INVESTIGATION: Incessant Attacks By Bandits Worsen Access To Healthcare In Katsina Communities

Bandits have attacked several communities in Katsina State, North-West Nigeria, destroying healthcare facilities, kidnapping and killing scores of health workers and residents. In this report, ARINZE CHIJIOKE looks at how these attacks impact access to healthcare in the state

For days, Samaila Rabiu watched helplessly as his mother’s condition worsened. She could barely keep any food down, but there was little he could do.

“She threw up any food we gave her, we did not know what the problem was”, he said. “But we could not also take her to the only healthcare centre in Wurma, our community for a test to be administered,”.

The healthcare centre, like much of Wurma, was reduced to rubble just four months earlier. In February, bandits stormed the remote community in Katsina’s Kurfi Local Government Area (LGA), leaving destruction in their wake. During the assault, at least 12 residents were kidnapped and later released after a ransom was paid.

Located about 8 kilometres away from Kurfi, the LGA headquarters with a population of 208,600 people, Wurma has been a hotbed of attacks by bandits whose activities have escalated in Katsina since 2017. In 2019, at least 49 people were kidnapped following a bandit attack on the community.

With the healthcare centre in ruins, Rabiu turned to local herbs in a desperate attempt to treat his mother. When those didn’t work, she was taken to a local patent store in the community, where they administered drugs and injections, but her condition only worsened. The pharmacist suggested Rabiu transport his mother to the General Hospital in Kurfi.

The journey was gruelling. Rabiu’s mother, now gasping for breath, was carried on the back of a motorcycle along rough roads. By the time they reached Kurfi, her strength had faded. As they wheeled her into the hospital, doctors examined her briefly before confirming that she had died.

Rabiu is certain his mother’s death could have been prevented if Wurma’s health centre had been operational.

“She wouldn’t have died,” he lamented. He added that many others in Wurma had suffered similar fates due to the absence of a well-run functional primary healthcare facility.

Rabiu also recounted the tragic story of Ahmed Musa, another resident who fell victim to the relentless violence plaguing their community. In July, criminals attacked Musa on his farm, leaving him with severe internal injuries. Desperately, his family brought him home, but with no hospital nearby, they were forced to wait until morning to seek help.

“When morning came, they rushed him to the local patent store,” Rabiu recalled. “But instead of running tests to determine the cause of his pain, the pharmacist immediately started administering an oral drip.”

Musa’s condition worsened, and despite their efforts, he died shortly after. Rabiu’s voice trembled as he spoke of his friend’s unnecessary death. “The government failed us,” he said, his face contorted with rage.

The situation mirrors the broader impact across Katsina State, where violence and insecurity have crippled healthcare infrastructure. Bandit attacks have left communities without functioning healthcare facilities, forcing residents to rely on quacks, patent stores and local herbs. In Wurma, like many other areas, this has led to preventable deaths and a healthcare system in ruins.

Once a beacon of hope

Before the attack, Rabiu and other residents did not have to travel long distances to access care. The Wurma PHC was somewhat adequate, housing different wards and departments including maternity, male and female wards, the consulting and immunization rooms, and the outpatient department where various health needs of residents were addressed.

“There were machines used to store vaccines and for different tests as well as doctors and midwives who helped in child delivery,” said village head of Wurma, Liman lawal.

“It had a vehicle that was used to transport patients whose conditions required further treatment to other hospitals.”

Not only did the Wurma PHC serve its residents, but it also catered to at least 10 neighbouring villages, including Lambo, just 10 minutes away, which relied on it due to their non-functional PHC. It was a critical lifeline.

Now, all that’s left are burnt roofs, shattered windows, and empty rooms. The equipment? Gone. The attack in February was just one of many that have ravaged healthcare services in Katsina State, leading to the closure of 69 primary healthcare centres, with at least 19 shut-down in Kurfi alone.

Healthcare at a standstill as PHCs remain in ruins 

Several months after the attack in Wurma, there are no signs that the Katsina State government intends to rebuild the PHC. This same story repeats across different communities in the state where healthcare centres have been destroyed by bandits. Many of the facilities remain closed, leaving communities without access to essential services.

The impact has been devastating. Supply chains have been disrupted, leading to shortages of medical equipment, drugs, and vaccines, hindering the state’s ability to provide effective healthcare and respond to public health emergencies. Residents, especially in far-flung areas like Wurma, are left with no choice but to remain at home when they fall ill, increasing their risk of preventable deaths.

A health expert in the state, Dr Adamu Saminu, stressed that vulnerable populations, including women, children, and the elderly, are disproportionately affected.

“Even before the attacks, maternal and child health indices were poor. Katsina had one of the highest numbers of malnourished children and a significant percentage of women facing pregnancy complications,” he said. “Now, with the insecurity, the situation has worsened.”

