Nigerian military ran secret mass abortion programme in war against Boko Haram

Since at least 2013, the Nigerian military has conducted a secret, systematic and illegal abortion programme in the country’s northeast, ending at least 10,000 pregnancies among women and girls, a Reuters investigation has found. Many had been kidnapped and raped by Islamist militants. Resisters were beaten, held at gunpoint or drugged into compliance, witnesses say.

Nigerian soldiers surrounded the Lake Chad island village where Islamist insurgents held her and many other women captive. Shells exploded. Bullets whipped by. As her captors fled, Fati blacked out in terror.

When she awoke in a military camp nearby, “I felt the happiest I ever had in my life,” said Fati, now in her early 20s, recalling the attack that occurred several years ago in Nigeria’s northeastern Borno state. Over more than a year, she told Reuters, she had been forcibly married to insurgents, beaten and repeatedly raped – resulting in a recent pregnancy. Now, finally, she had been rescued. “I was extremely grateful to the soldiers,” she said.

About a week later, Fati said, she lay on a mat in a narrow, dim room at a military barracks in Maiduguri, the state capital. It was rank, with cockroaches skittering across the floor. Uniformed men came in and out, giving her and five other women mysterious injections and pills.

After about four hours, said Fati, who was about four months pregnant, she felt searing pain in her stomach and black blood seeped out of her. The other women were bleeding as well, and writhing on the floor. “The soldiers want to kill us,” she thought.

REUTERS/Paul Carsten

Fati was four months pregnant when liberated from the insurgents. Soon after, she says, soldiers medically aborted the pregnancy without telling her. And she was warned: “If you share this with anyone, you will be seriously beaten.”Fati, early 20s

She recalled the injections, then understood: The soldiers had aborted their pregnancies without asking – or even telling – them.

After the women washed the blood down a squat toilet, she said, they were warned: “If you share this with anyone, you will be seriously beaten.”

Since at least 2013, the Nigerian Army has run a secret, systematic and illegal abortion programme in the country’s northeast, terminating at least 10,000 pregnancies among women and girls, many of whom had been kidnapped and raped by Islamist militants, according to dozens of witness accounts and documentation reviewed by Reuters.

The abortions mostly were carried out without the person’s consent – and often without their prior knowledge, according to the witness accounts. The women and girls ranged from a few weeks to eight months pregnant, and some were as young as 12 years old, interviews and records showed.

This investigation is based on interviews with 33 women and girls who say they underwent abortions while in the custody of the Nigerian Army. Just one said she freely gave consent. Reporters also interviewed five civilian healthcare workers and nine security personnel involved in the programme, including soldiers and other government employees such as armed guards engaged in escorting pregnant women to abortion sites. In addition, Reuters reviewed copies of military documents and civilian hospital records describing or tallying thousands of abortion procedures.

Portraits of some of the sources for this investigation. Some faces have been digitally masked to safeguard source identities. Reporters interviewed 33 women and girls who say they underwent abortions while held by the Nigerian Army. Reuters also interviewed five civilian healthcare workers and nine security personnel involved in the secret abortion programme, including soldiers and other government employees. REUTERS/Christophe Van Der Perre and Paul Carsten

The existence of the army-run abortion programme hasn’t been previously reported. The campaign relied on deception and physical force against women who were kept in military custody for days or weeks. Three soldiers and a guard said they commonly assured women, who often were debilitated from captivity in the bush, that the pills and injections given to them were to restore their health and fight diseases such as malaria. In some instances, women who resisted were beaten, caned, held at gunpoint or drugged into compliance. Others were tied or pinned down, as abortion drugs were inserted inside them, said a guard and a health worker.

Bintu Ibrahim, now in her late 20s, recounted how soldiers gave her two injections without her consent after picking her up with a group of other women who fled the insurgents about three years ago. When the blood came, and the terrifying pain, she knew she and the others had been given abortions. The women protested and demanded to know why, she said, until the soldiers threatened to kill them.

