Sudan is facing a humanitarian crisis that has left over 25 million people affected, while in northern Nigeria doctors are treating a neglected disease called noma that can disfigure and kill children. Those are the numbers the powerful are carrying into the 81st session of the United Nations General Assembly, where health leaders are again asking for faster progress on problems that have already crushed families across the continent.
Who Pays for Neglect
In northern Nigeria, 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. That is what survival looks like when a child is born into a system where treatment arrives late, if at all.
Muhammad Dalhatu, Ibrahim's father, said the cost had nearly shut the door. “I was very excited because I thought there was no solution to the disease,” he said. “Before, I was worried about the cost of the treatment, but when I was told it was free of charge, I was so happy.” The free care came from Doctors Without Borders, the humanitarian organization known by its French abbreviation MSF, which is carrying out multi-stage operations free of charge as part of its efforts to tackle diseases.
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 improved nutrition. But once the disease worsens, surgery is required.
The World Health Organisation classifies noma 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.
What the Institutions Admit
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. That is the language of the system itself, naming deprivation as a violation while the deprivation keeps grinding on.
During the United Nations General Assembly, which begins Tuesday, WHO has said it will engage heads of state and partners to raise global awareness and advance shared solutions to diseases and other health challenges. The phrase sounds tidy. The reality is messier. 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. WHO’s 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.”
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 comment 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 stigmatisation, 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.
The Bigger Ledger of Loss
The same machinery of neglect shows up across the continent in different forms. Nearly 178,600 women died from pregnancy and childbirth-related causes in African Union member states in 2023, accounting for about 7 out of 10, representing 69 per cent, of the estimated 260,000 maternal deaths worldwide that year. African Union member states also account for an estimated 1.18 million newborn deaths every year, over half of all that is, about 51 per cent, of the global total.
Those figures form the backdrop to Africa’s push for faster action on maternal, newborn and child survival as world leaders meet in New York for the 81st session of the United Nations General Assembly. At the centre of the continental agenda is the “Three Zeros” zero home deliveries, zero preventable maternal and newborn deaths, and zero unvaccinated children. The agenda seeks to move maternal and child health commitments from declarations to measurable action before the 2030 deadline. The figures are contained in a new Africa Centres for Disease Control and Prevention evidence review, The Causes and Drivers of Maternal and Child Mortality in Africa, released on September 9, 2026.
The review draws on evidence from all 55 African Union member states and finds that maternal mortality has fallen, but not fast enough to meet the Sustainable Development Goal target. Maternal mortality across AU member states declined by 42 per cent between 2000 and 2023, from 666 to 388 deaths per 100,000 live births. But the global target is fewer than 70 deaths per 100,000 live births by 2030. Africa CDC estimates that if the current rate of decline continues, the maternal mortality ratio across AU member states would still stand at about 330 deaths per 100,000 live births in 2030. “At the observed annual rate of reduction of 2.4 per cent, Member States will record approximately 330 deaths per 100,000 live births in 2030, close to five times the Sustainable Development Goal target,” the report says. It adds that meeting the target would require the rate of decline to increase roughly ten-fold.
The burden is uneven across the continent. West Africa has the highest maternal mortality ratio at 682 deaths per 100,000 live births and accounts for 55 per cent of maternal deaths in Africa. Central Africa records 439 deaths per 100,000, East Africa 260, Southern Africa 162 and North Africa 50. Africa CDC says four of the five regions together account for 99 per cent of maternal deaths on the continent.
The agency’s assessment also points to a problem beyond whether women reach health facilities. It identifies delays in receiving appropriate care, shortages of medicines and blood, staffing gaps and weak referral systems among the factors contributing to maternal deaths. Among countries that assessed whether maternal deaths could have been prevented, the estimated proportion of avoidable deaths ranged from 58 to 96 per cent. The review also found gaps in acting on lessons from previous maternal death reviews. Of the 34 AU member states whose maternal death review reports were examined, only 14 reported progress on recommendations from earlier review cycles. “Only one country both analyzed the three types of delay, assessed whether deaths were avoidable and tracked implementation of previous recommendations,” the report says.
The World Health Organisation estimates that 260,000 women died during and following pregnancy and childbirth in 2023. Sub-Saharan Africa alone accounted for about 182,000, or 70 per cent, of the global total. WHO says skilled care before, during and after childbirth can save the lives of women and newborns.
