The photograph is small, black-and-white, its edges frayed by time. He holds it gently, stares at the woman in the picture for a moment, then looks up at his father. “This is my mother,” he says quietly, as he looks for assurance. Aliyu Bala, his father, nods.
Adamu is about five years old, too young to remember her voice, her laughter, or the warmth of her embrace. Hauwa, his mum, died about four years ago from kidney complications after months of untreated illness inside an internally displaced persons (IDP) camp in Girei LGA, Adamawa State. Today, the only proof that she once lived is a photograph and the eight children she left behind.
Adamu stares at his mother’s worn picture intermittently throughout the interview.
Aliyu Bala, Adamu’s father, has lived with kidney disease for years. He was diagnosed before displacement, when he still had access to hospitals, laboratory tests and prescribed medication. But after the family fled their hometown, Dambuwa in Borno the illness followed him into the camp. Not long after, his wife Hauwa developed the same condition.
For Adamu, illness became part of daily life before he was old enough to understand what it meant or where it could lead.
When Treatment Became Impossible
Hauwa was alive when the family fled Dambuwa, but displacement quickly turned a manageable illness into something beyond the family’s control. Kidney disease requires consistent medication, regular laboratory tests and close medical monitoring — none of which were reliably available in the camp.
Aliyu watched helplessly as his wife’s condition deteriorated, fully aware of what treatment required but unable to afford it.
“I can’t even afford enough food for my family, let alone my wife’s expensive drugs and tests,” he said. “It was painful to see her like that.”
As the illness progressed, Hauwa grew weaker. She spent long hours in pain, confined to bed and gradually unable to care for her children. For Adamu, those months were confusing as his mother who once sat outside with the children now lying still, often silent.
“She used to sit outside with the children,” Aliyu recalled. “Later, she couldn’t sit for long. She was always lying down, holding her body.”
Neighbours and relatives sometimes contributed small amounts of money to buy medication, but support was irregular and never enough for a chronic condition. There were weeks and sometimes months when Hauwa received no drugs at all. Each interruption worsened her condition.
“Kidney sickness is not something you treat once,” Aliyu said. “When the drugs finish, everything starts again.”
Eventually, Hauwa died from kidney failure around 2022, leaving eight children behind. Adamu, barely a year, was too young to remember her clearly.
“That picture is all he has,” Aliyu said softly. “When he looks at it, that’s how he knows his mother.”
A Disease That Demands Care Many Cannot Afford
Kidney disease is a chronic condition requiring continuous care to prevent deterioration. The World Health Organization estimates that more than 788 million people worldwide live with chronic kidney disease, making it one of the fastest-growing causes of death globally.
In Nigeria, health experts warn that poverty, late diagnosis and the high cost of treatment are major drivers of kidney-related deaths — especially among vulnerable groups such as internally displaced persons.
For families living in camps, the choice is rarely between treatment options. It is often between food and medicine.
Before displacement, Aliyu farmed in Dambuwa, Borno State. His household once included 29 children and multiple wives. Life was demanding but stable, shaped by farming seasons and daily routines.
That stability collapsed between 2014 and 2015 as Boko Haram violence intensified.
“Sometimes they would attack and we would run into the bush,” Aliyu said. “We would return after two or three days and find everything disturbed. Later, it became impossible to stay.”
When he finally fled permanently, he escaped with only 17 of his children. One child died during the journey, along with the child’s mother.
After settling in the camp, Aliyu’s own kidney condition worsened. Doctors prescribed medication and tests, but the costs were overwhelming.
“In the camp, they prescribed drugs again,” he said. “But the money was too much.” Gradually, he stopped treatment.
Today, he lives with daily pain while raising children whose mother died from the same illness he continues to battle.
“I saw what happened to her,” he said. “I know what this sickness can do.”
Yet access to care remains beyond his reach.
A Pattern Across Camps
Aliyu’s story is not isolated. Studies show displaced populations face heightened health risks and major barriers to care. In northeast Nigeria, overcrowding, weak health infrastructure and limited clinic access increase vulnerability to disease.
Research indicates that about 13.2 per cent of displaced persons rely on home care or receive no formal medical attention when ill. Others delay treatment until conditions worsen — a dangerous pattern for chronic diseases.
Hannatu Paul, also in Damare Camp, shares a similar experience. She developed kidney disease after displacement and began treatment, but stopped eight months ago when she could no longer afford medication.
“It still hurts,” she said quietly. “But what can one do without the means?”
Medical Reality in a Humanitarian Setting
Medical experts warn that untreated kidney disease progresses silently but aggressively. Without consistent medication, laboratory monitoring, adequate nutrition and clean water, it often leads to irreversible failure.
Dr Gibson Peter, Medical Officer in charge of General Hospital Kashere, explained that kidney disease occurs when the kidneys gradually lose their ability to filter waste, regulate fluids and control blood pressure.
“When these functions fail, toxins and excess fluid build up, affecting almost every organ,” he said.
The disease often shows few symptoms in its early stages, making early detection critical.
“When damage becomes chronic and irreversible, patients may require dialysis or transplant — both extremely expensive and largely inaccessible to poor communities,” he said.
In camps, interrupted treatment can quickly turn a manageable condition into a fatal one.
“Some patients stop treatment not because they want to, but because survival priorities like food and shelter come first,” Dr Peter said.
Gaps Between Policy and Reality
Nigeria’s Basic Health Care Provision Fund (BHCPF) was created under the 2014 National Health Act to expand access to essential healthcare, particularly for vulnerable populations including IDPs.
According to the policy, registered displaced persons should receive essential services — consultations, basic tests and medicines — free at accredited primary health centres.
But in Damare Camp, Aliyu says medicines are often unavailable.
“Anytime we go, they say the drugs have finished,” he said.
Patients are given prescriptions and asked to purchase drugs privately — something many cannot afford.
Health policy experts say weak implementation, funding delays, poor supply chains and limited monitoring have undermined the programme’s effectiveness.
Nigeria is a signatory to international treaties recognising the right to the highest attainable standard of health. These obligations apply equally to internally displaced persons.
Mustapha Tukur, North-East Coordinator of the International Human Rights Commission, said displacement does not cancel rights.
“In any situation where a person cannot access proper healthcare, a right is being denied,” he said.
Back in Damare camp, such guarantees feel distant.
Aliyu continues to live with untreated kidney disease, fully aware of what it has already taken from his family. His youngest son now knows what his mother looked like only through her picture.
Whether he grows up with his father may depend not on medical knowledge but on something far simpler and harder to obtain in accessibility and affordability of treatment.
