Written evidence provided by MSF to the International Development Committee 

The UK’s development partnership with Nigeria 

About MSF in Nigeria

1. Médecins Sans Frontières/Doctors Without Borders (MSF) welcomes the International Development Committee’s inquiry into the UK’s development partnership with Nigeria.  
2. MSF is a medical humanitarian organisation that provides medical and other humanitarian assistance to people affected by conflict, epidemics, disasters and exclusion from healthcare. Our teams are composed of health professionals and logistical and administrative staff, united by a common charter. MSF’s operations are guided by medical ethics and the principles of impartiality, independence and neutrality. We are a non-profit, self-governed and member-based organisation. 
3. MSF has been active in Nigeria since 1996, responding to disease outbreaks and emergency health needs across the country, with a particular focus on maternal and paediatric healthcare. In 2024, MSF provided over 1.6 million outpatient consultations, administered 696,000 routine vaccinations and treated more than 530,000 malaria cases in the country.[1]
4. This submission draws on the first-hand experience and operational data of MSF teams working in northern Nigeria. Our nutrition programmes in the northwestern and northeastern states continue to expand as we see more patients as a result of a large, and largely ignored, malnutrition crisis that is pushing the population to its limits.[2]
5. In partnership with the Ministry of Health (MoH), MSF is currently running or supporting a total of 10 inpatient stabilisation centres (SCs) and 36 outpatient therapeutic programmes (OTPs) in Bauchi, Borno, Kano, Katsina, Kebbi, Sokoto and Zamfara states.

Growing nutritional needs in northern Nigeria

6. MSF is deeply alarmed by the high levels of acute malnutrition observed across its nutrition projects in northern Nigeria in 2024, and the worsening projections for 2025. In 2024, over 252,000 children with severe acute malnutrition (SAM) were admitted to MSF-supported OTPs, while approximately 76,000 children with SAM and medical complications were treated in SCs. These figures represent increases of 38% and 53% respectively compared with 2023.
7. In Katsina state alone, between January and the end of June 2025, MSF treated nearly 70,000 children for malnutrition – almost 10,000 of whom were hospitalised in a serious condition. Theseepresents a one-third increase compared with the same period in 2024.
8. In June 2025, admissions to the inpatientstherapeutic feeding centre (ITFC) in Katsina were up 73% compared with June 2024. Our projections estimate that the ITFCwill require over 800 inpatient beds by early August, far beyond its already expanded capacity.
9. Between January and June 2025 in Katsina, cases of nutritional oedema – the most severe and life-threatening form of malnutrition – were up 208% compared with the same period in 2024. Tragically, 652 children have died in MSF facilities so far this year, largely due to delays in accessing treatment. Alarmingly, malnutrition is also affecting adults. In July, screening of 750 mothers at MSF centres revealed that over half were acutely malnourished, with 13% of these suffering from severe acute malnutrition.[3]
10. In Kebbi state where MSF is running three ITFCs, in a single week in July it admitted 436 children, as a result of which the centres were already at bed capacity.
11. In the northeast and specifically in Maiduguri the capital of Bornoie see a different picture, with a slightly lower malnutrition caseload in 2025. This may be due to the forced movement of internally displaced people into the city and better food availability in the city.
12. There is no single solution for dealing with malnutrition. In northern Nigeria, malnutrition is driven by a combination of interrelated and context-specific factors that significantly impact both food availability and population health. These drivers vary significantly between regions, states and localities.

13. The crisis is compounded by recurring disease outbreaks – including of measles, diphtheria and meningitis – as a consequence of low vaccination coverage. High malaria prevalence, combined with limited access to primary healthcare and an under-resourced health system, further weakens health-seeking behaviour and exacerbates poor health outcomes.
14. At the same time, widespread insecurity has severely disrupted daily life. Many areas in the north face complex region-specific security challenges and conflict, with the presence of various armed groups and non-state actors.[4] Violence has displaced over 3.3 million people in the north,[5] further isolating communities and limiting access to livelihoods and healthcare.

