Free operations give hope to children with a neglected but deadly disease in Africa

SOKOTO, Nigeria (AP) — 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.

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 improving nutrition. But once the disease worsens, surgery is required.

In Nigeria, health workers are seeing more noma patients. Doctors Without Borders, the humanitarian organization known by its French abbreviation MSF, is carrying out multi-stage operations free of charge as part of its mandate to tackle neglected diseases.

Parents say the operations have given their children another chance to live a normal life, a relief for many in one of the world's poorest regions.

“I was very excited because I thought there was no solution to the disease,” said Muhammad Dalhatu, Ibrahim's father, an Islamic teacher married to a retail trader. “Before, I was worried about the cost of the treatment, but when I was told it was free of charge, I was so happy.”

Noma is classified by the World Health Organization 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.

While it is hard to track how common the disease is in different countries, a so-called “noma belt” stretches across Africa, from Senegal and Mauritania in the west to Ethiopia in the east.

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.”

But 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.

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.

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 comments 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 stigmatization, 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.

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Hussaina Alhassan, right, who underwent facial reconstructive surgery to help her recover from noma disease, is photographed at the Noma Children Hospital in Sokoto, northern Nigeria, Thursday, Sept. 3, 2026. (AP Photo/Ifeanyi Emmanuel)

A general view of the Noma Children Hospital in Sokoto, northwest Nigeria, Thursday, Sept. 3, 2026. (AP Photo/Ifeanyi Emmanuel)

Husaiba Shehu, who underwent facial reconstructive surgery to help her recover from noma disease, is photographed at the Noma Children Hospital in Sokoto, northwest Nigeria, Thursday, Sept. 3, 2026. (AP Photo/Ifeanyi Emmanuel)

Hajira Sahabi, 2nd left, and other children who underwent facial reconstructive surgery to help them recover from noma disease, sit with relatives at the Noma Children Hospital in Sokoto, northwest Nigeria, Thursday, Sept. 3, 2026. (AP Photo/Ifeanyi Emmanuel)

Hajira Sahabi, who underwent facial reconstructive surgery to help her recover from noma disease, poses at the Noma Children Hospital in Sokoto, northwest Nigeria, Thursday, Sept. 3, 2026. (AP Photo/Ifeanyi Emmanuel)

INGLEWOOD, Calif. (AP) — If there were a list of most important New York Giants, seemingly all those key players got hurt at some point during a 28-6 loss to the Los Angeles Rams on Monday night, starting with quarterback Jaxson Dart injuring his left knee during his team’s first series.

Coach John Harbaugh would not confirm reports that Dart sprained his MCL, choosing to wait for further testing.

“That's in the neighborhood of it, I would say,” Harbaugh said. “We'll get an MRI (on Tuesday) and have a real good feel for it, and give you more information from there.”

The Giants also saw top pass rusher Brian Burns sprain his left ankle and left tackle Andrew Thomas sustain an apparent lower-body injury in the fourth quarter. Wide receiver Malik Nabers had to pop his right shoulder back into place after dislocating it on the second-to-last play of the first quarter.

“But that's just part of football,” Burns said. “Guys go down every day, and it’s always next guy up. That’s why you try to develop a culture where you don’t slack off in production with the guys that’s behind.”

Even with that mentality, the Giants were never able to get back on track after Dart was hurt less than four minutes into the game while being pressured on third-and-8. Rams linebacker Byron Young hit Dart from the quarterback's right side, sending him into linebacker Josaiah Stewart, who undercut Dart's legs, resulting in a hard fall. Dart was eventually able to walk gingerly to the sideline under his own power, and he went into the medical tent for further evaluation before walking to the locker room.

Jameis Winston replaced Dart on the ensuing Giants drive.

Dart, who was 3-of-5 passing for 20 yards, spent the second half on the sideline in street clothes.

“Any time your quarterback goes down, obviously that's a gut punch to the team, right?” said Winston, who was 11 of 27 for 111 yards with one interception.

The body blows kept on coming.

Nabers was injured jockeying with Rams cornerback Trent McDuffie when he was targeted on a first-down pass. Nabers immediately grabbed his right shoulder and ran to the sideline, where he was clearly in pain. He was able to return on the next series, finishing with one reception for 1 yard on four targets, while clearly laboring at times.

“Nah, I ain't gonna make no excuse for anything that happened in the game,” said Nabers, who indicated he would undergo X-rays on Tuesday. “Yeah, I'm battling through injuries, but it doesn't make a difference on how the performance was.”

Burns got stepped on by Rams center Coleman Shelton but shook off a cart ride back to the locker room when the game ended. He would not speculate on his chances of playing against the Tennessee Titans on Sunday.

“I've dealt with this,” Burns said. “It just depends on how fast you can get the swelling and inflammation out. So I'm just going to do everything possible to get it as tamed as I can.”

The Giants had to navigate the absences of many of these same players last season. Dart sustained a concussion in Week 10 against the Bears during his rookie campaign, and Nabers missed most of the year with a torn ACL in his right knee.

But the enthusiasm of Harbaugh's victorious debut against the Cowboys now gives way to the likelihood Winston will be running New York's offense for the near future. An 11-year veteran who was drafted first overall in 2015, Winston started two games and appeared in three for the Giants in 2025, throwing for 567 yards with two touchdowns and two interceptions.

Harbaugh said the Giants can't get discouraged by their change in fortune.

“All around the league, everybody deals with it,” he said. “This is football. This is the NFL. This is what you do. So our task is not to lament it.”

See AP’s full NFL coverage here

New York Giants quarterback Jaxson Dart, center, watches from the sideline during the second half of an NFL football game against the Los Angeles Rams in Inglewood, Calif., Monday, Sept. 21, 2026. (AP Photo/Caroline Brehman)

New York Giants quarterback Jaxson Dart, left, walks off the field with linebacker Abdul Carter (3) after an NFL football game against the Los Angeles Rams in Inglewood, Calif., Monday, Sept. 21, 2026. (AP Photo/Caroline Brehman)

New York Giants quarterback Jaxson Dart, left, walks off the field with wide receiver Malik Nabers (1) after an NFL football game against the Los Angeles Rams in Inglewood, Calif., Monday, Sept. 21, 2026. (AP Photo/Caroline Brehman)

New York Giants quarterback Jaxson Dart (6) walks off the field with an injury during the first half of an NFL football game against the Los Angeles Rams in Inglewood, Calif., Monday, Sept. 21, 2026. (AP Photo/Caroline Brehman)

New York Giants quarterback Jaxson Dart (6) throws under pressure from Los Angeles Rams linebacker Byron Young during the first half of an NFL football game in Inglewood, Calif., Monday, Sept. 21, 2026. (AP Photo/Katie Chin)

New York Giants quarterback Jaxson Dart (6) walks off the field with an injury during the first half of an NFL football game against the Los Angeles Rams in Inglewood, Calif., Monday, Sept. 21, 2026. (AP Photo/Caroline Brehman)