Child survival faces a similar challenge. An estimated 4.9 million children died before their fifth birthday in 2024, including 2.3 million newborns, according to the latest United Nations child mortality estimates. Sub-Saharan Africa accounted for 58 per cent of global under-five deaths. Newborn deaths accounted for nearly half of all under-five deaths globally. Complications from preterm birth and complications during labour and delivery were among the leading causes, according to UNICEF.
Africa CDC argues that the continent’s challenge is therefore not simply a lack of medical solutions. Its review identifies health financing, frontline care, skilled health workers, emergency referral systems, essential commodities, data and accountability as critical areas for action. The agency cites examples from countries including Tanzania and Rwanda where improvements in referral systems, financing and quality of care have been linked to reductions in maternal deaths.
At the Second International Primary Health Care Conference in Arusha, Tanzania, African health leaders adopted a Call for Action describing primary healthcare as the “delivery gateway” through which the continent’s health and development ambitions must pass. The declaration calls for sustainable health financing, improved quality of care and stronger accountability.
Kenya launched its Every Woman Every Newborn Everywhere Acceleration Plan for 2026–2028, targeting preventable maternal and newborn deaths in 26 high-burden counties. The Government says it is investing about Sh12.5 billion in maternal and newborn health, including Sh4 billion for delivery and essential newborn care, Sh1 billion for lifesaving commodities, Sh2.5 billion for family-planning commodities and Sh5 billion annually for the recruitment of 5,000 nurses. The national plan also targets stronger emergency referrals, skilled care and accountability, with a six-month Rapid Results Initiative focused on the 26 counties.
Medical Services Principal Secretary Ouma Oluga has said maternal and newborn survival requires action beyond the Health Ministry. “The survival of mothers and newborns is a shared responsibility across government. Every sector has a role in addressing the barriers that prevent women and newborns from accessing timely and quality care,” Dr Oluga said.
WHO’s Regional Office for Africa has also launched a new manual to help primary health care workers identify suspected breast cancer earlier, assess symptoms and ensure timely referrals for diagnosis and treatment. The publication, Evaluation and Workup for Suspected Breast Cancer Using a Primary Health Care Approach, is designed to support nurses, midwives, medical doctors and clinical officers in recognizing warning signs, conducting initial clinical assessments and helping patients navigate diagnostic and treatment services.
The guidance supports implementation of the WHO Global Breast Cancer Initiative, which seeks to reduce breast cancer mortality through early diagnosis, timely treatment and quality care. Breast cancer is the most commonly diagnosed cancer among women worldwide and remains a major cause of cancer-related illness and death in the WHO African Region. In 2022, an estimated 2.3 million women were diagnosed with breast cancer globally, while around 670,000 people died from the disease.
In most countries across the African Region, more than 70% of breast cancer cases are detected at a late stage, limiting treatment options and reducing survival outcomes. “Primary health care providers are often the first point of contact for women with breast symptoms,” said Dr Benido Impouma, Director of the Health Promotion, Disease Prevention and Control Cluster at WHO Regional Office for Africa. He explained that strengthening frontline health workers’ ability to recognize warning signs, conduct clinical assessments, provide counselling and facilitate referrals is essential to reducing diagnostic delays.
The manual places particular emphasis on the early diagnosis of women with symptoms, especially in resource-constrained settings where health systems may not yet be equipped to implement organized, population-based mammography screening programmes. It provides step-by-step guidance on clinical breast assessments, identifying suspicious findings, promoting breast self-awareness, counselling patients and navigating referrals for imaging, pathology and treatment.
According to the guidance, delays of six months or longer between the emergence of symptoms and access to appropriate care remain common in many African settings. Such delays can contribute to advanced-stage disease and preventable deaths. The manual also highlights the role of primary health care facilities in promoting breast health, initiating referrals and ensuring that patients are not lost to follow-up.
WHO said the publication supports the three pillars of the GBCI: health promotion for early detection, timely diagnosis and comprehensive breast cancer management. Strengthening primary health care systems can help countries improve patient navigation, expand access to diagnostic services and provide continued support to women throughout treatment and survivorship.
The guidance also emphasizes patient navigation, a personalized approach designed to help women overcome barriers including fear, stigma, geographical distance, financial constraints and fragmented health services. Primary health care workers are encouraged to facilitate referrals, coordinate care, follow up on missed appointments and connect patients with psychosocial and practical support.
WHO called on member states, health managers, training institutions and development partners to adapt and implement the guidance, strengthen the skills of primary health care workers, establish clear referral pathways and improve links between primary care, diagnostic facilities and treatment services. “Strengthening breast cancer services at the primary health care level will reduce preventable deaths, advance health equity and accelerate progress towards universal health coverage,” Impouma added.