities, the current healthcare infrastructure does not come close to meeting the needs of the population.
This dire situation leaves pregnant women who want to attend a healthcare facility with limited choices such as giving birth at home, and if complications arise, embarking on a treacherous journey to try to reach one that is functioning.
It is also not enough that healthcare facilities are available, they must also be affordable. The economic reality in this region, worsened by soaring inflation rates, makes it difficult for people to afford hospital fees, drugs or even transportation to health facilities.
The result is that women become hesitant to go to the hospital, preferring to give birth at home with the help of more affordable traditional birth attendants, hence increasing the risk of experiencing complications.
Khadijah
Women have given birth at home for centuries, but mother’s and baby’s survival can hinge on preparing and planning for managing complications, which may also occur without warning. In Jigawa state, health professionals and facility-based delivery rates remain low with up to around 80% of deliveries occurring at home.
Nurse Unity says, “Most times, family members don’t bring the mother to the hospital until they see that the baby is not coming out and the mother herself is having seizures.”
Khadijah, a 58-year-old traditional birth attendant in Aujara community, Jigawa state, understands the value of hospital care if she can’t manage a complication, but has experienced women’s hesitation firsthand. “Some women take my advice when I say they should go to the hospital, while some refuse to go to the hospital because they say that they are used to giving birth at home.”
In many communities in Jigawa state, pregnant women often require permission from their husband or mothers-in-law to visit hospital. This practice is compounded by a trend of early marriage, at an age when women are not fully informed about pregnancy and are not physically ready to carry a child.
Khadijah explains that for some, “it is their husbands that prevent them from going to the hospital. Some men don’t see the relevance of antenatal care, while others don’t want another man to treat their wives.”
1.

What needs to be done?
To tackle maternal mortality, a multitude of factors must be addressed. State authorities and international organisations must scale up their activities and increase funding to healthcare in the region, ensuring that budget allocations for primary healthcare centres are properly utilised and thorough planning and strict implementation processes are in place. In 2023, MSF teams assisted 15,754 deliveries, performed 1,911 caesarean sections and completed 43,785 antenatal consultations. Yet, it is still a drop in the ocean when looking at the needs of women in Jigawa state.
Primary healthcare facilities, which are often the first point where pregnant women seek healthcare, need to be equipped with trained personnel, equipment and resources to manage childbirth-related complications. “Eighty two percent of the cases we receive at Jahun General Hospital are complicated cases that could have been prevented at the primary healthcare level.” says Abdulwahab Mohamed, MSF medical coordinator. “Women, especially those of childbearing age, also have to be informed about their health and wellbeing through health empowerment programmes led by state authorities or other health stakeholders”.
Pregnant women must be encouraged to go for antenatal care where they can be informed about their pregnancy journey and what to expect. Efforts must be made to mitigate cultural practices that hinder women from seeking care in medical facilities. Women should be allowed agency and given freedom to make decisions for their health.
MSF supports the Jigawa state Ministry of Health in providing comprehensive emergency obstetrics and newborn care. Our support started with vesicovaginal fistula repair in 2008, however, the project evolved into a 161-bed facility to care for pregnant women and newborns experiencing complications. MSF teams also provide maternal and neonatal healthcare in the states of Kano, Benue, Cross River, Zamfara and will open a large maternity hospital in Maiduguri in June 2024.

Accessing healthcare: An arduous journey for pregnant women in northwest Nigeria

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Troops repel bandits’ attack in AgatuBenue

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Troops repel bandits’ attack in Agatu
Benue

By Zagazola Makama

Troops of the Nigerian Army, in collaboration with the police, repelled an attack by suspected armed bandits on a joint patrol team in Agatu Local Government Area of Benue State.

Security sources said the incident occurred at about 9:00 a.m. on April 4, when the troops on routine patrol encountered the armed bandits.

According to the sources, the bandits opened fire on sighting the troops, leading to a gun duel.