The 2021 Multiple Indicator Cluster Survey (MICS) report also confirmed these alarming statistics. It revealed that in Katsina, one in six children (150 deaths per 1,000 live births) would likely die before their fifth birthday. This was largely due to insufficient immunization coverage, with only approximately half of the child population (53.8 percent) receiving vaccinations against preventable childhood diseases.

Additionally, traditional birth attendants were found to be responsible for the largest share of deliveries (31.1 percent), followed by relatives or friends (27.7 percent), and then skilled attendants (14.4 percent), according to a report by Budgit, a civic-tech organization focused on using technology to demand transparency and accountability in Nigeria and Africa.

Today, residents of Wurma must travel to Dutsin-Ma or Kurfi to access quality healthcare. The roads leading to these locations are in a terrible state; bumpy, often flooded, and desolate. Few vehicles ply the route, forcing people to rely on motorcycles or bullock carts tied to two cows, which significantly delay travel time.

For pregnant women, the journey is even more perilous. Wheelbarrows are often used to transport them to hospitals, a journey that often results in complications, and in some cases, the loss of the baby before they even reach medical care.

Residents say promises made by successive governments to construct the road has remained unfulfilled.

“Travelling to those locations should ordinarily take 25 to 30 minutes, but we spend over an hour,” said Lawal. “Some people have fallen ill just from the journey itself because of the road’s poor condition. Imagine what happens to the sick when they are transported on cows or wheelbarrows,” he added, his frustration evident. “It feels like embarking on a journey to hell.”

Attacks result in a shortage of personnel

Insecurity in Katsina has not only devastated healthcare infrastructure but also triggered an alarming exodus of healthcare professionals. Doctors in the state are either migrating internally to federal establishments or leaving altogether for other states or countries, seeking safer and better opportunities. From 2022 to 2023, at least 80 doctors have resigned from the state’s health service.

The situation has been made worse by the kidnapping and killing of health workers. According to Mannir Suleiman, chairman of the Katsina chapter of the Medical and Health Workers Union of Nigeria (MHWUN), about 83 of its members have been abducted since 2015. “Out of that number, 65 were released after ransom payments, while 16 have tragically been killed,” Suleiman stated.

Currently, the Katsina State government employs approximately 250 doctors to serve its population across 22 general hospitals, spread across 34 local government areas. Dr. Saminu, the immediate past chairman of the Nigerian Medical Association (NMA) in Katsina, said that more than half of these doctors are concentrated in the Katsina metropolis, where specialist and general hospitals are located.

“Other local governments have to make do with the remaining half,” he explained, painting a bleak picture of the doctor-to-patient ratio in the state. According to the World Health Organization (WHO) the recommendation ratio is 1:600 patients.

“In some general hospitals, you may only find two doctors; in others, not a single one,” said Dr Saminu. The shortage has left communities like Funtua Zone, which comprises 11 local governments, with five local governments having no doctor at all. “Thousands of residents in these areas have no access to a doctor and must travel at least 50km to see one when needed,” he added.

The situation is compounded by the fact that in the few communities with still-standing healthcare facilities, health workers no longer provide 24-hour services due to fear of attacks.

The Mabai experience

Umaru Mohammed was tending to his farm in Mabai when bandits launched an attack, firing indiscriminately. His brother, Tukur Mamuda, was struck by a bullet in the stomach. In desperation, Mohammed rushed Mamuda to the local Primary Health Centre (PHC) in Mabai, a remote community in Kankara Local Government Area (LGA). But they were informed at the facility that they could not attend to his brother because there was no doctor on ground.

“For several minutes, we waited for a car to transport us to Kankara, Mamuda was gasping for breath“, he recalled.  “Finally, we got one and took him to Kankara where he was revived.”

Mohammed said that his brother almost died because of the distance and bad state of the road. Kankara is located about 13 kilometres away from Mabai.

“Just two years ago, we would have been treated in Mabai itself,” he said.

Before a resurgence of banditry, the Mabai PHC was a beehive of activities. Patients coming from different communities queued up to access care. The PHC had different doctors and nurses who attended to different needs.

The centre was equipped with doctors and nurses to handle various medical needs. Now, the situation has drastically changed. Although the PHC remains physically intact, fear of attacks and kidnappings has deterred residents from seeking care. The road to Mabai has become a notorious hotspot for bandits, who routinely kidnap travelers for ransom.

“Some residents have even been forced out of their ancestral homes,” said Mustapha Usman, a staff member at the PHC. “Those who remain are too afraid to come to the clinic.”

The Officer-in-Charge (OIC) at the facility, Husseini Mohammed said that with rising insecurity, health workers (including doctors, nurses, and support staff) have increasingly become less enthusiastic about working in remote locations, even in communities like Mabai with structures still standing.

