It Takes a Village to Kill a Child

The death of a 1-year-old Nigerian toddler had many authors — Boko Haram’s viciousness, his own government’s negligence, and starvation’s relentlessness.

MAIDUGURI, Nigeria — A little more than a year ago, Aboubacar Aboubacar was born under the thatched roof of his family’s wood-and-straw hut in the village of Madriya in Nigeria’s northeastern Borno state. He knew very little in the beginning. His body seemed only to understand how to breathe and eat and issue a soft cry.

Except for his periodic pangs of hunger, the baby in his earliest days had little idea of violence. But in his short, hard life, Aboubacar would come to know it well.

While Aboubacar’s father, Aboubacar Yunnus, worked the fields, the infant stayed with his mother, Halima, and his older sister, Houwa, who was 13. He ate and slept as they cooked and cleaned. His 3-year-old brother, Yunnus, played and helped with chores.

At the end of every day, his father — a tall, rail-thin man who smiled when he was nervous — would come home, his clothes bearing flecks of earth and sweat. He would change into his clean jalabiya, the tails of the robe flapping as it let fresh air in. His calloused and sinewy hands often grasped a small, light blue Nokia phone, even though it held no SIM card and rarely held a charge.

Life had gotten harder in Madriya in recent years. As Boko Haram pursued its stated goal of establishing a caliphate in the Lake Chad region, it destroyed virtually everything in its path. Militants looted and burned villages, kidnapped children, and brutally murdered thousands of people. They mined fields and killed farmers as they tended their crops, strangling trade routes and hampering humanitarian access. Local markets dried up, and, like most of his neighbors, Aboubacar Yunnus was able to plant less and less each year. Food stocks dwindled, and neighbors increasingly talked about how people in nearby villages were dying of starvation.

Still, the family clung to a tenuous routine. Aboubacar ate and slept. Halima braided Houwa’s hair, the infant resting in his sister’s lap. Aboubacar Yunnus worked the fields and checked his Nokia phone. For the first eight months of Aboubacar’s life, things continued like this, hunger and uncertainty forming the backdrop to daily life. Then came the violence of Boko Haram.

Fathers with sick children talk to a staff member from the International Committee of the Red Cross in Muna camp, on the edge of Maiduguri, Nigeria. (MACKENZIE KNOWLES-COURSIN | Foreign Policy)

Halima holds her 1-year-old son, Aboubacar, in the hut where they live in Muna. (MACKENZIE KNOWLES-COURSIN | Foreign Policy)

Halima and her daughter, Houwa, who is 11 years old, hold Aboubacar as the family rides to the hospital in Maiduguri. (MACKENZIE KNOWLES-COURSIN | Foreign Policy)

It was nearly 1 p.m. one February day when the fighters arrived in pickup trucks and motorcycles, their AK-47 assault rifles and machetes held high. Aboubacar Yunnus was in his field, trying to salvage a spoiled harvest. Aboubacar was at home next to his mother as she ground the guinea corn the family grew. Even before she saw anything, Halima knew exactly what was happening. From outside the hut came the sound of gunshots and the screams of her neighbors, as the militants tore into the village.

Aboubacar’s father sprinted home from the fields to find the militants rounding villagers up, yelling and spitting with guns drawn.

“Where are your guns?” they demanded. “Give us your guns!”

The villagers insisted they didn’t have any, apologizing each time they repeated it.

“You are Fulani, and Fulani always have guns!” the fighters yelled, referring to the main tribe of the village. “Give them to us, or we’ll slaughter you!”

The back-and-forth continued as the villagers pleaded for their lives. The militants finally ordered everyone to lie down on the ground. Aboubacar, who had been in his sister’s arms, was soon wedged among dozens of bodies in the dirt, perhaps sensing the fear and anger and violence rising around him.

The fighters singled out six young men — the strongest-looking among the villagers — and forced them to lie down in a row.

“We’ll slit the throats of every man here if you don’t give us your guns!” the leader threatened as he waved a large blade at the row of bodies splayed out at his feet. But again the villagers insisted they could provide nothing. The six men on the ground pleaded. The villagers pleaded. Fear rippled from body to body.