“If they had left me with the baby, I would have wanted it,” said Ibrahim, whose account was confirmed by a fellow former captive, Yagana Bukar.

At military facilities and in the field, some abortions proved fatal. Although Reuters could not determine the full scope of the deaths in nearly 10 years of the programme, four soldiers and two security officers said they witnessed women die from abortions, or saw their corpses afterward.

Ibrahim said she also witnessed a woman die after an injection at the time of her own abortion near a small village in the bush – an event corroborated by her companion Bukar.

“That woman was more pregnant than the rest of us, almost six or seven months,” Ibrahim said. “She was crying, yelling, rolling around, and at long last she stopped rolling and shouting. She became so weak and traumatised, and then she stopped breathing.

“They just dug a hole, and they put sand over it and buried her.”

Reuters was unable to establish who created the abortion programme or determine who in the military or government ran it.

Nigerian military leaders denied the programme has ever existed and said Reuters reporting was part of a foreign effort to undermine the country’s fight against the insurgents.

“Not in Nigeria, not in Nigeria,” said Major General Christopher Musa, who heads the military’s counterinsurgency campaign in the northeast, in a Nov. 24 interview with Reuters that addressed the abortion programme. “Everybody respects life. We respect families. We respect women and children. We respect every living soul.”

General Lucky Irabor, Nigeria’s chief of defence staff, did not respond to requests for comment from Reuters. On Dec. 2, a week after Reuters sought an interview with Irabor and shared detailed findings and questions with his office, the military’s director of defence information released a five-page statement to reporters , and later posted it on Facebook and Twitter. Major General Jimmy Akpor said Reuters was motivated by “wickedness” and a “bullying” mentality, according to the statement.

“The fictitious series of stories actually constitute a body of insults on the Nigerian peoples and culture,” Akpor added. “Nigerian military personnel have been raised, bred and further trained to protect lives, even at their own risk, especially when it concerns the lives of children, women and the elderly.”

The scene of a blast that police said took at least 21 lives in the capital of Abuja in June 2014. No one claimed responsibility for the attack, which came as Boko Haram was increasingly targeting civilians in its insurgency. REUTERS/File photo

Women and girls are trapped in a titanic struggle in northeast Nigeria between the federal government and Islamist extremists – a war that has raged for 13 years. At least 300,000 people have died since the conflict began, some due to violence, many more from starvation and disease, according to the United Nations and human rights groups. The northeast, a region of semi-arid savannahs, thick forest and floodplains, once was known as the breadbasket of the nation. But in the course of the war it has collapsed into economic devastation and widespread hunger, creating massive displacement and what the U.N. has called one of the world’s worst humanitarian crises.

Central to the abortion programme is a notion widely held within the military and among some civilians in the northeast: that the children of insurgents are predestined, by the blood in their veins, to one day take up arms against the Nigerian government and society. Four soldiers and one guard said they were told by superiors that the programme was needed to destroy insurgent fighters before they could be born.

“It’s just like sanitising the society,” said a civilian health worker, one of seven people who acknowledged performing abortions under army orders.

Four of the health workers interviewed by Reuters also said that the programme was for the good of the women and any children they might bear, who would face the stigma of being associated with an insurgent father.

The army-run abortion programme has been in place since at least 2013, and procedures were being performed through at least November of last year, according to accounts from soldiers. The enterprise has been elaborately engineered, the sources told Reuters, with pregnant former captives of insurgents transported regularly in trucks under armed guard, sometimes in convoys, to barracks or hospitals across the northeast for abortions.

The procedures have occurred in at least five military facilities and five civilian hospitals in the region, according to witness accounts and documentation reviewed by Reuters. Many occurred in Maiduguri, the largest city in Nigeria’s northeast and the command centre of the government’s war on Islamist extremists.

