Record-breaking measles cases at MSF facilities in Maiduguri, Nigeria

Factors impacting the spread of measles 

In 2023, MSF teams treated nearly 10,000 patients for measles in both of MSF’s health care facilities—Gwange Pediatric Hospital and Nilefa Kiji Nutrition Hospital—and in MSF-supported primary health care centers in Maiduguri. Between October and December 2023, MSF treated 3,965 patients—nearly three times as many that were treated during the same period in 2022. 

“We did not expect such a large influx of patients, particularly at the end of the year,” said Abdulwahab Mohamed, MSF medical coordinator. 

Dr. Tochukwu-Okoli attributes this alarming rise in the number of cases to an inability of public health actors to achieve the 95 percent vaccination rate required to suppress measles. “This is notably due to the difficulties for health workers in accessing rural communities surrounding Maiduguri,” Dr. Tochukwu-Okoli said, as insecurity in the region has presented challenges for carrying out vaccination campaigns. 

This is not the only difficulty in achieving broader vaccination coverage. The interruption of routine childhood vaccinations during the COVID-19 pandemic has disrupted health systems and has had a negative impact on the implementation of routine immunizations campaigns. Technical complications also create interruptions in the cold chain that keeps vaccines refrigerated, leaving them unusable. 

The measles spike coincides with an unprecedented diphtheria outbreak in northern Nigeria and a malaria season that has lasted longer than usual. The diphtheria outbreak, with 24,500 suspected cases and more than 600 deaths reported since it was officially declared in January 2023, is yet another strong indicator of the dramatic setback in routine immunization programs and the lack of long-term efforts to increase vaccination coverage in the country.

The dual threat of malnutrition

When Maryam Umar’s youngest daughter contracted measles, she took no chances. She had already lost a son to the disease. “I was really scared and started crying because [I knew] of the severity of the disease,” the mother of six children recalled. She immediately brought her daughter to Gwange Hospital, where MSF staff operate two wards dedicated to treating measles. The toddler was discharged after one week of oxygen therapy. 

Because measles affects the immune system, it can lead to serious complications long after the virus is gone. This is what makes the virus so deadly—it leaves a child open to other, specifically diarrheal, diseases.  

“Measles is notorious for precipitating malnutrition,” said Dr. Tochukwu-Okoli, voicing concerns about the significance of a measles spike in a context where malnutrition is so prevalent—the virus has a degenerative impact on the gastrointestinal lining. The diarrhea, Dr. Tochukwu-Okoli, explained, “makes it difficult for the child to retain and absorb nutrients in the post-measles phase, and purges the child of essential micronutrients, further suppressing a child’s immunity.” 

In northeastern Nigeria, where access to nutritious food is seasonally limited (among other factors), diseases like measles lead to higher levels of malnutrition and create a vicious cycle in which malnutrition leads to further immune suppression. In turn, this generates higher morbidity and mortality linked to measles and other diseases. 

Adding to this problem is the complex security situation in northern Nigeria, significant funding cuts by international donors for the country, and the continuous neglect of public health infrastructure. Due to the high prevalence of vaccine-preventable outbreaks—including measles, diphtheria, and meningitis—MSF is cautioning international and national stakeholders not to look away at what could be a perfect storm for a worsening humanitarian crisis in 2024.