The leader of the militants knelt down on the back of one of the young men, sliding the blade under his neck. Then he began to saw. After the young man’s head was severed, four other militants raised their guns and fired into the line of men lying at their feet. The fighters proceeded to loot everything of value from Madriya. When they had finished, they mounted their vehicles and tore out of town. Aboubacar’s family and the rest of the villagers were left trembling, facedown in the dust.

Early the next morning, the whole village picked up and left. Aboubacar Yunnus gathered Houwa and Yunnus while Halima bundled Aboubacar onto her back. They began walking west, leaving behind everything and nothing. For three days, Aboubacar stayed swaddled and hitched against his mother as they walked. They had no food and barely any water. The heat was relentless.

On the third day, they arrived at the city of Maiduguri, where they were met by troops in the Nigerian military. More men with guns and stern faces lined the villagers up and, one by one, took the men aside to be interrogated. Those suspected of collaborating with Boko Haram were put in the back of a pickup truck and driven off for further questioning. Some were never heard from again, a number of villagers said.

Nigerian President Muhammadu Buhari — a retired major general and former military ruler — was elected last year on a promise to end Boko Haram’s reign of terror in the country’s northeast. Since then, he has launched a new offensive against the group, retaking large tracts of land and killing scores of fighters. But suicide bombings, kidnappings, and attacks continue. Fear and insecurity still plague much of the region, and civilians continue to flee their ancestral villages.

Maiduguri, the capital of Borno, has absorbed nearly 1.7 million internally displaced people (IDPs) since the insurgency began. The government-run camps are overflowing, and aid agencies are at their limit. Increasingly, people are being forced to settle in informal camps on the city’s outskirts, where access to basic services like potable water, sanitation, and even food is extremely limited.

Because the war against Boko Haram, like all wars, is waged through propaganda as well as military force, the poor conditions in these settlements aren’t just a tragedy for their residents — they are a major setback in the government’s fight.

Displaced people wait for food to be distributed in Muna. (MACKENZIE KNOWLES-COURSIN | Foreign Policy)

Displaced mothers hold their children as they wait for food to be distributed outside Maiduguri. (MACKENZIE KNOWLES-COURSIN | Foreign Policy)

Displaced women wait beside stacks of food being distributed by the ICRC in Muna. (MACKENZIE KNOWLES-COURSIN | Foreign Policy)

A mother who recently fled her home in the countryside for the relative safety of Maiduguri feeds her child. (MACKENZIE KNOWLES-COURSIN | Foreign Policy)

ICRC staff members distribute food to newly arrived displaced people as a dust storm blows through the outskirts of Maiduguri. (MACKENZIE KNOWLES-COURSIN | Foreign Policy)

A young displaced woman walks through a dust storm in Maiduguri. (MACKENZIE KNOWLES-COURSIN | Foreign Policy)

Displaced people wait for food to be distributed in Muna. (MACKENZIE KNOWLES-COURSIN | Foreign Policy)

“The government wants them far away from where people look,” a local health worker named Ibrahim, who asked that his last name be withheld, said of those fleeing insecurity in the countryside. “They [the government] need to show they have control.”

The daily arrival of hundreds of terrified civilians doesn’t help that narrative. So the government has been pushing displaced people into ad hoc settlements farther and farther out of town, as far from sight as possible.

“There has been a lot of long-term neglect and a refusal to act upon the plight of the IDPs,” Grema Terab, the former head of Borno’s State Emergency Management Agency, the organization in charge of the state’s humanitarian response, recently told the Guardian.

The result has been rising rates of disease and death — not in the impoverished rural hinterland, but in the state’s capital city. In July, the medical charity Médecins Sans Frontières described the situation as a “large-scale humanitarian disaster” and warned that a famine could soon be declared.

“The most heart-wrenching cases we are seeing involve young children hit by what I call the three M’s: malnutrition, measles, and malaria,” said Hélène-S. Plennevaux, the deputy head of the International Committee of the Red Cross (ICRC) in Nigeria. “The food shortage has reached a critical point, and as always the victims are the most vulnerable civilians — women and children especially.”

