by Ogbeni Olawale Dawodu,
Noma, a rapidly progressing and often fatal infection of the face and mouth, is increasingly afflicting children in northern Nigeria, with health workers and humanitarian agencies reporting a worrying rise in cases amid deepening poverty and insecurity in the region.
The disease, classified by the World Health Organisation (WHO) as a neglected tropical disease, begins as gum inflammation in malnourished children living in polluted environments before rapidly destroying soft tissue and bone. It mostly strikes children aged two to six in poor communities, and untreated cases carry an extremely high fatality rate.
Ibrahim Dalhatu was just three years old when he contracted the disease. Now eight, he has undergone six facial reconstructive surgeries since his first operation in 2021 at the Noma Children Hospital in Sokoto State. His father, Muhammad Dalhatu, an Islamic teacher, described his relief at learning the treatment came free of charge.
“I was very excited because I thought there was no solution to the disease,” Dalhatu said. “Before, I was worried about the cost of the treatment, but when I was told it was free of charge, I was so happy.”
The surgeries are carried out by Doctors Without Borders (MSF) as part of its broader campaign against neglected diseases in the region.
WHO has not updated its global noma data since 1998, when it put annual cases at 140,000 with a 90 percent fatality rate. However, a study published in July in The Lancet Global Health, drawing on data from the Sokoto hospital, recorded more than 50,000 noma cases across 12 northern Nigerian states between 1999 and 2024. Experts note the disease follows a so-called “noma belt” stretching across Africa from Senegal and Mauritania to Ethiopia.
Yuka Makino, a WHO technical officer for oral health, said research has linked noma to more than 100 different microorganisms, describing it as an opportunistic, polymicrobial infection driven chiefly by extreme poverty and severe malnutrition. WHO has referred to the disease as a marker of absolute poverty, while the UN Human Rights Council has said the conditions that produce it amount to a human rights violation against affected children.
MSF’s Nigeria medical coordinator, Bukola Oluyide, said the organisation is now seeing more acute cases and is pushing awareness campaigns to get children into treatment earlier.
“We are seeing more acute noma cases, and we are veering toward awareness for the community so they can bring their children earlier to prevent tissue loss and require reconstructive surgery later in years,” Oluyide said.
According to Makino, Nigeria records more noma cases than other countries partly because of its specialist hospitals and government-led reporting systems, which capture more cases than are typically documented elsewhere. Nigeria’s federal and Sokoto state health ministries did not respond to requests for comment on government plans to tackle the disease.
At the Sokoto hospital, more than 500 children were treated for noma between 2023 and 2025, according to data reviewed by the Associated Press. Others remain on the waiting list for surgery at the three annual sessions MSF runs for children well enough to undergo the procedure. Dr Abubakar Abdullahi Bello, chief medical director of the Noma Children Hospital, said the disease’s speed makes early intervention critical.
“It is quite worrisome,” Bello said. “The disease damages the mouth tissues within a short period. It eats up the tissue within two weeks of onset if the patient does not receive treatment.”
Ibrahim has largely recovered and can now eat and speak normally following nasal fistula surgery, but not every child is as fortunate. Nigeria has only two noma hospitals, one in Sokoto and a second, more recently built, in Abuja in 2023.
Four-year-old Maryam Sabiu’s son, infected with noma in 2024, remains on the waiting list, too young for surgery. The disease has left a hole in his cheek extending toward his eye, causing him constant pain that his mother soothes through frequent breastfeeding, a practice that has brought her own pain and stigma.
“I feel like the way people would stop and look at my child is one of the worst experiences in my entire life,” Sabiu said.