“The troops responded decisively, forcing the bandits to retreat after a brief exchange of fire,” the source said.

The attackers reportedly fled through a nearby river, taking advantage of the difficult terrain.

The sources confirmed that no casualty was recorded among the troops during the encounter.

Following the incident, troops have intensified patrols and commenced combing operations in surrounding bushes to track down the fleeing suspects.

The operation is part of ongoing efforts by the military to curb banditry and sustain peace in the area.

Troops repel bandits’ attack in Agatu
Benue

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Six more top bandit leaders eliminated alongside Ado Allero’s son in Zamfara offensive

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Six more top bandit leaders eliminated alongside Ado Allero’s son in Zamfara offensive

By Zagazola Makama

Additional details have emerged on the identities of notorious bandit leaders eliminated during the recent military offensive in Tsafe Local Government Area of Zamfara State, where the son of feared kingpin Ado Allero and scores of fighters were neutralised.

At the heart of the operation was the elimination of Kachalla Iliya Sarki, the son of Ado Allero, alongside more than 65 fighters and several high-ranking commanders who had long orchestrated attacks, kidnappings, and cattle rustling across Zamfara and neighbouring states.

For years, the forests of Tsafe, Shinkafi, and Zurmi have served as operational bases for heavily armed groups, with Allero’s network emerging as one of the most feared. The death of his son, widely regarded as a rising figure within the hierarchy, is not just a tactical success, it is a symbolic strike at the core of the group’s command structure.

Security sources confirmed that the offensive, which targeted multiple camps in Munhaye and surrounding forest enclaves, led to the elimination of several key commanders.

Among them was Kachalla Biyabiki, a notorious kidnapping kingpin linked to numerous abductions in the western Tsafe axis. Intelligence indicated he had at least 10 victims in captivity at the time of his death, with ransom negotiations ongoing.

Also killed was Kachalla Dogon Bete, a feared field commander known for leading violent raids on rural communities and coordinating cattle rustling operations.

Other commanders neutralised include Kachalla Dan Bakolo, believed to be responsible for arms supply and logistics; Kachalla Na’Isa, a sub-commander involved in enforcement operations; Kachalla Yellow, linked to reprisal attacks; and Kachalla Mudi, associated with kidnapping activities along rural transit routes.

Together, these figures formed a critical part of the operational backbone of banditry in the Tsafe–Shinkafi corridor.

“These individuals were key actors within the network. Their neutralisation has disrupted command and control structures in the area,” a security source said.

The offensive, which targeted multiple camps in Munhaye and surrounding forest enclaves, also resulted in the destruction of hideouts and recovery of weapons and other logistics.

However, security experts warn that the killing of such high-profile figures—particularly the son of Ado Allero—may provoke retaliatory attacks by fleeing elements seeking revenge.

Troops have consequently intensified clearance operations, aerial surveillance, and aggressive patrols across Tsafe, Shinkafi, and adjoining areas to prevent regrouping and forestall possible reprisals.

Efforts are ongoing to track down remaining loyalists and dismantle residual cells operating within the wider Zamfara-Katsina forest corridor.

In Zamfara’s forests, where power shifts quickly and alliances are fluid, today’s victory can only be secured by tomorrow’s vigilance.

Six more top bandit leaders eliminated alongside Ado Allero’s son in Zamfara offensive

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Why truth, not narratives, will end the killings in Plateau’s endless cycle of bloodshed

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Why truth, not narratives, will end the killings in Plateau’s endless cycle of bloodshed

By Zagazola Makama

In Plateau State, the sound of gunfire is no longer shocking. It is expected. What follows each incident has also become predictable outrage, media attention, blames and accusations, as well as a rush to frame the tragedy within familiar narratives.

The latest reports of miners lynched by unknown gunmen have once again drawn national and international attention. Youth leaders, clerics, and advocacy groups are already describing the incident in sweeping terms, some branding it as genocide.

