Médecins Sans Frontières (MSF), otherwise known as Doctors Without Borders, has warned that Nigeria risks losing more children to noma, a largely neglected but preventable disease that can destroy the face within days, unless the government urgently strengthens early detection, community surveillance and access to treatment.
The international humanitarian organisation said the disease, which primarily affects malnourished children living in conditions of extreme poverty, remains a serious public health concern despite growing national and international efforts to combat it.
MSF Country Representative in Nigeria, Ahmed Aldikhari, who raised the concern at the 2026 National Noma Day commemoration in Abuja, said the country must move beyond policy commitments and translate existing interventions into effective action at the grassroots, where vulnerable children are most likely to be missed by the healthcare system.
He stressed that the difference between survival without permanent disability and a lifetime of severe facial disfigurement could depend on how quickly the disease is recognised and treated.
Aldikhari called on the Federal Government to strengthen community-based surveillance, equip frontline health workers to recognise the early warning signs of noma and ensure that suspected cases are promptly referred to specialised treatment facilities.
He said the inclusion of noma in Nigeria’s Surveillance Outbreak Response Management and Analysis System (SORMAS), alongside efforts to integrate the disease into primary healthcare guidelines, represented important progress but would achieve little without effective implementation across states and local government areas.
The MSF representative also welcomed the launch of the National Strategic Plan on Oral Health 2026–2031 by the Federal Ministry of Health, describing it as an opportunity to institutionalise noma prevention, early diagnosis and treatment within the country’s broader healthcare delivery system.
However, he insisted that the responsibility for combating the disease must not rest solely with the Federal Government or specialised hospitals, arguing that effective intervention requires coordinated action involving state governments, local authorities, community health workers, traditional and religious leaders, teachers and caregivers.
According to him, community-based identification is particularly important because noma often develops among children in disadvantaged communities where access to healthcare is limited and awareness of the disease remains low.
Noma, also known as cancrum oris or gangrenous stomatitis, is among the most devastating diseases affecting vulnerable children, yet it remains relatively unknown outside communities and medical circles where cases are frequently encountered.
The disease begins as an infection of the gums, often presenting with painful, swollen or bleeding gums and foul-smelling breath. Without prompt intervention, it can progress rapidly, destroying the soft tissues and bones of the mouth and face, sometimes within a matter of days.
It primarily affects children between the ages of two and six, particularly those experiencing severe malnutrition, poor oral hygiene, weakened immunity and recurrent infections.
The World Health Organisation (WHO) has identified noma as a neglected tropical disease and described it as a disease closely associated with extreme poverty, social exclusion and inadequate access to essential healthcare.
In December 2023, the WHO formally included noma on its list of neglected tropical diseases following an initiative spearheaded by Nigeria and supported by 32 member states.
The recognition was significant for Nigeria, which has long been one of the countries at the centre of efforts to address the disease.
According to WHO estimates, noma was associated with approximately 140,000 new cases annually worldwide, based on estimates dating back to 1998. The organisation also estimated a case fatality rate of about 90 per cent, although it acknowledged that early treatment can substantially reduce the risk of death.
The actual burden remains difficult to establish because many affected children are never diagnosed or reported. Some die in their communities without reaching a hospital, while survivors frequently endure severe facial deformities, difficulties eating and speaking, psychological trauma and social discrimination.
Importantly, noma is not contagious. Its occurrence is strongly associated with preventable conditions, including malnutrition, poor oral health, inadequate sanitation and untreated infections.
The disease is particularly tragic because early intervention with antibiotics, improved nutrition and appropriate oral hygiene can halt its progression before permanent facial damage occurs.
However, when children arrive at hospitals after the infection has advanced, treatment becomes considerably more complicated, often requiring multiple reconstructive operations and prolonged rehabilitation.
Against this background, MSF said it had sustained its partnership with the Federal Ministry of Health and the Sokoto State Ministry of Health in providing comprehensive care for people affected by noma at the Noma Children’s Hospital in Sokoto State since 2014.
Aldikhari disclosed that the collaboration had facilitated more than 1,759 major reconstructive surgeries for 1,174 patients through 35 surgical missions over the past decade.
In 2026 alone, he said, MSF conducted 114 surgeries for 96 patients, underscoring the continuing demand for specialised treatment.
The interventions extend beyond surgery to include inpatient management of acute noma cases, oral physiotherapy, nutritional support, community engagement, health education and mental health and psychosocial services.
The organisation has also invested in developing local medical capacity, with 28 Nigerian surgeons and 14 anaesthetists trained by international specialists to improve the country’s ability to manage complex noma cases.
The training is particularly important given the specialised nature of reconstructive procedures required by survivors, many of whom suffer extensive tissue damage that affects their ability to eat, speak and perform everyday activities.
For MSF, however, the ultimate objective should not simply be to expand the number of reconstructive surgeries performed but to prevent children from reaching the stage where such procedures become necessary.
This, Aldikhari suggested, requires a fundamental shift towards prevention, early diagnosis and timely referral.
The MSF representative said Nigeria’s primary healthcare system must become the frontline of the country’s response, given that primary healthcare facilities are often the first point of contact for families seeking medical attention for sick children.
He called for the integration of routine noma screening into primary healthcare services and the training of frontline health workers to recognise its earliest symptoms, provide appropriate initial care and refer suspected cases without delay.
He also advocated stronger community surveillance involving traditional rulers, religious leaders, teachers, caregivers and community health workers, noting that these groups could help identify children showing early symptoms before their conditions deteriorate.
He welcomed the inclusion of noma in SORMAS but cautioned that the effectiveness of the surveillance system would depend on consistent reporting, adequate training, reliable data management, supportive supervision and the timely use of information to guide interventions.
He further urged the government and development partners to provide sustained funding for the implementation of the National Strategic Plan on Oral Health, expansion of treatment facilities and strengthening of referral networks.
Beyond the health sector, the disease also highlights the consequences of persistent poverty, food insecurity, inadequate sanitation and unequal access to basic healthcare.
Efforts to eliminate noma, therefore, cannot be separated from broader interventions to improve child nutrition, access to clean water, sanitation, immunisation and essential primary healthcare.
Nigeria’s leadership in securing WHO recognition for noma as a neglected tropical disease has provided an important platform for mobilising international attention and resources.
The challenge now is ensuring that the recognition translates into measurable improvements in the lives of children, particularly those in remote and underserved communities.
The introduction of noma into disease surveillance systems and the development of a national oral health strategy provide important policy foundations. However, without adequate funding, trained personnel, functional referral systems and sustained public awareness, many children could continue to arrive at specialised hospitals only after irreversible damage has occurred.
For Aldikhari, the country’s response must be guided by the understanding that noma is preventable and treatable, and that no child should be condemned to death or lifelong disability because an easily recognisable disease was detected too late.
He urged the Federal Government, state governments, development partners, healthcare professionals and communities to renew their commitment to eliminating the disease through sustained investment, stronger collaboration and improved access to early treatment.
He said bringing noma out of the shadows would require more than public declarations, insisting that effective surveillance, community awareness and accessible treatment must become realities for families most at risk.
Ultimately, Nigeria’s success in tackling noma will not be measured only by the number of surgeries performed or policies introduced, but by how many children are identified early enough to avoid the devastating consequences of a disease that should never have been allowed to destroy their lives.
