MSF’s Seven-Year Mission Transforms Lassa Fever Care in Ebonyi, Nigeria

After seven years of dedicated intervention, Médecins Sans Frontières (MSF) has successfully concluded its mission in Ebonyi State, Nigeria, empowering local health authorities to take full ownership of Lassa fever care. Once overwhelmed by high mortality rates and fear among healthcare workers, Ebonyi’s health system has emerged stronger, safer, and more confident—thanks to MSF’s sustained support, strategic investments, and capacity-building efforts.

Crisis in 2018: A Healthcare System Under Siege

In early 2018, Ebonyi State, located in southeastern Nigeria, faced one of its worst Lassa fever outbreaks, a hemorrhagic fever endemic to West Africa. Hospitals, particularly the Alex Ekwueme Federal University Teaching Hospital (AE-FUTHA) in Abakaliki, were stretched to breaking point. Personal protective equipment (PPE) was scarce, infection control procedures were inadequate, and diagnostic delays compounded the crisis.

The outbreak claimed many lives, including 16 healthcare workers—a devastating blow that created fear, chaos, and near-paralysis within hospital facilities. “People were afraid to go near the emergency room,” recalls Dr. Nnennaya Anthony Ajayi, then head of clinical services at AE-FUTHA’s virology unit.

MSF Steps In: From Emergency Response to Long-Term Partnership

MSF’s arrival in Abakaliki was initially meant as an emergency response. However, recognizing the systemic vulnerabilities and the absence of sustainable protocols for handling Lassa fever, MSF evolved its mission into a multi-year partnership with the Ebonyi State Ministry of Health and AE-FUTHA.

“We had to put an end to this series of avoidable deaths,” said Alain-Godefroid Ndikundavyi, MSF’s last project coordinator in Ebonyi. “Our main objective was to reverse that trend and to reinforce the hospital’s capacity to better receive and treat patients with the disease.”

MSF’s efforts included:

• Establishing triage and observation areas for safe patient intake

• Implementing rigorous infection prevention and control (IPC) protocols

• Distributing high-quality PPE and biosafety materials

• Training over 230 healthcare workers in IPC and clinical care

• Strengthening laboratory infrastructure for timely and accurate diagnosis

• Covering full costs of patient care, including dialysis, medications, and nutrition

From 2018 to 2024, 1,701 suspected and 427 confirmed Lassa fever cases were managed with MSF’s support, resulting in a significant drop in fatalities—particularly among healthcare workers.

Beyond the Hospital: Community-Based Outreach

Recognizing that Lassa fever spreads rapidly in low-awareness, high-vulnerability environments, MSF took its fight to the grassroots. A specialized health promotion team was mobilized to deliver:

• Over 4,500 community education sessions

• Nearly 1,300 outreach visits across Ebonyi State

• Culturally sensitive awareness campaigns addressing misconceptions

• Encouragement of early detection and treatment-seeking behavior

MSF also supported two rural clinics in Izzi Unuhu and Onuebonyi, enhancing local capacity through:

• Provision of diagnostic equipment and medications

• Sanitation improvements, including the construction of water towers

• On-site training to help staff identify and refer suspected Lassa cases quickly

“To truly fight Lassa, the response had to start at the community level,” emphasized Ndikundavyi.

A Planned and Empowered Transition in 2025

At the end of 2024, MSF formally handed over operations to the Ebonyi State Ministry of Health and AE-FUTHA, ensuring that local authorities could sustain progress. This transition included:

• Donations of ambulances, medical tools, and IPC materials

• Stockpiles of supplies to last through peak season

• Creation of internal IPC and outbreak response committees

• Collaboration with the Nigeria Centre for Disease Control and Prevention (NCDC) to standardize national Lassa care guidelines

To ensure a smooth transition, MSF kept a support team on standby until March 2025, ready to offer technical support if needed.

Lasting Impact and a Healthier Future

Today, AE-FUTHA is almost unrecognizable compared to the panic-stricken institution of 2018. Healthcare workers are trained, equipped, and supported by well-defined safety protocols. Patients are treated with dignity, and Lassa fever survivors are welcomed as community heroes, not shunned.

“We are no longer afraid,” says Dr. Ajayi. “MSF helped us believe that we could fight Lassa fever—and win.”

The numbers speak for themselves: while 24 confirmed cases were recorded in 2024, only one staff death occurred—a tragic but telling contrast to the 16 healthcare worker fatalities in 2018.

Ongoing Challenges, Renewed Hope

Although MSF’s operational role has ended, the battle against Lassa fever continues. The threat of resurgence remains, especially with ongoing challenges like environmental conditions, rodent control, and public awareness. But with empowered health institutions, trained frontline workers, and an engaged community, Ebonyi State is better prepared than ever.

MSF’s departure marks not the end, but the beginning of a new chapter of local resilience, self-reliance, and excellence in infectious disease control.