Left: Aboubacar Yunnus comforts Houwa in the State Specialist Hospital in Maiduguri. Right: Halima cradles young Aboubacar in the hospital. (MACKENZIE KNOWLES-COURSIN | Foreign Policy)

Aboubacar’s family ended up in Muna, one of the sprawling informal camps that surround Maiduguri. Located on the farthest edges of town, Muna sits just barely inside the security berm that rings the city and a mile or two from a forest where Boko Haram moves freely. In May, when Foreign Policy visited the camp, more than 14,000 people were living there. Hundreds more were arriving each week, their makeshift wooden huts spreading out across the dusty plains.

Much like the village Aboubacar’s family had fled, life in their new home revolved around searching for food and gathering news of events outside — where Boko Haram had attacked recently, who was fleeing where, what conditions were like in one village or another. At night, the voices of neighbors carried easily through the tightly packed huts. Sleep was often fleeting as empty stomachs churned. With no source of income and only a tiny amount of savings that they had managed to bring with them, the family was forced to ration the oil and grain distributed by the ICRC, one of the only aid agencies working in Muna. It was enough to slow the creep of malnutrition but not to stop it entirely in the growing bodies of young children.

One month passed and then two. The children grew thinner, and finding supplementary sources of food became a daily endeavor.

With food sparse, hygiene minimal, and conditions cramped in Muna, many succumbed to disease. In May, the local government administration set up a tiny clinic in a thatched-roof hut in the camp. In its first week of operation, doctors treated a total of 151 children for severe acute malnutrition — characterized by an extremely low weight-to-height ratio, severe wasting, and, often, nutritional edema — and 48 people for measles. According to Mohamed Ibrahim, one of the two government clinicians working there, 14 children died from a variety of causes in the clinic’s first 10 days. With just the two clinicians and a small allotment of medicine provided each week by UNICEF, the clinic was unable to meet the demand for care, which quickly exceeded 300 patients per day.

By the end of the third month in Muna, Aboubacar had become sick with diarrhea and vomiting. Houwa and Yunnus soon fell ill as well. Having watched other children die in the camp, Halima rushed them to the clinic. They waited in line for a full day, only to meet an overwhelmed clinician who gave them paracetamol, an oral rehydration solution, and zinc. The causes of the diarrhea — bacteria from the unclean drinking water in the camp, most likely — remained untreated, however, and the illness persisted.

One-year-old Aboubacar is weighed at the State Specialist Hospital in Maiduguri. He weighs 10.4 pounds — the average weight of a 1-month-old baby. (MACKENZIE KNOWLES-COURSIN | Foreign Policy)

Aboubacar lies on the examination table at the State Specialist Hospital in Maiduguri. (MACKENZIE KNOWLES-COURSIN | Foreign Policy)

Exhausted, Halima cradles Aboubacar in the hospital. Her son has been diagnosed with chronic diarrhea, severe malnutrition, bronchopneumonia, and malaria. (MACKENZIE KNOWLES-COURSIN | Foreign Policy)

Hospital staff members tend to Houwa and her brother Yunnus in the State Specialist Hospital in Maiduguri. (MACKENZIE KNOWLES-COURSIN | Foreign Policy)

With each day that passed, Aboubacar became sicker and more fragile. The bones of his frail body began to show, and the contours of his frame became almost birdlike. Food passed through him without nourishing his body. After another handful of unsuccessful visits to the clinic, his mother and father were at a loss. Eventually, he stopped being able to move, his limbs straightening and his joints locking so that he was encased in a kind of frozen body.

Houwa and Yunnus were not faring much better. Houwa’s dehydration and malnutrition had become so bad that it made her cross-eyed, the muscles in one eye simply unable to re-center the iris. She was barely able to walk and no longer held Aboubacar, her arms too weak. Yunnus had stopped playing altogether.

