When cholera began spreading through Borno State in early May, what followed was one of the most severe outbreaks the state had seen in recent years. What made the difference during one of Borno's most severe cholera outbreaks, and what will it take to keep children and families safe in the months ahead?
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when it all started...
In early May, a devastating cholera outbreak began in Maiduguri, the capital of Borno State, one of the most severe the state has experienced in recent years. Within weeks, it spread across the State, with over 12,000 suspected cases. Many families were affected, and it became one of the worst cholera outbreaks in the state.
For 10-year-old Ibrahim, it started when “he complained of weakness of the body” … his mother narrates...
“…he became very weak... he started vomiting and passing out stool continuously nonstop at the same time, then he called me to assist him in the toilet, so when I entered the latrine and saw his condition, I was shocked because I was heavily pregnant that time, so I called for help, then he was rushed to the hospital... I lost hope that my son will come back home alive. ”
– Ibrahim*’s mother
Nurse Bulama with a child at the Cholera Treatment Centre in Borno State
WHEN EVERY MINUTE COUNTS
Cholera does not wait. Without fast treatment, people can die within hours. Globally, it affects millions each year, with an estimated 1.3 to 4 million cases and up to 143,000 deaths annually (WHO). Yet, Cholera remains both preventable and treatable if medical treatment and care are reached in time.
At the height of the outbreak in Borno, the state was grappling with one of its most severe cholera outbreaks in recent years. Cases were rising rapidly, and children, families, and entire communities were in urgent need of support. The pressure was immense. Health systems were stretched to their limits, and any delay in response risked costing lives.
Save the Children Nigeria stepped in early, as it became clear that the outbreak would not slow on its own, and became one of the first international organisations to respond. Waiting was not an option. Every delay carried a cost, and that cost would be measured in human lives.
With support from the Nigeria Humanitarian Fund and additional support from the Save the Children Humanitarian Fund, Save the Children Nigeria was able to address urgent gaps and support the cholera treatment response in the state. Working closely with the Borno State Ministry of Health, a Cholera Treatment Centre was set up in Njimtilo Infectious Disease Centre with a capacity of 200 beds.
Save the Children strengthened the centre’s capacity, increasing medical personnel from 18 to 95, ensuring care could keep pace with the rising number of patients. Treatment and medicines were provided free of charge, removing barriers and making it possible for families to seek help when they needed it most.
At the treatment centre, people kept coming. At some point, over 200 people were trooping into the treatment centre daily. There was no time to pause.
At the Save the Children cholera treatment centre gate, foot chlorination is put in place as part of standard infection prevention and control measures.
Save the Children strengthened the centre’s capacity, increasing medical personnel from 18 to 95, ensuring care could keep pace with the rising number of patients. Treatment and medicines were provided free of charge, removing barriers and making it possible for families to seek help when they needed it most.
At the treatment centre, people kept coming. At some point, over 200 people were trooping into the treatment centre daily. There was no time to pause.
During the outbreak I realised how vulnerable children and families can be during a public health emergency, many children were brought to the CTC in critical conditions with severe dehydration, hypoglycemia, lethargy…
- Nurse Bulama
Nurse Bulama at the Cholera Treatment Centre, Njimtilo
The Cholera Treatment Centre became more than a facility. It became a place people could reach for life-saving treatment and care, and be received without hesitation. Those affected by cholera were treated free of charge, and daily meals were provided.
For 10-year-old Ibrahim*, it became the place where things began to shift.
He arrived unconscious, his body weakened by cholera. Today, he looks strong and healthy; you would never guess how close he once was to losing consciousness. What brought him back was not just the treatment itself, but the fact that it came on time and continued until he was well enough to stand again.
When I was taken to the hospital, I was very weak, infact I was unconscious when I was taken from the home to the facility. I regained [consciousness] … I [could] hear the ambulance that was transporting me to the CTC. When we got to the CTC, I was admitted immediately and was given a bed, and the doctors and nurses attended to me immediately, which gave me hope of surviving…
- Ibrahim*
What mattered most for us at the peak of the outbreak was clear: that people got care when they needed it most.
Ibrahim*
THE QUESTION THAT REMAINED?
But even in the middle of the response, there was a question that could not be ignored:
What happens in communities where the treatment centre is far away?
Distance is not just miles. It is time. It is cost. It is hesitation. And in a cholera outbreak like this, those things matter. So, the work did not stop at treatment. As part of building something that lasts beyond the emergency, Save the Children Nigeria is supporting the training of doctors, nurses, WASH focal persons and community health workers across 18 Local Government Areas in Borno State.
Not just to respond now, but to be ready next time.
To strengthen knowledge. To sharpen practical skills. To make sure that when emergencies come, response does not have to start from zero.
Emergency preparedness, in this context, is not theory. It is a health worker recognising the signs early. It is knowing exactly what to do without hesitation.
The training has greatly improved my knowledge and skills in managing cholera, acute meningitis, measles, and Ebola. I am now more confident in identifying symptoms early, providing appropriate case management, educating patients and caregivers, following infection prevention and control measures, and making timely referrals for severe cases. This will help me provide better quality healthcare services and contribute to reducing illness and deaths in my community.
– Maryam
Maryam at a training organised by Save the Children Nigeria
LIFE-SAVING CARE IN ACTION + PARTNERSHIP THAT WORKS
Since its inception, the treatment centre has treated over 2000 patients. More than 2000 people have been discharged.
The case fatality rate remains below 1 per cent. This means that almost everyone who receives care survives. Behind these numbers are real children and people who have received life-saving treatment. Children like Ibrahim, who arrived at the treatment centre weakened by cholera.
Today, he looks like any other healthy child; you would never know what he endured. The difference was simple, but decisive: he reached care in time.
