Erica Vogel, UNICEF USA associate director of public relations for news and emergencies, recently accompanied TIME reporter Aryn Baker and photojournalist Lynsey Addario on assignment in northeast Nigeria, where violent conflict has displaced hundreds of thousands of women and children — including expecting mothers — at grave risk to their health and safety. Nigeria's 'Flying Midwives' Are Helping Save Moms and Babies appears in TIME's Feb. 18, 2019 special issue, The Art of Optimism. This is Erica's story.
Fanna, 15, was the third mother to give birth since we had arrived in Banki. Unlike the first two babies, Fanna's baby arrived quietly, and was lying motionless in a metal crib at the foot of the delivery table. Gloria, one of the midwives on duty, was trying to revive him, but he wasn't responding. I turned away, unable to look.
I had come to Nigeria with Aryn Baker, TIME's Africa correspondent, and photojournalist Lynsey Addario to observe UNICEF midwives at work on the front lines in northeast Borno State, one of the most dangerous places to have a baby on earth. Here, the maternal and newborn mortality rates are twice the national average, which is already among the highest globally. Poor health outcomes are one of the consequences of years of violent conflict between warring groups, known in the West as Boko Haram. Since 2015, the fighting has displaced more than 1.8 million people — 59,000 in just the past few months.
Nigerians who can, and who have the means, have fled Borno State for safer parts of the country. Those who can't leave are left to fend for themselves, or make their way to settlements where UNICEF and other organizations can provide assistance.
UNICEF-trained midwives play an important role in the ongoing humanitarian effort. There are three dozen of them so far in regular rotation working in Borno State. Traveling in small groups, they are transported by helicopter to work four to six weeks at a time in one of the camps for the internally displaced.
Resources are scarce, and it is a challenge to meet even the basic health needs of everyone. But having a midwife present during labor and delivery and the first critical hours of a newborn's life makes an enormous difference, drastically improving the chances of survival for both mother and baby.
Inside the camps, the midwives see patients at the health clinic, typically a basic two-room structure with little or no electricity. They also go tent to tent, checking on pregnant women who are often malnourished and in need of attention, and encouraging them to come to the clinic for regular checkups. After attending a birth — which can happen virtually anywhere, at any time, and in most camps it is considered too risky to leave your tent after dark — midwives can help the mothers with breastfeeding and guide them on kangaroo care and other lifesaving techniques.
Complicated cases get referred to the short-staffed state hospital in Maiduguri, or in neighboring Cameroon, hours or even days away. Such referrals are rare, however, because transporting patients is dangerous and requires escort by UN Peacekeepers. The UNICEF midwives are often able to get ahead of the issues and avert disaster.
An estimated 250,000 women displaced by the conflict with Boko Haram in Northeast Nigeria give birth every year. According to Unicef, 50,000 of those deliveries will have complications that, without the assistance of a trained midwife, could result in death of the mother or child. Yet there are only 50 midwives in the entire region. At clinics in the IDP camps of Bama and Banki, midwives work in dangerous and difficult conditions, often with few resources, limited electricity and the constant threat of violence. On assignment for @Time in #borno with @lynseyaddario #unicef
My trip with the TIME team took us to three different camps, including one in Bama. Yanza, 35, was the first patient we encountered at the health clinic there. She had come in unconscious and in a wheelbarrow. The relative who brought her in told us she found her lying in a pool of her own blood, a stillborn baby by her side. Yanza had left the clinic the previous day, complaining about the heat. Christiana, the midwife on duty, began treatment for malaria, and, we learned a few weeks later, saved her life.
Gloria, the midwife in Banki, proved just as skillful. Though it took a few moments, Fanna's baby, the newborn who had appeared lifeless upon arrival, eventually let out a cry. And I could exhale.
UNICEF's midwife program is just one component of a broader effort aimed at improving maternal and child health all across Nigeria. UNICEF supports primary health care services in more than 50 camps in Borno and other conflict-affected states.
UNICEF's ongoing humanitarian mission in Nigeria also involves providing clean, safe water and improved sanitation, providing psychosocial support to children traumatized by violence, and setting up temporary classrooms and providing learning materials so displaced children can continue their education. In 2018, UNICEF vaccinated more than 300,000 children in Nigeria against measles, and treated more than 210,000 children suffering from severe acute malnutrition.
Maintaining humanitarian support in Nigeria is critical to ensuring those affected by violence and displacement do not slip further into crisis. Help UNICEF continue to support vulnerable women and children in Nigeria. Your contribution can help make a difference.
Learn more about how UNICEF and partners are working to ensure all mothers and babies have access to affordable quality care through the Every Child ALIVE campaign.
Maimuna is a young mother, living w/ her family in a hard-to-reach settlement. Just one day after giving birth, she brough her baby to the mobile clinic to be vaccinated. The clinic, supported by @UNICEF_Nigeria & @CanadaDev, brings #healthcare to the remote cornes of #Nigeria. pic.twitter.com/vZmqcJjfCr— UNICEF Nigeria (@UNICEF_Nigeria) December 21, 2018
Top photo: A UNICEF health worker returns baby Aishat to her mother Hausa at a UNICEF-supported health clinic in the Muna Garage displacement camp, Maiduguri, Borno State, northeast Nigeria. © UNICEF/UN0233279/Naftalin