Mr. Henry Gray:

I thank the joint committee for this opportunity, which is greatly appreciated by Médecins sans Frontières. I hope the information we share with the committee will enhance its understanding of the difficult challenges that lie ahead in these two contexts.

I will begin by speaking about the Lake Chad crisis as it affects Borno state. Borno state is not a small dusty part of northern Nigeria. It is approximately the same size as the Republic of Ireland. Its population of 6 million is slightly bigger than the population of this country. It is a large part of Nigeria. It is poor and has a history of turmoil and poverty. The long-running political crisis in this part of Nigeria has been driven through a kind of disenfranchising of the north from the south. In recent years, this has been exacerbated by the ongoing conflict with the Boko Haram group, which has led to chronic food insecurity across the State and chronic insecurity in general. Data is very weak in Borno. We do not know exactly what is going on across the state because very little of this huge landmass is accessible. While we are able to access 15 or 20 towns within Borno state, there are huge blackspots where we have no idea what is going on. This is giving us cause for concern. We simply do not have enough data on more than a third of the population to be sure of their condition. When we are able to reach new areas or new populations, we often find that people are in extremely bad shape. We have new arrivals with severe malnutrition. We find among certain age groups that huge tranches of people, including children and elderly people, have been lost through death and disease. We are missing people.

There has been an improvement in the situation in recent months. This fragile gain is associated with the end of the growing season, when more food is available and arrives into some urban centres. While circumstances have improved as a result of the work of non-governmental organisations and UN agencies, we are approaching a very critical period because the hunger gap is arriving. Every year, there is a period when not as much food is available because the supply of food starts to dry up naturally. We expect to see more and more cases of severe malnutrition in the centres we operate from the end of April, through May and into June. The hunger gap will have potentially huge impacts towards the final quarter of the year.

I am aware that the Irish Government made a generous pledge at the Oslo conference in February in respect of the Lake Chad crisis. Representatives of MSF and I are not here to ask for money, which is refreshing for us and possibly the committee. However, we would like the Irish Government to use its influence to chase up other donors at the conference that pledged to give money. A huge amount of money was pledged but many have not yet delivered. We ask the Irish Government to use its influence to follow up on the pledges made in order that UN agencies and other NGOs will be able to access the money.

Our principal challenges are security and access. Boko Haram is not particularly supportive of activities carried out by NGOs, the United Nations or the Nigerian Government. The Nigerian Government also presents a challenge as it is not facilitating access to all areas which we should be able to reach. The lack of access leads to a lack of data which also leads to our missing potentially vulnerable groups. A small town in the region has a population of 100,000 people. Maiduguri, the state capital, has a population twice that of Dublin. These are not small places.

We understand the focus is on food and security and the word "famine" has been used. We have seen severe malnutrition across the regions. However, we also ask the Irish Government not to forget that there are other activities which are ongoing and need to be carried on. They include the prevention of meningitis, measles and malaria, three key diseases which affect people who are even mildly malnourished. If these activities are not carried on and supported, we will just be moving people who will die from measles or meningitis instead of malnutrition. This is not a funding issue of robbing Peter to pay Paul. Both need to be paid. There is an additional ask. There is an additional need to provide aid for the people of Borno.

The final point I wish to make which may be influenced at state level is that there are worrying humanitarian red flags. The Nigerian authorities are keen to return to normality where everyone lives in his or her local government area. That is the most worrying red flag. Approximately one third of the population are displaced within the state, while approximately 1 million are living in the state capital who should not be. The state authorities would like to move people back to from where they came. We are extremely concerned that forced relocation from urban centres back to rural areas or local government areas would increase humanitarian needs because those who require assistance are being forced into places where we do not have access. We do not want people to be forced to leave centres where organisations such as MSF and Oxfam are looking after them. We do not want them to be moved to the middle of nowhere where we do not have access or the necessary security guarantees to operate with a minimum degree of safety.

South Sudan is another country that has been flagged as being at risk of famine. It has a short but unfortunate history. It has been independent for nearly six years, but it has not seen more than six months of peace in that entire time.

As in the case of Borno, food insecurity and the potential for famine are created by political fighting among the political elite in Juba which has been inflamed and fed fuel to the ethnic fire. Ethnic groups inside Sudan which have never really got on are now standing toe to toe, with disastrous consequences for local populations. Civilians are not respected. The warring parties - the belligerents - have no respect for the sanctity of human life or even the basic right to live a peaceful life. This has meant that huge swathes of South Sudan have become inaccessible for humanitarian groups such as MSF and the UN agencies. This again has led to a paucity of good solid data to give us a clear picture of how bad the position is. What is sure is that it is bad, but it has been bad for years. We again ask that the focus not solely be on malnutrition, food insecurity or famine but that we continue to support the preventive strategies to provide for immunisation against epidemics, the provision of mosquito nets and such basic things to keep people alive. We also ask that the Government of South Sudan be taken to account. Without a political settlement, we will continue to save a life every day in South Sudan. However, rather than saving it once and having peace for six months, we will save that life the following week and subsequent weeks. There is no gain from the work we are doing. We are doing huge work at a considerable cost and risk to our people, but there is a need for a step change and a shift in the politics of South Sudan if we are to make progress.

To be frank, this is MSF's largest mission. We have 17 projects ongoing in South Sudan. There are well over 150 international staff, as well as a huge budget, but we do not see anything getting much better. We are not in the business of development. We are there to provide a humanitarian and an emergency response, in particular, but this is just an emergency on an emergency and nothing seems to get better. In terms of providing assistance in breaking the political impasse in South Sudan, I wish the Irish Government luck first because I do not believe this is a simple task. However, without it, someone from MSF, Oxfam or any major NGO that committee members wish to name will sit here every year or two years or as often as he or she is invited to tell the committee about the state of South Sudan. I will hand over to Ms Conway who is just back from a mission there, where she was working as a midwife. She will give the committee a short testimony.