SOKOTO, Nigeria (AP) — Ibrahim Dalhatu was just 3 years old when he contracted noma, a severe disease that disfigures the face and kills most of the children it infects.
He had his first facial reconstructive surgery in 2021 at the Noma Children Hospital in Nigeria's Sokoto state. Since then, Ibrahim, now 8, has had six operations to help him recover.
Noma is a rapidly progressing, and often fatal, infection of the face and mouth. It begins with gum
inflammation in malnourished children living in polluted environments and quickly spreads to destroy soft tissues and bones. It mostly affects 2- to 6-year-old children, especially in poor communities.
Early-stage treatment includes antibiotics, wound care and improving nutrition. But once the disease worsens, surgery is required.
In Nigeria, health workers are seeing more noma patients. Doctors Without Borders, the humanitarian organization known by its French abbreviation MSF, is carrying out multi-stage operations free of charge as part of its mandate to tackle neglected diseases.
Parents say the operations have given their children another chance to live a normal life, a relief for many in one of the world's poorest regions.
“I was very excited because I thought there was no solution to the disease,” said Muhammad Dalhatu, Ibrahim's father, an Islamic teacher married to a retail trader. “Before, I was worried about the cost of the treatment, but when I was told it was free of charge, I was so happy.”
Noma is classified by the World Health Organization as a neglected tropical disease, meaning it receives little or no global attention and funding, despite its impact on victims. WHO has said evidence shows the disease “can be greatly reduced by early treatment.”
WHO has not updated its data on noma since 1998, when it estimated 140,000 cases per year with a 90% fatality rate. A study published in July in The Lancet Global Health journal, relying on data from the Sokoto hospital, reported over 50,000 noma cases across 12 northern Nigerian states between 1999 and 2024.
While it is hard to track how common the disease is in different countries, a so-called “noma belt” stretches across Africa, from Senegal and Mauritania in the west to Ethiopia in the east.
Yuka Makino, a technical officer for oral health at the agency’s Africa office, said research has shown that noma can be caused by 117 different microorganisms, calling it “an opportunistic, polymicrobial infection.”
But the major risk factors, experts say, are extreme poverty and severe malnutrition. WHO calls the disease “a marker of absolute poverty.” The United Nations Human Rights Council says the conditions leading to it constitute a human rights violation for affected children.
In northern Nigeria, ravaged by the fallout from armed violence and economic hardship, experts say more children are being diagnosed with noma. Many of those affected arrive late for treatment due to a lack of awareness and the deadly impact of the disease, MSF and medical officials said.
“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,” said Bukola Oluyide, Nigeria medical coordinator at MSF.
According to WHO's Makino, Nigeria reports more noma cases than other countries due to its specialist hospitals, large population and a government-led response that likely ensures more cases are reported than in most other countries.
Neither the federal Ministry of Health nor the state ministry for Sokoto responded to a request for comments regarding the government's plans to combat the disease.
At the specialist hospital in Sokoto, more than 500 children with noma from across northern Nigeria were treated between 2023 and 2025, according to data seen by the AP. Others are waiting for surgery at the three sessions MSF runs each year for the children whose bodies can take it.
“It is quite worrisome,” said Dr. Abubakar Abdullahi Bello, the chief medical director of the Noma Children Hospital. “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. He can eat and speak normally after nasal fistula surgery, but not every child has the same opportunity. Nigeria has only two noma hospitals, including one in Abuja, recently built in 2023.
Maryam Sabiu's 4-year-old son, who was infected with noma in 2024, is one of those on the waiting list. The disease has created a hole in his left cheek, extending toward his left eye, but he is too young for surgery. He is in pain and cries constantly. His mother breastfeeds him frequently to soothe him. This has led to pain and stigmatization, she said.
“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.
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