Zuwaira Hanafi stood in shock as four doctors rushed past her to enter the ward where her eight-month-old daughter, Hambali, lay semiconscious.
At the entrance to the healthcare facility in Kaita community in Nigeria’s northern Katsina state, medical personnel were using colour-coded tape to measure the diameter of children’s arms and determine their levels of malnutrition. A steady stream of mothers, some as young as 15, filtered through with children, many of them, like Hambali, arriving in a critical state.
The children are victims of an unprecedented hunger crisis gripping vast swathes of Nigeria. The Red Cross has warned that up to 33 million Nigerians could face severe hunger this year, a record figure. According to the United Nations Office for the Coordination of Humanitarian Affairs, about 6.4 million Nigerian children are expected to be acutely malnourished by the end of 2026, the majority in the north.
According to Dr Soma Bahonan, the head of the Nigeria mission at the Alliance for International Medical Action (Alima), which runs the Kaita facility alongside local officials, increasing numbers of mothers are also presenting with acute malnourishment.
Clockwise from top left: a family walks through the front gate of the Alima medical facility in Kaita; a woman sits waiting for her child to be weighed.; a medical worker stands between two rows of hospital beds at the Alima medical facility; a medic reviews documents. Locals say the 80-bed facility, funded by Alima and its donors since it was established in 2021, has been a lifesaver for people living nearby. Last year, its malnutrition programme treated more than 36,000 children
Alima also supports mobile clinics that can reach children whose families are unable to travel to Kaita, and can even facilitate transport to the facility from the surrounding area.
But it faces an impossible challenge. Katsina state is at the centre of the intergenerational hunger crisis in Nigeria, where longer-term drivers of food insecurity, such as climate shocks and poor governance, have recently been exacerbated by a rise in attacks by jihadists and other non-state actors that have prevented access to some communities, as well as aid funding shortfalls.
Map showing location of Kaita in Katsina state
Across the country, the doctor-to-patient ratio is roughly 1:9,000, far less than the 1:600 recommended by the World Health Organization. Thousands of doctors are fleeing abroad, citing late payment of their meagre salaries. Digital health startups and private-sector partnerships have made inroads in big cities such as Lagos and Abuja, but not elsewhere due to infrastructure shortcomings and inflation.
“Nigeria remains in a polycrisis: an economic/cost of living crisis, a security crisis, a human capital development crisis, a human development crisis,” said Joachim MacEbong, a senior analyst at the Lagos office of Control Risks, a risk consultancy. “All four feed on and amplify each other.”
Bahonan said that “even with the results we’re seeing in Kaita, the wider situation is very concerning”.
In nonprofit circles, strategising has begun to combat enhanced risks during the upcoming lean season, which runs from June to September.
Last year, the Nigerian government partnered with the World Bank to provide basic nutrition packages to millions of vulnerable households under the Accelerating Nutrition Results in Nigeria project. The second phase is now under way.
Still, experts say more needs to be done to increase food affordability for vulnerable households and social protection alongside sustained investment in maternal nutrition.
Key to this is fixing the supply chain for drugs and equipment. Peter Bunor Jr, cofounder and head of growth at Field Intelligence, a health-tech company working on pharmaceutical supply chains in Africa, said this requires “grappling with changes [that are] happening globally”.
“For everyday people, this [dire supply chain situation] translates into travelling long distances only to find that the drug they need isn’t available, or substituted with whatever is accessible, often at great cost,” he said. “What makes this especially acute during a hunger crisis is the compounding effect: malnutrition weakens immune systems, increasing demand for treatments at exactly the moment supply chains are most strained.”
In 2018, Field Intelligence launched the Nigeria Health Logistics Management Information System, the country’s first such system, to track data relating to the pharmaceutical supply chain for public health initiatives. Unicef recently joined the platform, which is now managed by the health ministry, and Bunor hopes more organisations follow suit “so shortages can be anticipated and addressed before they become crises”.
Aid workers are also holding out hope that the health sector – at the sharp end of foreign aid cuts – gets more attention from the Nigerian government soon.
Clockwise from top left: a whiteboard lists monthly patient statistics, including admissions, transfusions, deaths and referrals, at the Alima facility in Kaita; women sit and wait outside a building at the facility; a young man sits outside in a waiting area; three women sit on hospital beds with children at an Alima facility.
In the 2025 federal budget, the health sector was allocated only roughly about 5.2% of the total 47.9tn naira budget. For years, the budget has hovered below the 15% Abuja Declaration target agreed on by member nations of the African Union. It is one of the lowest per capita spends on health across the continent.
In February, Nigerians were shocked when the health minister, Muhammad Ali Pate, lamented that of the 218bn naira (£119.6m) budget allocated for operations and capital projects supervised by the ministry headquarters, only 36m naira (£9,751) – just 0.0165% – was released.
“It’s a figure that tells its own story,” MacEbong said. “There are saloon cars from 2023 that are more expensive.”