Parts of northern Nigeria are seeing a rise in the number of children diagnosed with noma, a rapidly progressing infection that can destroy facial tissue and bone and kill most of those affected, amid extreme poverty, malnutrition, limited awareness and difficulties accessing early medical care. Doctors and experts say many children do not reach treatment facilities until their condition has worsened and they need complex reconstructive surgery.
Ibrahim Dalhatu was three years old when he contracted the disease. Since 2021, the boy, now 8, has undergone six operations at a specialist hospital for children with noma in Sokoto state, northern Nigeria. Médecins Sans Frontières performs the multi-stage operations free of charge.
Ibrahim’s father said he was initially worried about the cost of treatment, adding: “When I was told it was free, I was very happy.” Noma usually begins with gum inflammation in malnourished children living in polluted environments, before the infection spreads rapidly and destroys soft tissue and bone in the face and mouth.
Noma symptoms and stages of surgical treatment
The disease mainly affects children aged between 2 and 6, particularly in poor communities. In the early stages, treatment can include antibiotics, wound care and improved nutrition. But when the disease worsens and the damage extends to tissue and bone, surgery becomes necessary to repair disfigurement and restore facial functions as far as possible.
Experts identify extreme poverty and severe malnutrition as the main risk factors associated with the disease. The World Health Organisation describes noma as “a sign of absolute poverty”, while the United Nations Human Rights Council considers the conditions that lead to infection a violation of the rights of affected children.
In 2023, World Health Organisation Director-General Tedros Adhanom Ghebreyesus said: “Noma is more than a disease; it is a social indicator of extreme poverty and malnutrition, and it affects the most vulnerable.” Risk factors are compounded in northern Nigeria, which is suffering the effects of armed violence and economic hardship.
Poverty and malnutrition worsen the spread of the disease
Médecins Sans Frontières and medical officials say the number of children diagnosed with the disease is rising, while limited awareness of its symptoms means many cases reach treatment late. Bukola Oluwole, MSF’s medical affairs coordinator in Nigeria, said: “We are seeing more severe cases, and we are working to raise community awareness so that they bring their children early, preventing tissue loss and the need for reconstructive surgery years later.”
The World Health Organisation classifies noma as a neglected tropical disease, a group of diseases that receive only limited international attention and funding, or none at all.
The disease was added to this category on 15 December 2023, following a request led by Nigeria’s Ministry of Health in January of the same year and backed by letters of support from 31 countries, according to MSF. The latest published WHO estimates of the scale of the disease date back to 1998, when it estimated around 140,000 cases a year, with a mortality rate of 90%.
By contrast, a study published by The Lancet Global Health in July last year recorded more than 50,000 cases in 12 states in northern Nigeria between 1999 and 2024, based on data from Sokoto Hospital. Cases are not confined to Nigeria: the area known as the “noma belt” stretches across Africa, from Senegal and Mauritania in the west to Ethiopia in the east.
Falling funding deepens the gap in the fight against noma
However, Yuka Makino, the WHO Africa office’s technical officer for oral health, says Nigeria records more cases than other countries because it has specialist hospitals, a large population and a government-led response that is likely helping to detect more cases than are recorded in most countries. Efforts to combat the disease are facing mounting funding pressures.
Nigeria has only two hospitals treating noma: one in Sokoto and the other in the capital, Abuja, which was built in 2023. Sokoto Hospital treated more than 500 affected children from across northern Nigeria between 2023 and 2025.
Two hospitals and limited surgical rounds for children
Other children are still waiting for their turn in one of three annual surgical rounds organised by MSF for those whose physical condition allows them to undergo surgery. The Federal Ministry of Health and the Sokoto State Ministry of Health did not respond to a request for comment on the government’s plans to combat the disease.
