Ignorance, Poverty, inadequate healthcare trigger fatal convulsions among children in Abuja IDP camp

Kaltumi Mustapha was waiting her turn to fetch water at a borehole on a sunny afternoon in 2019 when a neighbour came running and urged her to return home immediately.

Panic gripped Mrs Mustapha as she abandoned her bucket and hurried back to her shelter. She found her four-year-old daughter, Aisha, convulsing on the floor, her body jerking violently, teeth clenched, and breath weakening.

“I was so scared that this might be worse than I had seen before. I wanted to hold her, but her bones were rigid, and her body was stiff. I had to carry her with all my might and rushed her to the hospital in town, Waru,” Mrs Mustapha recalled.

Sadly, despite desperate efforts to save her, Aisha did not survive this episode. Her death is one of many in Abuja’s Wassa IDP camp, where convulsions – often linked to preventable illnesses – continue to claim young lives.

The silent threat

According to Medical News Today, convulsions are rapid, involuntary muscle contractions that cause uncontrollable shaking and limb movement lasting from a few seconds to several minutes. They are commonly associated with epileptic seizures but can also result from infections, fever, or brain trauma. Also, they may affect a specific part of the body or the entire body.

Studies have also shown that cerebral malaria, a severe form of malaria, can cause convulsions, coma, and even death. The parasite that causes malaria, plasmodium falciparum, can infect the brain and cause inflammation, leading to convulsions and other neurological symptoms.

The study added that over 575,000 cases occur annually in sub-Saharan Africa, primarily affecting children under five. The mortality rate remains alarmingly high, with 15-20 per cent of children dying despite treatment. Survivors face an increased risk of neurological damage, cognitive impairments, behavioural difficulties, and epilepsy.

Epilepsy – a chronic neurological disorder marked by recurrent seizures – is another significant cause of convulsions. According to the World Health Organisation (WHO), approximately 50 million people worldwide live with epilepsy, with 80 per cent residing in low- and middle-income countries like Nigeria.

Globally, convulsions remain a significant public health concern, with one per cent of children under 15 experiencing convulsions annually.

According to a review and meta-analysis published in BMC Public Health, nearly one in 50 children are suffering from epilepsy in Africa.

The WHO estimates that up to 70 per cent of people living with epilepsy could live seizure-free if properly diagnosed and treated. However, in IDP camps, where access to healthcare is severely limited, convulsions often go undiagnosed and untreated, leading to dire consequences, including death.

One of many episodes

Mrs Mustapha recalled that it wasn’t the first time Aisha had experienced convulsions, but on that day, the situation was worse.

Kaltumi Mustapha

Before the unfortunate episode that claimed Aisha’s life, her mother had been taking her to a nearby chemist for some injections administered by a nurse.

The nurse, who later told her that the facility lacked the capacity to fully treat Aisha’s illness, advised her to try traditional medicine instead.

“I started using traditional medicine, but her convulsions became more frequent and severe,” Mrs Mustapha said. “She became weaker, and after a week, the sickness struck again in the middle of the night—and that was it.”

Mrs Mustapha, a petty trader from Gwoza in Borno State, fled her home in 2014 due to insurgent attacks. She now faces constant battles with hunger, disease, and the trauma of violence.

A pattern of tragedy

Aisha’s death was not an isolated case; convulsions claimed the lives of 12 other children in the camp within five years leaving behind grieving parents who could do little to save them due to poor healthcare access and a lack of awareness about the condition.

Mariam Ali, a mother of five, lost her three-year-old daughter, Shadiya, to convulsion in 2022.

Mariam Ali

“It happened so fast,” she recalled. “One moment, she was fine, then she started shaking violently. Her fists clenched, her legs stiffened, and saliva came from her mouth. It lasted about 10 minutes… then she stopped breathing.”

Mrs Ali couldn’t even call for help – helplessly watching as her daughter slipped away. It was only after the tragedy that she first heard the term ‘chiwon susu,’ the Hausa name for convulsions – an affliction that had been quietly killing children in the camp.

For Aisha Shuaibu, another widow in the Wassa camp, the pain cuts even deeper – she lost two of her eight children to convulsions, one six years ago and another four years ago. Like Mrs Ali, she noticed a troubling pattern: the illness always seemed to strike during the hot season, catching parents off guard.

Aisha Shuiabu

Her son, Aliyu, was just one year and six months old when convulsions claimed his life.

“It started with a high fever, and his eyes turned yellow,” she recounted. “I rushed him to a chemist, and they gave him injections. That same evening, his temperature spiked again, so I took him back to the nurse at the chemist. He was given two drips, but his breathing became heavy while receiving the second one, then slower. The nurse checked him, but after a few minutes, he was gone.”

These stories are all similar. The parents were displaced by the Boko Haram insurgency in Borno State. Struggling with displacement and poverty, they faced the additional burden of losing their children to preventable illnesses because proper healthcare was out of reach in a camp the government does not officially recognise.

Conflicting beliefs, limited healthcare options

Beyond grief, many parents in the camp are confused about the cause of convulsions and how to treat them. The lack of awareness and limited healthcare access forced many to rely on conflicting medical advice – one from health workers and another from indigenous community members who believe in traditional remedies.

The chairman of the IDP camp, Geoffery Bitrus, recalled how the increasing number of child deaths in the camp prompted him to search for answers.

“When the situation worsened, I reached out to a friend, a doctor who runs a chemist, to ask about the condition.

He informed me that it was chronic malaria,” Mr Bitrus said.

However, his findings conflicted with the beliefs of the indigenous people, who insisted that the illness “does not require injections and can only be treated by local doctors using traditional medicine.”