The Maiduguri sites include the detention centre at Giwa Barracks, where Fati said she was forced to have an abortion. Other sites include the Maimalari Barracks, which is the city’s main military base, and two civilian hospitals – State Specialist and Umaru Shehu. The two hospitals did not comment for this story.

The conflict zone

The abortion programme has taken place in the northeastern states of Yobe, Borno and Adamawa, where the Nigerian military has been fighting Islamist insurgents. The satellite image shows the location of sites in Maiduguri where abortions were performed.

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The programme is clandestine, said eight sources involved – sometimes kept secret even from colleagues in the same hospital. At certain civilian hospitals, women taken for abortions were held in separate wards from other patients or had their names entered into separate registers, some of the sources said.

Nigerian officials said that if such abuses existed, it would be impossible to hide them from the multitude of international and local aid groups, including U.N. agencies, that are engaged in humanitarian efforts in the northeast.

“Everybody has free access to what we’re doing,” said Major General Musa. “There is nothing hidden under the sun, nothing. Nobody has ever accused us of any of this. We have not done it. We will not do it. It is not in our character.”

Asked whether forced abortions could happen without the knowledge of aid groups, Matthias Schmale, the top U.N. official in Nigeria, said he was “at this moment not in a position to make public comments to the media on this sensitive and important matter.”

Aspects of the Nigerian Army’s abortion programme remain murky. Because of the secrecy involved, it is impossible to know precisely how many abortions were done. Interviews and documents suggest the count could be significantly higher than the tally of at least 10,000 cases that Reuters was able to establish. Patients at times were asked if they wanted an abortion, according to some sources, but Reuters could not determine how many were given a choice.

The war effort is run by a coalition of forces led by Musa. It has been spearheaded since 2013 by the Nigerian Army’s 7 Division, a unit created under then-President Goodluck Jonathan. The division remains the main counterinsurgency force under current President Muhammadu Buhari, a former general.

A spokesperson for Jonathan told Reuters that the former president had “no knowledge of any allegation of such heinous acts” by the Nigerian Army. “To the best of his knowledge, Dr. Jonathan never read or heard about such practices of the Nigerian military or its partnership, officially or unofficially,” the spokesman said.

Reuters did not receive responses to detailed questions sent to President Buhari’s office; the Ministry of Defence; the Nigerian Army headquarters in the capital, Abuja; and 7 Division’s commander in Maiduguri.

Some of the most powerful military leaders in Nigeria oversaw counterinsurgency operations in the northeast as the abortion programme grew. Among them were the much-decorated Lieutenant General Tukur Buratai, who served as chief of army staff for nearly six years until he retired from the military in January 2021. Some of Buratai’s former subordinates in the northeast have since risen to national prominence, including defence chief Irabor; the late Ibrahim Attahiru, who briefly succeeded Buratai as army chief before a fatal plane crash in May 2021; and current army chief Faruk Yahaya.

Buratai and Yahaya did not respond to detailed requests for comment.

Waging war on Boko Haram

The abortion programme began during the presidency of Jonathan. It continued under Buhari. Buratai led the army for nearly six years. An ex-subordinate, Irabor, is now defence chief. Boko Haram splintered and was overtaken by Islamic State’s local branch. Many Nigerians still refer to both groups as Boko Haram.

Soldiers said orders came from direct superiors on how to run and tally abortion transports, how to keep the programme under wraps and where to bury any casualties. Health workers at civilian hospitals said their orders to perform abortions came from army officers.

Abortion is widely frowned upon in culturally conservative Nigeria, in both the Christian-dominated south and in the majority-Muslim north. It is also illegal except to save the life of the mother. In the north, any person found guilty of participating in an abortion, including the woman, can be charged with a felony and given up to 14 years in prison, and potentially a fine. Causing a woman’s death by performing an abortion without her consent is also punishable by life in prison in the north. Reuters could not determine how frequently abortions result in criminal prosecution.

