"Being a woman in the world is not easy. In Nigeria..." Isabelle Mouniaman, Medecins Sans Frontieres Deputy Operational Director, shakes her head, "I think there is no word to describe what has been going on there for years."
The Parisian has just visited Borno State, where she witnessed Nigeria's civil war-induced humanitarian crisis up close. From the comfort of a Glebe cafe, she lists the horrors faced by women in the Boko Haram-ravaged northeast corner of the African country, where the jihadist group has been fighting the Nigerian government since 2009.
"You've been displaced, you've lost your husband, your brother, your cousin; you ended up with four, five, six kids, probably none of them are yours because you lost them on the journey," says MSF's head of operations in Nigeria, "you're living under a tent in high temperatures with nothing to eat or you have to share everything. Then your kids are not vaccinated so they are dying of measles, then there is the malaria outbreak coming, pneumonia, diarrhoea, and they are weakened by malnutrition. And they are traumatised."
On a rare visit to Sydney, she paints a sad, quietly disintegrating image of Borno.
"It's a forgotten crisis", she says, after watching interest in Boko Haram wane since over 200 schoolgirls were kidnapped in Chibok in 2014. "Today no one is very interested in the situation."
The state capital, Maiduguri, is a former commercial hub with pockets of normality. There are playgrounds, the odd school, parks, hospitals, four-lane roads and marketplaces. It is also home to 1.2 million internally displaced people who, doubling its population, have arrived in the state capital with nothing, often after many months of walking and surviving on very little food or shelter.
Hundreds of thousands of men have disappeared, presumed dead. Babies and children under five are all but absent, succumbed to the long journeys of escape.
As survivors, women and children bear the brunt of the crisis. Mouniaman met women who took eight months to creep in hiding from Baga, close to the shores of the ever-shrinking Lake Chad, to Maiduguri. By car, the journey takes around three hours.
Once they do make it to the city, the picture barely improves. Women who have come from formerly Boko Haram-controlled Bama are treated suspiciously for fear of sympathising with terrorists.
Mouniaman describes the heads of household who lead the new arrivals, often just 16- or 17-year-old girls who attempt to care for up to about 15 family members.
"She would have walked days, weeks, even months; she would have lost some of her youngest children, she would have taken some of the children of her sisters, cousins, relatives; she could have been abused and then struggling to cope in a makeshift shelter with no food, no water, nothing," she says.
Those who make it into one of the MSF-supported 11 aid camps in Maiduguri, which shelter just 10 per cent of the displaced population, are given about 35kg of millet, beans and oil per household, per month. The worse cases of malnutrition - which rate way above the charity's usual threshold emergency levels - are admitted directly to therapeutic feeding centres, where the sickest children are given the nutrients needed to save their lives, then funnelled into ambulatory feeding centres, more of which are urgently needed.
Where MSF succeeds to intervene, the results are good. In some camps, acute malnutrition as high as 19 per cent in July, today sits at around 2 per cent. How to multiply that help to over a million people, however, is the challenge for those who manage what Mouniaman already calls "a massive intervention."
So severe and wide-ranging are Nigeria's medical and social emergencies, it is one of the few places on earth that is receiving the attention of all five of MSF's international sections.
In the southern river states, the charity's focus is on sexual violence, directed at girls and women - 40 per cent of whom are under 12 years of age - from men within their communities.
In Jigawa, to the west of Borno, MSF targets women's health, where emergency obstetrics and fistula programs are attempting to reduce the rates of complications associated with first pregnancies at very young ages. Many of its midwives are Australian and a dozen Australian staff are currently working with the charity in the country.
Right now, MSF and Nigeria need volunteers, donations - and a large-scale miracle.
"I can't see any positive outcome from this. Next year is going to be the same, could be worse," Mouniaman says, predicting that, as more remote areas of Borno gradually become accessible, a fuller picture of the true severity of the crisis will emerge.
"We don't know what we will find there."
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