Resettled But Not Recovered: Borno communities struggle for primary healthcare after return

Across Borno State, providing accessible healthcare for resettled communities remains a work in progress. Years of conflict have devastated the health infrastructure, leaving many newly resettled residents dependent on overstretched and under-resourced Primary Health Centres (PHCs).

Aisha Ali, originally from Kalmari and now resettled in Dalori by the Borno State Government, recounts her experience at the community health facility, Litari Daloriye, which means Dalori hospital in the local Kanuri language.

Two weeks earlier, Mrs Ali had trekked several miles at dawn, carrying her young son who had been ill all night. When they finally arrived, she was told the facility could neither manage her son’s swollen bladder nor offer any medication as the hospital had run out of essential drugs.

“This is not the first time I heard such from the health personnel,” she lamented. “So, we had no other option but to use traditional medicine prepared by his father.”

She expressed her frustration over the persistent shortage of essential medicines, including basic supplies like intravenous fluids.

“Others and I always complain about this. They always say ‘it’s not available,” she said.

She also lamented a major challenge in the community: health workers often arrive late and leave early.

This, she said, leaves patients stranded during emergencies, especially at night when the only available options are to travel long distances to Maiduguri, the state capital.

“No matter how serious the emergency is, whether it’s a woman in labour or any other case, if it happens at night, the only options are to travel all the way to University of Maiduguri Teaching Hospital or the General Hospital in Maiduguri, or just wait in pain till the next day,” she said.

Mrs Ali, however, acknowledged that their children do benefit from immunisation services at the facility.

“The hospital structure looks good, and water is available. But I want to call on the government to provide ‘Litari Daloriye’ with sufficient medicines and, if possible, establish more hospitals,” she said.

Kukawa’s Mixed Reality: Progress, but still gaps

Fati Bukar, who was resettled in Kukawa in 2024, said she frequently visits a nearby PHC that everyone refers to as the “dispensary.”

Mrs Bukar explained that the facility had previously struggled to operate due to security concerns, but in recent months, service delivery has improved.

“Patients, especially pregnant women, now get proper checkups. They provide immunisation, family planning services, and medicines,” she said, attributing these improvements to persistent complaints made by the resettled residents.

Mrs Bukar, however, lamented that only minor cases are handled at the ‘dispensary’ and the majority of the residents still have to travel far to Maiduguri city for serious health issues.

“My appeal is for the government to bring in more specialised health personnel and equipment, so we won’t have to be transferred out of town for every serious condition,” she said.

Demand for accountability

In Dalori, Modu Mustapha, Aisha’s husband, has little faith in the current system. He no longer visits the hospital due to repeated disappointments.

Mr Mustapha said the same type of medicine is administered to patients regardless of their differing ailments, which he believes is inappropriate

“One thing that troubles me is how they give the same type of medicine to patients with different illnesses. I’m not a doctor, but I know that’s not right,” he said.

He urged the government to address the situation by ensuring regular drug supply, employing more healthcare workers and strengthening the quality of medical checkups.

Similarly, Mr Abubakar, husband to Fati, said the PHC in Baga, Kukawa LGA, is the only functional facility he is aware of.

He noted that the facility is equipped to handle basic emergencies, and he often takes his family there when urgent care is needed.

However, he highlighted two major challenges: the occasional unavailability of medicines and the long distances people have to walk to get to the facility.

“Sometimes, the hospital gets overcrowded, and the work becomes overwhelming because it’s the only functioning health centre. The government should consider building more health facilities,” he said.

Ibrahim Kaujima, who also resettled in Kukawa in 2024, shared his experience with this reporter.

“Just three days ago, I took my mother to the hospital, and she was well taken care of. They even gave us free medicines. For cases beyond their capacity, they refer patients to Maiduguri or Monguno LGA.”

Mr Kaujima, however, noted that transportation becomes a challenge after 3 p.m. due to bad roads and security threats.

“More hospitals need to be built so that people don’t have to suffer unnecessarily. I call on both the government and NGOs to look into this matter,” he said.

The pressure on healthcare services is intensified by Borno’s large internally displaced population. According to the National Bureau of Statistics (NBS), the state hosts over 877,000 IDPs – 77 per cent of Nigeria’s total, causing the demand for care to continue rising.

Health workers on the ground

Waziri Bura, who works in one of the Kukawa PHCs, said four PHCs are currently active: Doron Baga PHC, Baga PHC, SSC Cross Kauwa, and a clinic in Kukawa.