Forced abortions may also violate the Nigerian military’s code of conduct. The most recent version publicly available, issued in 1967, states that “under no circumstances should pregnant women be ill-treated or killed.”

In his statement, Major General Akpor said the Nigerian military has rules of engagement and other guidelines that protect civilians, and thus would never “contemplate such evil of running a systematic and illegal abortion programme anywhere and anytime, and surely not on our own soil.”

Forced abortions may amount to war crimes and crimes against humanity, according to four legal experts briefed by Reuters on its findings. Although forced abortions are not specifically criminalised under the Rome Statute of the International Criminal Court, the experts said, they could be construed as torture or other inhumane treatment and be prosecuted as such.

A soldier who escorted women to abortion sites explains what happened after they were rescued from insurgents and the rationale behind the abortion programme. Reuters used voice-over for the people interviewed on-camera for this story to protect their identities. REUTERS/Christophe Van Der Perre

Melanie O’Brien, an associate professor of international law at the University of Western Australia, called the potential crimes “extremely grave,” citing the vulnerability of the women and the young age of the victims as possible aggravating factors.

“If these numbers are accurate, it’s horrific, really horrific,” she said.

Under a principle in international law called “command responsibility,” Nigeria’s top military commanders could be held accountable for crimes by troops under their supervision, even if the soldiers weren’t acting on orders, O’Brien said.

Nearly all sources for this story said they spoke to Reuters at their peril. All the health workers, soldiers and guards spoke on condition of anonymity. Reuters is not identifying some alleged abortion sites to protect sources’ identities. Fati and most of the other women who underwent abortions asked not to be fully named, for fear of reprisals from the army or ostracism for their association with insurgents, however involuntary. Ibrahim and Bukar said they agreed to speak using their full names, despite receiving death threats from soldiers, because they now live outside the country.

“I wouldn’t wish this to happen to any person, any woman in the world,” Ibrahim said.

Nigerian soldiers hold a Boko Haram flag seized in the retaken town of Damasak in March 2015. That month, shortly before a presidential election, the army said it had secured most of the northeast – one of many premature declarations of victory. REUTERS/File photo

A war without end

Two decades ago, an Islamist fundamentalist movement, Boko Haram, was born in Nigeria’s northeast. In 2009, the killing of its founder, Mohammed Yusuf, by Nigerian police spurred its transformation into an armed insurgency. The rebellion grew in strength under the fanatical leadership of Yusuf’s protégé, Abubakar Shekau.

The Nigerian Army took over the fight against Boko Haram from a task force of security agencies in 2013. The army’s new 7 Division soon faced chaos: Three division commanders left within a year, and soldiers repeatedly mutinied over poor conditions. In 2015, Amnesty International accused the military of extrajudicial killings, torture and enforced disappearances in the conflict.

The Nigerian government ultimately issued a report on Amnesty’s allegations, saying there was insufficient evidence to support any abuses by its officers.

The International Criminal Court’s prosecutor found in 2020 that grounds existed to investigate possible war crimes and crimes against humanity by both Nigerian security forces and insurgents. But the court has not opened a probe.

The ICC’s Office of the Prosecutor declined to comment on Reuters’ findings.

Boko Haram gained global notoriety in 2014 for the abduction of 276 secondary schoolgirls in the town of Chibok, a raid that prompted the #BringBackOurGirls campaign. By late 2014, Boko Haram had pushed government forces out of many major towns across the states of Borno, Adamawa and Yobe.

As of 2016, the military had retaken many of the towns, but fighting continued in the countryside. That year, Boko Haram split, partly over Shekau’s wanton killing – even of Muslims he deemed insufficiently zealous.

The main splinter group became the recognised regional branch of Islamic State, branded Islamic State West Africa Province (ISWAP). It is now the dominant insurgent faction. Still, many Nigerian soldiers and civilians, including those in this report, refer to both groups as Boko Haram.