“One of our workers was nearly kidnapped on his way to the hospital just this June,” Husseini said. “They chased him until he abandoned his motorcycle and fled into the bush. Since that incident, he hasn’t returned to the community.”

Now, those working to keep the Mabai health centre going are casual workers and volunteers from Mabai. Of these, only two receive monthly stipends, while the others work for free. But as volunteers, their capacity to provide care is limited.

Auwal Kabir, one of the volunteers, shared that when cases are too severe, they have no choice but to refer patients to Kankara General Hospital, 12 kilometres away, where they can receive better medical attention.

Poor release of funds for healthcare 

An analysis of Katsina State’s budget performance reveals a pattern of poor commitment to primary healthcare delivery, even as insecurity ravages communities. The current administration claims to have spent N3.77bn on healthcare within 10 months, but on the ground, the residents especially those in rural areas are yet to feel the impact.

For instance, out of N690m earmarked for medical products, appliances, and equipment in the 2023 budget, only a paltry N78.67m (11.4 percent) was released. Reacting to this, Mabai OIC, Mohammed explained that the facility’s only regular supply of drugs for treating malaria comes from the Global Fund. He added that at times, staff members have had to pool their resources to buy medications for patients.

Similarly, out of N7 billion allocated for public health services in 2023, only N233.65 million (3.2 percent) was released, with no specific budgetary provisions for communities affected by bandit attacks.

The trend continues in 2024. Out of N2.4bn earmarked for primary healthcare in 2024, only N6.9m (0.3 percent) was released in the first quarter , and nothing was disbursed in the second quarter. Additionally, out of the N796 million set aside for the Drugs and Medical Supply Agency, only N194.5 million (24 percent) was released in the first quarter, while no funds were released in the second quarter.

In June this year, the state governor, Dikko Radda of Katsina State announced another allocation of over N10bn to the chairmen of the state’s 34 local government areas for the construction of primary health centres that will bolster healthcare infrastructure and services across the region.

He noted that three new PHCs would be built in each local government area, aligning with the World Health Organization’s (WHO) resolution advocating for accessible and efficient healthcare facilities in rural areas.

“Before the end of the year, we’ll make sure that no fewer than 361 functional primary health care centres are provided in the state,” he was quoted as saying.

By his own admission, the governor said that the only challenge will be that of staffing. “We have shortages of staff to man these centres and to recruit health workers is not easy now, but we will do that in due course.”

Dr. Saminu confirmed that the projects were already ongoing. He however noted that it was concerning that nothing is being done yet to reopen some of the health centres shut down or rehabilitate those destroyed by bandits.

“Recruitment not enough” – Expert 

Late last year, the state government made some recruitments into the state healthcare sector, following the departure of health workers. But Dr. Saminu said that recruitment alone does not solve the problem. According to him, the state has to do more to improve the standard of living of the health workers who are deciding to stay back.

“Ordinarily, nobody would want to work in the security prone areas”, he said. “The state government can consider paying them higher than the Federal government workers because if you employ them and fail to pay them well, they will leave as they come in because there are wide range of opportunities outside. Those that remain will not be committed as they should to healthcare delivery.”

In 2023, Suleiman of the MHWUN requested the state government to review the health workers staff register and welfare, particularly in the frontline local government areas prone to attacks.

Dr. Saminu also stressed the need for robust security measures to protect healthcare workers and facilities in remote, attack-prone communities. “This requires addressing the root causes of banditry and insecurity to create a more stable environment for healthcare delivery. It’s ultimately the duty of the federal government to ensure this,” he added.

Other experts have also underscored the need for the implementation of telemedicine services and mobile clinics to provide healthcare services in areas with limited access due to security concerns.

State doing a lot to address challenges

Dr. Shamsuddeen Yahya, Executive Secretary of the Katsina State Primary Healthcare Development Agency said in an interview with this reporter that the state government was doing enough in terms of tackling the challenges posed by insecurity on the healthcare sector. He however failed to give details, insisting that he has an instruction not to speak except he is directed by the Commissioner for Health.

“I have a lot to say, but clearance has to come from the Commissioner”, he said. In the past, I spoke about the issue and it almost landed me into trouble, Now, I have to receive approval before I can speak.”

Attempts to reach the health commissioner yielded little success. This reporter contacted him via calls and a text message on Thursday, September 12, but the Commissioner said he was traveling and wouldn’t comment until his return. Follow-up attempts were made on Monday, September 16, and Tuesday, September 17, but no response was received by the time of publication.

This report is published with support from the Wole Soyinka Centre for Investigative Journalism (WSCIJ) under the collaborative Media Engagement for Development, Inclusion and Accountability project (CMEDIA) funded by the MacArthur Foundation.

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