UK funding to Nigeria

15. The UK has been a longstanding partner to Nigeria. While recent UK government priorities have shifted towards economic development partnership, it is critical that acute medical and humanitarian needs are not overlooked. 
16. The value placed on this partnership is reflected in the UK’s 2025/26 bilateral aid allocation to Nigeria, which remains steady compared with other contexts where funding has seen significant reductions. The FCDO has allocated £135 million for 2025/26 compared with £117 million in 2024/25.[6] However, this remains well below historical levels, particularly following the substantial aid reductions in 2021 that led to widespread programme reprioritisation. As humanitarian needs grow, the UK government must sustain its commitment to lifesaving aid and support of the local health system.
17. The FCDO’s flagship humanitarian programme for Nigeria – the Humanitarian Assistance and Resilience Programme (HARP) – has been historically focused on the northeast, despite growing humanitarian need in the northwestern states since 2020. While an expansion of HARP to include the northwest is being proposed, as above, the current funding envelope is expected to remain the same. Without substantially increased funding, the overall reach and effectiveness of this extension of the programme is likely to be limited, even though a focus on the northwest is urgently needed.

18. Recent global aid reductions have exacerbated challenges on the ground, resulting in clinic closures, disrupted supplies of ready-to-use therapeutic food (RUTF) and decreased access to vaccinations. These constraints have compounded the effects of existing barriers to healthcare such as insecurity, displacement and limited socioeconomic opportunities.

Recommendations

19. Given the escalating malnutrition and health crisis in northern Nigeria, particularly in Katsina, Sokoto, Kebbi and Zamfara states, the UK must step up its engagement and support in both conflict and non-conflict areas, focusing on the following key objectives.
20. Sustain and expand emergency nutritional support: the UK should urgently increase direct financial assistance to maintain and scale access to lifesaving nutrition services. This should include ensuring the availability of RUTF and expanding both outpatient and inpatient care in regions with the highest rates of malnutrition. MSF estimates that at least $11 million in funding for RUTF is urgently required for just three states alone. Supplementary feeding programmes for children with moderate acute malnutrition and for pregnant and breastfeeding women must also be expanded, with support for locally sourced, nutrient-rich supplementary food options such as Tom Brown.
21. Reinforce PHC systems as the front line against malnutrition: strengthening Nigeria’s PHC infrastructure is essential to address malnutrition at scale. UK support should focus on rehabilitating and equipping PHC facilities to deliver nutrition-specific services, including mid-upper arm circumference screening, nutrition counselling and treatment. Investment in community health worker networks and workforce training will improve early detection and referral, especially in remote or under-served areas. This can be achieved through the expansion of pre-existing health strengthening programmes such as Lufiya.
22. Bolster disease prevention and integrated health services: the UK should help expand preventive health measures that reduce the underlying drivers of malnutrition, such as disease outbreaks and comorbidities. This should include supporting seasonal malaria chemoprevention, expanding mosquito net distribution, and strengthening routine and catch-up vaccination campaigns. Enhanced surveillance and epidemiological capacity at the local level are also critical to improved early warning and outbreak control.

23. Promote sustainable, long-term financing for nutrition: in parallel with emergency assistance, the UK should champion sustainable nutrition financing through multilateral and national channels. This should include contributing to initiatives such as the Child Nutrition Fund and supporting the integration of nutrition into broader development financing, including through multilateral development banks and private sector partnerships. The UK can also help ensure that global mechanisms such as Gavi are equipped to deliver vaccines in fragile and humanitarian settings such as northern Nigeria.
24. Support food security and livelihood recovery: UK development aid should support scaled-up food security and livelihood initiatives that address the root causes of malnutrition. This should include adapting food distribution strategies to reach displaced and vulnerable populations and investing in community-based income-generating activities that enhance household resilience over time.