If not of the immediate support I received, it could be a different story now, and we did not pay any money; everything was free...
- Ibrahim
Ibrahim*
At the treatment centre, there was no slowing down. Save the Children staff worked seven days a week, week in, week out, making sure every child and patient was attended to, because every life mattered. This response was not done alone. Save the Children Nigeria worked, and continues to work, closely with the Ministry of Health in the state.
This collaboration made it easier to act quickly, set up services, and reach affected communities.
The state government and Save the Children International has done a lot of things in order to mitigate this outbreak in the state. They supported the state in terms of human resource for health, particularly doctors, nurses, communities and other cadres. They also help in the supply of drugs and medical consumables.
-Director, Public Health, Dr Goni Ali
TAKING THE RESPONSE INTO COMMUNITIEs: CHANGING BEHAVIOURS THROUGH KNOWLEDGE
The response did not stay inside the treatment centre. It moved outward, into communities, into everyday spaces, into the places where infection begins and, if not stopped, spreads.
As part of Save the Children’s cholera preparedness plan, Community-Based Volunteers (CBVs) are trained on the Case-Area Targeted Intervention (CATI) approach.
The Case-Area Targeted Intervention (CATI) is a quick way to stop diseases like cholera from spreading.
When someone is found to have cholera, response teams quickly identify the case and ensure immediate referral of the identified case to the Cholera Treatment Cente for appropriate care. At the household level, the team implements CATI activities including disinfection, water chlorination, hygiene promotion, and sensitisation on transmission, prevention, and how to stop further spread.
These interventions specifically target the cholera case household and neighbouring households within a defined radius of approximately 50m - 150m.
Save the Children volunteers in a community in Borno state
At the Treatment Centre, a dedicated volunteer collects the patient’s household location details during admission. That information is passed quickly to mobile teams moving through communities. Within 24 to 72 hours, the mobile team would then locate the patient’s household to carry out disinfection, water chlorination, community sensitisation, and hygiene kit distribution.
At the community level, community volunteers conduct house-to-house hygiene promotion sessions on proper handwashing practices at critical times, safe water handling, food hygiene, safe excreta disposal, and early referrals of suspected cases. In addition, they demonstrate household water treatment methods and promote safe water storage practices, and promote environmental sanitation, including waste disposal.
This is to help community members become more aware, adopt healthier behaviours, and take hygiene more seriously. In many ways, they became a bridge between the health system and the people around them.
A Save the Children volunteer with Ibrahim*, his mother and some neighbours
Patients who received treatment were supported with hygiene kits, buckets, soap, and basic items, so they could continue protecting themselves and their families at home, reducing the risk of the disease spreading again. Hygiene kits, buckets, soap, and basic supplies are provided both at discharge and within communities, helping families act on what they had learned. So, the response was not only treating illness. It was interrupting its path.
For Ibrahim*s’ mother, the cholera kits will help me in practicing good hygiene all time, she told us.
Awareness became a form of protection. Sometimes, it showed up in small ways, like Ibrahim’s* mother choosing to wash plates early and not leaving them over the night and ensuring her seven children washed their hands regularly.
Before the volunteers visit, I only know how to wash hands before eating, after entering toilet and before cooking. But now that my son has contacted cholera and with WASH volunteers awareness, I intensify on critical times of handwashing, where I ensure and monitor my children in washing their hands properly and ensure my dirty plates are washed before going to bed at night
- Ibrahims* mother
Ibrahim and his mother
WHAT’S WORKING NOW AND WHAT MORE NEEDS TO BE DONE
When we step back and look at the success of our response, a few things stand out, not as separate efforts, but as parts of one coordinated response that came together at the right time. The speed of it was the first. Also, funding was available and used quickly, making it possible to act without delay.
Then the people: Save the Children supporting and providing the state with trained health workers and volunteers who knew what to do and did not hesitate. A treatment centre able to receive those who arrived. Community volunteers carrying information into homes, into conversations, into decisions people make every day.
And the way it is all connected: partnering with the government, partners, and communities, working in sync rather than in fragments. Because of that, the response moved.
And because it moved, lives were saved. But it would be too easy to stop the story there.
The outbreak is not over. And responses like this cannot run on urgency alone. They need consistency. Sustained funding is part of that story now. Not just to respond in moments of crisis, but to keep treatment centres running, to continue training health workers and WASH focal persons across all 27 LGAs, to ensure that information keeps moving through communities, reaching those who have not yet been reached.
Because there are still places where treatment is not immediate. Where distance still shapes decisions. Where clean water is not guaranteed. That is where the next stretch of work lies.
Strengthening what is already working. Extending it further. Making sure systems do not slow down just because the first wave is being managed.
So, the work continues, not with the same urgency of the first response, but with a steady commitment to stay ahead. And in that continuity, in showing up again and again, is where more lives will be saved.
Save the Children community volunteers in a household in Borno State
AT THE HEART OF IT ALL
This response is not just about systems or numbers. It is about children, families, and communities.
It is about seven-year-old Mama Hajja, who reached care in time and was given a chance to recover. And about 10-year-oldIbrahim, who now looks strong and healthy and can play football. You would never know he once battled cholera at its worst.
And not just Hajja* and Ibrahim*, but hundreds and thousands of children and families who made it through one of the worst cholera outbreaks in Borno state, because medical treatment care reached them in time. It is about the moment someone reaches care in time. It is about the relief of recovery. It is about the quiet work happening every day to protect lives.
In Borno, this response shows what is possible when speed meets purpose, when resources are moved quickly enough to meet the needs of children, families and those who stand beside them.
And in moments like this, Save the Children Nigeria stands where it matters most, close to children, alongside the families who care for them. Working to ensure no child is lost to preventable diseases, and that families have what they need to stay healthy.
Photo credits: Mogbonjubade Adesulure