But beneath the headlines lies a more complicated and more troubling reality. Plateau is not witnessing isolated acts of violence. It is caught in a deeply entrenched cycle of reprisals, where attacks and counter-attacks have become the norm, and where truth is often buried beneath sentiment and selective narratives.

In the early hours of April 3, troops responded to a distress call from Sabongida village in Jos South Local Government Area. What they found was grim: the lifeless, beheaded body of a 30-year-old herder, identified as Shafiyu, lying in the bush. Security sources indicated that the killing was allegedly carried out by suspected Berom youths. Before the shock of that incident could settle, retaliation came swiftly.

Later that same day, armed men attacked an illegal mining site in Gyel village, Riyom Local Government Area. Three miners, including Samuel Davou, were killed in cold blood, while others fled for safety as troops moved in to secure the area. What might appear as separate incidents are, in reality, part of a continuous chain of violence, one feeding directly into the other.

Across Plateau, recent events reveal a troubling pattern that has defined the conflict for years.
On March 25, the body of Abdullahi Mohammed , a Fulani boy, was discovered in a shallow grave in Mangu Local Government Area, raising suspicions of targeted killing. On the same day in Riyom, irrigation farms belonging to several farmers were destroyed, by Fulani herdsmen, an act capable of provoking immediate retaliation.

Three days later, on March 28, gunmen assassinated Alhaji Bilyaminu Julde, a prominent Fulani community leader and Ardo of Gindiri, in Barkin Ladi. The attack, carried out at his residence, sent ignited tensions through the Fulani community and set off alarm bells across the state.

That same day, another flashpoint emerged in Riyom, where stray cattle destroyed farmlands in Tahoss village an incident that further strained relations between farmers and herders.
By April 2, violence had escalated again. In Bokkos Local Government Area, troops foiled an attack by suspected armed herders following a clash with vigilantes over grazing disputes. One vigilante sustained gunshot injuries.

Then came April 3, a day that encapsulated the crisis. Aside from the killing of the herder in Sabongida and the retaliatory attack on miners in Gyel, more killing were reported in Jos South.
On the same day, troops in Barkin Ladi recovered suspected rustled cattle reportedly taken by the Birom armed militia, while in Riyom, another Fulani youth was allegedly killed in an isolated attack. Each of these incidents is not just an entry in a security log. They are links in a chain, each one strengthening the justification for the next.

The Plateau conflict has increasingly been framed through singular lenses, often ethnic or religious. While these dimensions exist, they do not fully capture the complexity of what is happening on the ground. What emerges from security reports and field accounts is a cycle of reciprocal violence involving armed elements across communities. Fulani herders have been attacked and killed. Berom farmers and miners have also been targeted in deadly reprisals.
Yet, public discourse often pointing fongers only one side of the suffering.

This selective framing creates a dangerous distortion. It fuels anger, deepens divisions, and makes reconciliation even more difficult. More importantly, it prevents a clear understanding of the crisis one that is essential for any meaningful solution.

As observed by Simon Kolawole, the conflict has become a cycle of “attacks and counter-attacks, reprisals and counter-reprisals.”
In such an environment, violence becomes normalized. Communities begin to see retaliation not as a crime, but as justice.
Without accountability, peace remains elusive,”he said in his latest article, titled The Killing fields in plateau State.

In Plateau State, the search for peace has become a long, uncertain journey with no immediate destination in sight. Despite sustained military deployments and repeated calls for calm, deadly attacks continue to rage across communities, reinforcing a grim reality: this is a conflict deeply rooted in cycles of violence, mistrust, and silence.

For many residents, the first instinct after every attack is to look toward the government, Security forces and President Bola Ahmed Tinubu. Questions are asked why were the troops not there? Why was the intelligence not acted upon? Why are communities left exposed?

