Over 25 million people across Sudan face a humanitarian crisis, while in northern Nigeria, children as young as three years old are fighting for their lives against noma, a disfiguring and often fatal disease that thrives in conditions of extreme poverty. These crises underscore a broader failure: nearly 178,600 women died from pregnancy and childbirth-related causes in African Union member states in 2023, accounting for 69 percent of the estimated 260,000 maternal deaths worldwide that year.
As world leaders gather for the 81st session of the United Nations General Assembly, African health officials are pressing for faster progress on maternal and child survival, stronger primary care systems, and recognition that these deaths aren't inevitable. They're preventable.
A Disease Born of Poverty
Ibrahim Dalhatu was just three when noma struck. The rapidly progressing infection destroys facial tissues and bones, killing most children it infects. He's now eight years old and has undergone six operations at the Noma Children Hospital in Nigeria's Sokoto state since his first reconstructive surgery five years ago. His father, Muhammad Dalhatu, an Islamic teacher, said he was relieved when he learned the treatment would be free. "Before, I was worried about the cost of the treatment, but when I was told it was free of charge, I was so happy."
Doctors Without Borders, known by its French abbreviation MSF, performs these multi-stage operations at no cost. But the disease shouldn't exist at all. The World Health Organization classifies noma as a neglected tropical disease and calls it "a marker of absolute poverty." The United Nations Human Rights Council goes further, stating that the conditions leading to noma constitute a human rights violation for affected children.
Noma begins with gum inflammation in malnourished children living in polluted environments and quickly spreads. It mostly affects 2- to 6-year-old children in poor communities. Early-stage treatment includes antibiotics, wound care and improved nutrition, but once the disease worsens, surgery is required. WHO hasn't updated its data on noma since 1998, when it estimated 140,000 cases per year with a 90 percent fatality rate. A study published two months ago 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.
Yuka Makino, a technical officer for oral health at WHO's Africa office, said research has shown that noma can be caused by 117 different microorganisms, calling it "an opportunistic, polymicrobial infection." The major risk factors are extreme poverty and severe malnutrition.
Too Few Hospitals, Too Many Children Waiting
In northern Nigeria, ravaged by armed violence and economic hardship, more children are being diagnosed with noma. Many arrive late for treatment due to lack of awareness and the disease's deadly speed. "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.
Nigeria has only two noma hospitals, including one in Abuja built three years ago. Within the last three years, more than 500 children with noma from across northern Nigeria were treated at the specialist hospital in Sokoto, according to data seen by the AP. Others are waiting for surgery at the three sessions MSF runs each year for 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."
Maryam Sabiu's 4-year-old son, infected with noma in 2024, is on the waiting list. The disease has created a hole in his left cheek, extending toward his left eye, but he's too young for surgery. He cries constantly from pain. His mother breastfeeds him frequently to soothe him. "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.
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.
Maternal Deaths: Progress Too Slow
African Union member states also account for an estimated 1.18 million newborn deaths every year, over half, about 51 percent, of the global total. 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 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 14 days ago. 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 percent 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. 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 percent of maternal deaths in Africa. Central Africa records 439 deaths per 100,000, East Africa 260, Southern Africa 162 and North Africa 50.
System Failures, Not Medical Mysteries
Africa CDC's assessment 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 percent.
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 percent, of the global total. WHO says skilled care before, during and after childbirth can save the lives of women and newborns.
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 percent 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.
Countries Taking Action
Africa CDC argues that the continent's challenge isn't 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.
Kenya launched its Every Woman Every Newborn Everywhere Acceleration Plan for the current plan period of 2026–2028, targeting preventable maternal and newborn deaths in 26 high-burden counties. The Government says it's 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.
Strengthening Primary Care for Breast Cancer
The World Health Organization Regional Office for Africa has also launched a new manual this month 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.
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 percent 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.
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 aren't lost to follow-up.
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.
Why This Matters:
These aren't natural disasters. They're failures of investment, infrastructure and political will. When nearly 180,000 African women die from preventable pregnancy complications in a single year, and children contract a disease that WHO calls "a marker of absolute poverty," the problem isn't medical knowledge. It's resource allocation. Countries like Rwanda and Tanzania have shown that improvements in referral systems, financing and quality of care can reduce maternal deaths. Kenya's investment of Sh12.5 billion in maternal and newborn health, including recruitment of 5,000 nurses, demonstrates what's possible when governments prioritize primary care. The fact that 58 to 96 percent of maternal deaths in some countries were deemed avoidable reveals a system failure, not a medical mystery. Strengthening primary health care, ensuring skilled birth attendants, maintaining essential medicine supplies, and building functional referral systems are proven interventions. The question isn't what works. It's whether governments and international partners will commit the resources and political capital to make it happen before 2030.