“We’re caught between two perspectives, unsure what to believe. The doctor’s explanation doesn’t match what the Gbagyi people say. But the last situation we encountered was in 2023,” he added.

The Gbagyi people, indigenous to the community and privy to the medical condition, introduced traditional medicine to the IDPs when the convulsions started striking the children in the camp.

IDP houses

Nkechi Obianozie, a neurologist at the University of Abuja Teaching Hospital, Gwagwalada, explained that convulsions, commonly called seizures, are caused by abnormal electrical discharges in the brain.

Ms Obianozie noted that while people often associate convulsions with jerking movements, there are many types of seizures.

“Some may involve a person appearing to daydream, smelling strange odours, or experiencing abnormal sensations on one side of the body,” she said

She noted that in children, genetic factors often cause convulsions, while in adults, seizures may be triggered by brain injuries or infections like cerebral malaria or meningitis.

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“Cerebral malaria is a common cause of seizures in Nigeria, particularly in areas like IDP camps where healthcare and sanitation are limited. In these environments, infections like cerebral malaria are more prevalent,” she said.

She emphasised that proper sanitation and timely medical intervention are essential in preventing severe complications that lead to death.

Lack of PHC

Mr Bitrus, the chairman of Wassa IDP camp, said a committee was inaugurated to plead with the government to reopen a Primary Health Centre in the area. He, however, said the committee reached out to the government on multiple occasions but got no response.

Locked facility

“The facility was built in 2009 and functioned well for two years. But after some time, they lacked drugs in the facility, and it stopped functioning. That led to a clash between the IDPs and the health care workers, and it resulted in the lockdown in January 2023.”

He further explained that the government promised to reopen and expand the facility, but nothing has been heard from them ever since.

The Nigerian government has repeatedly promised to strengthen the country’s health system, particularly the primary healthcare sub-system, to deliver quality and comprehensive healthcare services, but the reality of the IDPs is far from it.

Managing convulsions

Ms Obianozie stressed that seizures can be managed with appropriate medication, although access to these drugs is often a challenge in resource-limited settings.

She also noted that many families in low-income settings struggle to afford these medications, leading to tragic outcomes, especially in vulnerable environments like IDP camps.

“Convulsions should be treated at any hospital, even primary health centres. However, there’s a gap in access to essential medicines, such as anticonvulsants, which are critical in preventing brain damage or death during prolonged seizures,” she said.

Ms Obianozie called for improved sanitation, access to vaccinations, and proper treatment for diseases like malaria to reduce the occurrence of convulsions.

“Poor living conditions, lack of access to mosquito nets, and overcrowded environments like IDP camps increase the risk of infections that can cause seizures.”

The neurologist urged the government to prioritise healthcare access and ensure that medications for seizures are readily available at health centres to prevent unnecessary fatalities.

According to a humanitarian worker, Babangida Shuaibu, while committees exist at the local, state, and camp levels to monitor and coordinate activities in IDP camps, there is little more than a procedural requirement for NGOs to inform these committees of their visits.

Mr Shuaibu said beyond this, structured support mechanisms for IDPs are lacking.

He said a camp can host about 78,000 people, but they have only one small primary school and no real healthcare facility.

“Makeshift clinics often double as classrooms, and medicines are scarce. The lack of proper healthcare infrastructure forces residents to rely on temporary interventions by NGOs, which are neither consistent nor sufficient to address their needs,” he said.

He added that even if someone gets medicine, they may not have eaten, and without food, the medicines would not work. He also emphasised the interplay of malnutrition and inadequate healthcare in worsening health outcomes.

Drawing from personal accounts, he highlighted the pervasive trauma among displaced persons, many of whom struggle with insomnia and withdrawal.

Water facility

“Some victims don’t even sleep at night. They sit in silence, trapped by memories of their experiences, and this is why there is a need for the establishment of rehabilitation teams comprising medical professionals and counsellors to help victims begin their journey to healing.”

Functional health clinic

An environmental expert, Emmanuel Kilaso, noted that infections like malaria, meningitis, malnutrition, and epilepsy pose significant risks to displaced populations due to underlying conditions.

Mr Kilaso explained that these conditions are more prevalent in northern Nigeria, and they are exacerbated by poor healthcare infrastructure.

“In overcrowded camps, where resources are scarce, these infections can go untreated, leading to severe complications and even death due to mismanagement and corruption; public health infrastructure is not adequate to effectively manage cases of convulsions, which may even result in death or become more complicated in the future.”

He added that environmental factors, particularly poor sanitation in IDP camps, foster the transmission of diseases like malaria and meningitis, which can result in convulsion, especially in children.

Surroundings

“If the IDP camps are not properly managed, the quick spread of diseases like malaria and meningitis is inevitable. These health challenges are worsened by the lack of access to healthcare services, making it difficult to detect infections at an early stage,” he added.

To address these issues, Mr Kilaso recommends setting up mobile clinics in IDP camps to enhance healthcare access.

“Mobile clinics can provide essential screenings, vaccinations, and preventive treatment for diseases like malaria. Partnership with NGOs can help supply medication and even establish food banks to tackle malnutrition,” he said.

He also suggests a more sustainable approach to managing convulsions in IDP camps, including training community health workers in basic first aid and providing anti-seizure medications for those at high risk, particularly children.

Mr Kilaso highlighted that, currently, healthcare policies in Nigeria do not fully account for the unique needs of IDPs.

He added that there are provisions for IDP camps, but the implementation of the policies is often insufficient, and the political willpower to address the issue is lacking.

“Advocacy groups, on the other hand, can gather data on healthcare disparities and work to raise public awareness of the challenges faced by displaced individuals. By collaborating with policymakers, media, and international organisations, these groups can apply pressure for better healthcare services in IDP camps,” he said.