These concerns are valid. The primary responsibility of any government is the protection of lives and property. Yet, beneath these criticisms lies a difficult truth that is often left unspoken. In many cases, the same communities that demand protection are unwilling to confront the problem from within.

Across flashpoints in Riyom, Barkin Ladi, Bokkos, and Mangu, patterns have consistent which suggest that perpetrators of violence are not faceless outsiders operating in isolation. They are often known by name, by face, by affiliation. But they are rarely exposed. Instead, a culture of silence prevails. Fear, loyalty, and sometimes complicity prevent communities from identifying or handing over those responsible for attacks.

This silence creates a protective shield around perpetrators, allowing them to strike repeatedly without consequences. The result is a dangerous cycle: attacks occur, blame is assigned externally, and the real actors remain embedded within the communities.

There have been instances where youth leaders publicly blamed Fulani groups for atrocities even in cases where the victims themselves were Fulani. Such claims stretch logic and risk undermining credibility. The argument that a group would attack itself, rustle or poison its own livestock, and transport it into rival territory solely to assign blame raises fundamental questions.

While misinformation is a powerful tool in conflict, it cannot fully explain away patterns that are repeatedly documented by security agencies. These narratives, rather than promoting justice, deepen mistrust and inflame passions, making reconciliation more difficult.

This cycle has blurred the lines between victim and aggressor. Communities that mourn their dead today may be accused of launching attacks tomorrow. In such an environment, truth becomes contested, and justice becomes subjective. A herder is killed, reprisal follows.
Miners are attacked, revenge is planned.
Cattle are rustled, retaliation is inevitable. Each incident becomes both consequence and justification.

Intelligence gathering, the backbone of effective security operations depends heavily on local input. When communities withhold information, protect suspects, or distort facts, security agencies are left to operate in the dark.
This creates gaps that perpetrators exploit.
Blaming the government alone, without acknowledging this dynamic, presents an incomplete picture of the crisis.

Security forces have remained active, responding to distress calls, conducting patrols, and attempting to stabilize volatile areas. Yet, their presence has not been enough to stop the killings. The reality is that no amount of military deployment can fully secure a population that is unwilling to cooperate.

One of the most dangerous drivers of the conflict is impunity. For decades, perpetrators of violence in Plateau have rarely been brought to justice. Killings are recorded, condemned, and eventually forgotten until the next incident occurs.

Community, religious and youths leaders, who should serve as stabilizing forces, are increasingly unable to control armed youth groups. Such interventions are rare and often overshadowed by more powerful forces of anger and revenge. In many cases the leaders are the once directly fueling the crises and encouraging the youths to take up arms to carry out reprisals attacks.

The nature of the Plateau conflict makes it resistant to purely military solutions. This is not a conventional war with clear battle lines. It is a fragmented conflict driven by local grievances, economic competition, and historical mistrust.
Calls for heavy-handed interventions, including suggestions of foreign military involvement, fail to recognize this reality. Force alone cannot resolve a conflict that is rooted in social and communal dynamics.

If Plateau is to break free from this cycle, the first step must be honesty. The violence must be acknowledged for what it is a series of interconnected attacks involving multiple actors, not a one-sided campaign. Only then can meaningful solutions emerge.

This is not just a story of victims and aggressors. It is a story of a society caught in a loop of vengeance, where yesterday’s victim can become today’s perpetrator. Until the truth is confronted in its entirety without bias, without omission peace will remain elusive.

The government must move beyond reactive security measures and take decisive steps to address the root causes of the conflict. This includes ensuring accountability, strengthening intelligence capabilities, and facilitating genuine dialogue among communities.Equally important is the role of local leaders. They must rise above partisan interests and work actively to restrain their followers, promote peace, and reject all forms of violence regardless of who commits them.

Zagazola Makama is a Counter Insurgency Expert and Security Analyst in the Lake Chad Region

Why truth, not narratives, will end the killings in Plateau’s endless cycle of bloodshed

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