With no money for medicine or transport, the family continued to deteriorate until June, when aid workers happened upon them by chance and intervened. In a last-ditch effort to save Aboubacar, who was in critical condition by then, the family was evacuated to the State Specialist Hospital in Maiduguri. Aboubacar cried in pain as Halima carried him into the pediatric ward, his face revealing agony and confusion. In the hope of replenishing some of the vital liquids and salts the infant had lost, clinicians spent 15 minutes stabbing for one of the threadlike veins that wove up his thin arm.

But Aboubacar’s body had already begun to shut down. As malnutrition progresses, the body enters a state of catabolism, gradually devouring the muscles of the outer limbs and using them for energy. Eventually, the peripheral nervous system powers off, and the body can barely move. Organs fail, one by one, in order of least importance for survival: Kidney function slows, the liver degrades, bone marrow productivity declines, anemia emerges. The body attempts to preserve the brain at all costs.

Aboubacar was nearing the end of this deadly sequence: He was diagnosed with severe acute malnutrition; chronic diarrheal disease; severe dehydration; malaria; marasmus; bronchopneumonia; and severe electrolyte derangement, a mineral imbalance that impairs muscle function, among other things. He weighed 10.4 pounds — the average weight of a 1-month-old baby.

His siblings, Houwa and Yunnus, were in slightly better shape: They were diagnosed with severe acute malnutrition, chronic diarrheal disease, severe dehydration, malaria, and mild electrolyte derangement. Thirteen and 3 years old, respectively, they weighed 46 and 22 pounds.

Inside the stifling pediatric ward, fluids began to flow, and small amounts of donated medicine and food followed. The children slept. Exhausted, Aboubacar Yunnus and Halima sat in silence in the saunalike hospital room, their foreheads beaded with sweat.

Over the next few days, Yunnus and Houwa grew stronger, and emotion slowly returned to their eyes and faces. Houwa was able to stand on her own and then slowly walk.

Two young boys look on as their friend digs a grave in Muna on the edge of Maiduguri. (MACKENZIE KNOWLES-COURSIN | Foreign Policy)

Men bury the body of a young boy named Abba, who died earlier that day in Muna. Just 1 year old when he died, Abba was sick with chicken pox and severe diarrhea. (MACKENZIE KNOWLES-COURSIN | Foreign Policy)

Men lay Abba’s body to rest in the informal gravesite outside Muna. (MACKENZIE KNOWLES-COURSIN | Foreign Policy)

Displaced men pray at Abba’s funeral outside Muna. (MACKENZIE KNOWLES-COURSIN | Foreign Policy)

Bulami Kyari, a man who was displaced from his home in Mafa, a small town in Borno, stands next to the grave of his 3-year-old daughter, Fatima, whom he buried the day before. (MACKENZIE KNOWLES-COURSIN | Foreign Policy)

A young man looks behind as he and others walk back to Muna settlement after burying a three-year-old girl who had died earlier that day. (MACKENZIE KNOWLES-COURSIN | Foreign Policy)

Worried about money for food and medicine, Aboubacar Yunnus paced the room, his blue Nokia clutched tightly in one hand. The conditions in Muna hadn’t improved, and the prospect of returning to the deprivation that nearly killed his entire family weighed heavily on his mind.

After four days, Houwa was released, returning to the camp with her father. Yunnus followed a few days later, but Aboubacar stayed behind with his mother — he hadn’t improved. Halima cradled him constantly, sometimes rocking him back and forth in the hope of lulling his pain and fear, other times simply holding him quietly for hours, his small body drawn taught and locked.

On June 18, 16 days after he arrived at the hospital, Aboubacar Aboubacar died, his small body finally unable to sacrifice any more of itself. Like the thousands of other civilians who have died as a result of conflict, starvation, and disease in northern Nigeria, his death went unnoticed to those beyond his family.

Across the road bordering Muna sits a small but growing gravesite. On most evenings, a group of men approaches with at least one small body wrapped in white and then returns to the camp empty-handed, the gravesite at least one plot bigger. The funerals are short and efficient, but the weight on the men is visible as they return.

Aboubacar was buried here, at the farthest margins of Maiduguri, in a small hole dug at the unmarked gravesite. He was 1 year old.

Mackenzie Knowles-Coursin is a freelance photographer based in Istanbul. Follow him on Instagram at: @mkcoursin.