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Crisis in Nigeria: How to Train a War Surgeon

28 Mar 2024
By Mohammed Ibrahim and Pat Griffiths
Surgery in the weapon-wounded ward supported by the ICRC. Source: Mohammed Ibrahim

More than eight million people require humanitarian assistance in Nigeria. In a bid to save civilians in one of the longest-running conflicts in West Africa, training is underway to prepare the next generation of Nigerian war surgeons. 

“Today is your last day on earth,” These are the final words Husseini Jibrin remembers hearing before he was shot in both legs. He had been out collecting firewood with friends near his home in northeast Nigeria. Conflict has reigned in this part of the world for more than a decade – pitting several countries of West Africa’s Lake Chad Basin against groups either known for their affiliation with Islamic State or the words “Boko Haram.” 

“My friends bandaged my injured legs to stop the bleeding, put me in a cart and brought me all the way from the bush to town, where I was taken straight to the hospital,” Husseini tells us. But his injuries were so serious that they needed specialised care. The next day, he was bundled into a car and taken to Maiduguri, the capital of Nigeria’s northeast Borno State, where he was referred to the State Specialist Hospital and admitted to a ward for weapon-wounded patients. 

“Arriving at the hospital, I was immediately attended to, and treatment provided to remove the bullets from my legs,” Husseini says. “They have taken good care of me since I arrived four weeks ago.” 

Rest and regular meals have speeded Husseini’s recovery, as has the presence of his mother, who had helped him make the long journey. 

“I hope to return to work as a labourer or continue my herbalist business and farming when I recover fully,” he says.  

While Husseini’s story is unique, he’s not alone. As should never happen, but too often does, he – a civilian – was made a target in a time of conflict. 

The impact on people of this particular conflict is reflected in numbers. At least eight million people need humanitarian assistance across Nigeria. More than two million have had to flee their homes. The number of those registered by the Red Cross Movement as missing due to conflict (23,000) is the highest in Africa. Millions live amid food insecurity, while hundreds of thousands of children are acutely malnourished.  

All this is taking place in the continent’s largest economy, country, and democracy by population. And as global memory of the “Chibok girls’” capture fades, this is a place where conflict has been largely overlooked by the world. 

It’s a place where war surgeons are, more than ever, vital – just as they are in short supply.

Beyond wounds of war, many of the patients that Clara Okafor cares for bear invisible scars. Clara is the head nurse working with the International Committee of the Red Cross (ICRC) in a ward for weapon-wounded patients at the State Specialist Hospital of Maiduguri. “The physical injury tends to affect them more,” she says. “Because this is someone, or a group of people, who might already have been in a frail state before the injury.” 

Malnutrition, mental health needs, and concerns for safety can easily compound the challenge of recovering from a bullet or shrapnel wound. More than a decade of conflict has hit civilians hardest here. 

“We have this multidisciplinary approach,” Clara says. “All in an attempt to give holistic care to the patients.” 

Sighting medical staff with Red Cross badges over their scrubs is common in this ward of the hospital. But it won’t always be this way. The ICRC has been supporting weapon-wounded patients in this ward since 2015, a peak in terms of displacement and civilian casualties during the conflict. 

After eight years, and more than 19,000 surgeries and close to 4000 admissions, this humanitarian organisation, which has been working in warzones for close to two centuries, is looking to hand the ward back to the hospital. 

That requires training. Clara and her ICRC colleagues play an important role in this process, working alongside Nigerian nurses, anaesthetists, and surgeons from the hospital who rotate through the ward every few weeks. Hundreds of nurses have received training in the ward since 2015 and, from this year, a cohort of 16 surgeons and anaesthetists, too. “I wouldn’t say there are no challenges, because we are human,” Clara says. One challenge is facing cases when their help isn’t enough. 

“Maybe there is no intervention that is possible to save their life – that can be really traumatising for me, the caregiver,” Clara says. “But I think we have a really good support system.” And the highs are high. Clara sometimes hears from former patients, even on weekends. “They just call – to say hi and appreciate me for what we do,” she says. “That really gives me joy.” 

“They used to call me the ‘professor of skin grafts’,” Dr Hyeladzira Ahmadu grins. Training alongside the ICRC in the weapon-wounded ward, she had been so quick to pick up this particular surgical skill that colleagues would book skin graft procedures and call her to carry them out. In her own time, Dr Hyela surfs the net, consumes news, and loves to travel. She’s also a war surgeon in-training. 

Every month, eight Nigerian surgeons from the hospital rotate through the weapon-wounded ward. Two each week. Six anaesthetists rotate through as well. Working alongside ICRC surgeons, anaesthetists, and nurses, their counterparts at the hospital learn how to run a weapon-wounded ward by doing. Cow parts are regular practice components. Tendons for repair, intestines for suturing, slabs of beef for ultrasounds. “I think it’s a good strategy because first of all they brought the employees into it,” says Dr Hyela.  

“We were working hand in hand. They were teaching us a lot of things. Little by little, they were giving us chances to do it with their assistance – and right now, we can do it without.” While ICRC material support for the ward is planned to continue, more and more, in a gradual process that will span the next year, its day-to-day management will be run by the Nigerian staff of the State Specialist Hospital. 

“I’ve learned a lot from them – a lot,” Dr Hyela says of those she trains with. For her, the experience – helping patients who have survived bomb blasts, blunt trauma, bullets, or shrapnel – has informed what she wants to do next. “I have an interest in traumatology,” she says. “I really want to specialise in it.” 

For future victims of Nigeria’s long-running conflict, this decision will make all the difference.

By Mohammed Ibrahim and Pat Griffiths, with the International Committee of the Red Cross (ICRC) in Maiduguri

This article is published under a Creative Commons Licence and may be republished with attribution.