Kerri Ann Kelly is the head of mission for Doctors Without Borders/Médecins Sans Frontières (MSF) in Nigeria. She explains how the complex humanitarian situation in Borno State, in the northeast of the country, will only get worse with the rainy season and widespread malaria.

Seventy-year-old Musa Kime arrived in Rann, a town in Borno State, a few weeks ago. Along with other people from his village, Kime walked 13 miles on foot at night to reach the safety of this small town in northeast Nigeria. “I just want some food and a place to stay,” says Kime. “I have not much hope.”

Others like Kime continue to arrive in towns across the region every day, fleeing the long-running conflict between the Nigerian military and armed groups. According to the United Nations, 1.7 million people have been displaced in northeastern Nigeria, 78 percent of them in Borno State.

Mohammed Jabu, who just arrived in Rann, sits under a communal shelter, waiting to receive humanitarian aid. He expresses anxiety about the future. “We came here with little or no clothes and belongings. There is not a lot of food here either.” For the displaced people in Rann, the lack of food and shelter supplies will only get worse during the rainy season.

Rann is home to more than 40,000 people, including the local community and internally displaced people from surrounding villages. Heavy rains from July to September transform the town into an island, leaving residents cut off from the outside world. It has become increasingly difficult for humanitarian organizations to reach people with much-needed shelter, food supplies, and lifesaving medical care. Food insecurity is also a big problem with the season between harvests – when farmers are unable to sow their fields – fast approaching.

The risk of waterborne disease is also concerning. Heavy rains lead to numerous pools of stagnant water which are easy breeding grounds for mosquitoes. Open defecation and overflowing pit latrines increase the risk of outbreaks, which can spread unchecked throughout towns. At a time when people are coping with reduced food supplies, falling sick with malaria or diseases such as hepatitis E can prove deadly. Pregnant women and children under the age of five are the most vulnerable.

In response, a preventive malaria treatment program for children under five was launched by the Borno State government in collaboration with several humanitarian organizations, including MSF. In Rann, MSF trained 47 teams of community health workers and provided malaria treatment for 14,725 children in three days.

There is no access to inpatient hospital care in Rann. Humanitarian organizations can only reach the town by helicopters. During the dry season some residents risk the insecure roads to access a hospital in a town over 15 miles away, but in the rainy season this is simply not possible. The general hospital in the town was destroyed in 2014 during the conflict and it is only now being renovated by the local authorities.

Many of the new arrivals in our Rann health facility report that continued insecurity and lack of food forces them to leave their villages to escape the ongoing conflict. As people continue to arrive in Rann and other towns across northeastern Nigeria, the need for better medical facilities, shelters, and sanitation facilities is urgent.

Rann has not been spared the violence. On January 17, 2017, the town was bombed by a Nigerian military plane, killing 90 people and injuring at least 150 others. Following the bombing, MSF provided medical care through mobile clinic teams who regularly visited the town. Since September 2017, MSF has had an ongoing presence in Rann.

In March 2018, MSF was forced to temporarily suspend activities in Rann following an attack on a military base. Three humanitarian aid workers from other organizations were killed in the attack. Today, there is a lack of health and sanitation services in Rann, and aid organizations that are present do not have permanent teams with experienced, senior staff, which hampers the effectiveness of the humanitarian response. The need for more humanitarian aid across northeastern Nigeria is apparent. Food, medical care, and sanitation services haveto be ensured so communities in Rann and other villages can live in safety and with dignity. The sheer number of people who lack these vital requirements shows that the humanitarian crisis is far from over in northeastern Nigeria.

In Rann, MSF provides outpatient care, including a therapeutic nutrition program. In northeastern Nigeria MSF is providing primary and secondary health care in eight locations across Borno State and in the capital of Yobe State, Damaturu. MSF teams run nutrition programs for malnourished children, provide mental health support, respond to disease outbreaks and provide emergency pediatric care, among other services.