Mr Bura said the PHCs provide services such as child delivery, antenatal care, and immunisation. Of the workforce, 40 per cent are female and 60 per cent are male, including volunteers, he said.

According to him, ward development committee officials regularly visit the facilities due to the growing IDP population in the town.

He also noted that ambulances are available to transport patients to Maiduguri when cases go beyond their capacity, particularly during childbirth or surgical emergencies. He highlighted some progress, including improved malaria treatment and the availability of HIV medication.

However, insecurity remains a significant challenge. Referrals at night are difficult due to fears of attacks and explosions. He believes resolving the security issues would lead to substantial improvements in healthcare delivery.

Bashir Sandiya, the senior special assistant on Media and Publicity to the Chairman of Konduga LGA, Abba Abbari, spoke on the council’s efforts to improve access to healthcare across communities under its jurisdiction, including Dalori.

Mr Sandiya stated that 30 functional PHCs under their supervision now receive medicines and ambulances. “Recently, Auno PHC received an ambulance after a needs assessment,” he said.

“In every community, we rely on councillors to share pressing issues before we take action. Regarding Dalori, I believe Ali Mairamme, the councillor, is unaware of the situation; otherwise, he would have forwarded it.”

He assured that now that the issue has been raised, the council would investigate and determine whether the situation could be addressed at the chairman’s level, the primary health care board, or the state level.

He urged residents to channel complaints to their community leaders and encouraged parents to take advantage of available immunisation services.

Beyond local efforts, the Borno State Contributory Healthcare Management Agency (BOSCHMA) has enrolled over 115,000 vulnerable individuals in free healthcare programmes since 2020. Services are provided through 183 accredited PHCs, a promising step toward inclusivity.

State-Level Perspective: Director weighs in

The Director of Community and Family Health Services at the Borno State Primary Healthcare Development Board, Mala Abdulwahab, provided a broader view of the state’s health sector recovery.

Mr Abdulwahab explained that prior to the insurgency, Borno State had at least 700 PHCs, but the crisis reduced that number to about 100.

In response, the government initiated construction and rehabilitation efforts, bringing the number of functional PHCs to over 400, including facilities in resettled communities.

He explained that resettled populations fall into two categories: those in rebuilt homes and those in temporary camps. “People in homes usually have centres nearby. For camps, we deploy outreach teams every Friday to provide basic services.”

He said insecurity remains a major challenge, but the collaboration with military personnel and civilian joint task force members helps PHC operations continue. “Even in conflict areas, services are ongoing because healthcare is a necessity.”

On Kukawa’s request for more health centres, he said it would be considered, but urged residents to appreciate current efforts. As for Dalori’s complaints, he stressed that the hospital is functional and serving its purpose.

“People need to understand what primary healthcare means. It’s the first point of contact, providing basic and nearby emergency care. Some limitations like drug shortages or the need for referrals shouldn’t be mistaken as failure,’ he said.

“The situation is overwhelming, and the government is doing its best.”

He credited national and international partners for bolstering healthcare delivery in the state.

Highlighting successes, Mr Abdulwahab noted that 2025 has so far recorded no major outbreaks of cholera, whooping cough, or measles—a significant improvement.

“Before, insecurity prevented us from reaching 15 LGAs. Now, most are accessible, which also encourages humanitarian groups to assist.”

A functional PHC benefits all

Functional primary healthcare centres are the backbone of Nigeria’s health system, especially in fragile and conflict-affected settings like Borno State.

They serve as the first point of contact for preventive, promotive, and basic curative services — including maternal care, immunisation, and disease surveillance. Without accessible and well-staffed PHCs, efforts to reduce health inequities and reach vulnerable populations stall.

A 2022 report titled “The State of Primary Healthcare Service Delivery in Nigeria” shows that Borno and 17 other Nigerian states are weak in PHC service delivery.

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The other states are Sokoto, Taraba, Kebbi, Katsina, Zamfara, Yobe, Kogi, Jigawa, Rivers, Gombe, Cross River, Edo, Bayelsa, Akwa-Ibom, Plateau, Imo, and Kaduna.

Findings from the report also blame Nigeria’s deteriorating healthcare system on the weak governance structures and operational inefficiencies.

For resettled communities in Borno, access to healthcare is no longer just about infrastructure. It’s about trust, consistent availability, and safety.

While improvements have taken root, true recovery will mean building a system that can be relied upon—day or night, crisis or calm.