     Boko Haram’s abduction of 276 schoolgirls in 2014 from the northeastern town of Chibok shocked the world. That April, protestors in Abuja demanded security forces search harder for the victims. REUTERS/File photo

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    The Nigerian government has repeatedly declared victory only to see the militants continue their attacks. Tens of thousands of women and children have been sucked into the conflict, with some recruited into the insurgency’s ranks and others forced to become fighters and suicide bombers, according to human rights groups and scholars. The insurgents also have forced women and girls into sexual slavery, marriage and bearing their children, the sources say.

    Reuters could not reach leaders or representatives of Boko Haram or ISWAP for comment for this story. In June, Islamic State released a video that celebrated ISWAP’s operations and called on Muslims to travel to Nigeria to wage war until “sharia-based governance” is achieved.

    No precise tallies exist for how many people have been kidnapped by insurgents or escaped from them. In February 2021, the Nigerian government issued a report that said “tens of thousands of hostages have been freed.” The International Committee of the Red Cross told Reuters in August it had registered more than 25,000 people as missing in Nigeria, almost all as a result of the war in the northeast, adding that the tally was “only the tip of the iceberg.”

    For many women, liberation from captivity hasn’t brought salvation. Even after being freed, they live under a cloud of suspicion, according to soldiers, guards and former captives. They are frequently viewed by the military and their own communities as defiled by their association with militants, the more so if they carry children seen as destined by blood to continue the insurgency.

    Akpor and Musa disputed the idea that former captives are viewed in this way by authorities, citing the government’s and the military’s care of family members of recently surrendered insurgents. Thousands of such fighters, along with their wives and children, have turned themselves in since Shekau’s death in May 2021. The generals said the Borno state government has been sheltering and providing for the new arrivals – among them pregnant women – in camps.

    “The children were neither aborted nor yanked from their mothers and killed,” Akpor said.

    Vehicles transporting women and children rescued by the Nigerian military from Boko Haram arrive at an internally displaced people’s camp in Yola, Adamawa State, in 2015. REUTERS /File photo

    Dubious rescues

    For Fati, who haltingly told her story to Reuters in interviews over more than a year, the war began one night about five years ago, when militants invaded her hometown of Monguno.

    Tearing through Nigerian Army defences that night, the insurgents rampaged through the streets, gunning down soldiers and terrified residents. Amid the chaos, Fati said she and her family were split up. Barefoot and wearing only a robe, she fell in with a group of fleeing women, ducking into darkened streets and alleyways at the slightest sound or sight of danger.

    On the fringes of town, Islamist insurgents were waiting. Fati was captured, whipped and shunted into one of two pickup trucks with the other women, she said. They drove through the night to the shores of the vast Lake Chad, where fighters loaded the women into canoes. As the sun rose, the captives were ferried out toward the lake’s myriad islands.

    “We couldn’t jump,” Fati said, because none of the women could swim. “We were all just crying.”

    Trapped by the militants in a village of thatch and mud huts, Fati said she was married off three times, forced to take a new husband whenever the previous one didn’t return from the war. The third, who impregnated her, “was the worst out of all of them,” she said. “He would hit me with the butt of his gun … He would beat me until I was sick.”

    When the Nigerian soldiers came that day about three years ago, she welcomed them.

    After arriving in Maiduguri, soldiers took her and other women to a local hospital, where they were told to urinate in bottles, she said. A day later, at Giwa Barracks, uniformed people she took to be military doctors injected her and five others with something in their arms and their backsides.

    “They just said we were not healthy enough,” Fati said. After about four hours, she started to feel intense stomach pains. Then came the bleeding. Soon, she said, “all six of us were writhing in pain on the floor.”

    Afterward, she said, none of the staff mentioned the abortion to her.

    Reuters could not confirm all the details of Fati’s account. But other residents said insurgents launched repeated attacks on Monguno around that time. In addition, Fati’s sister told Reuters that she described the abortion at Giwa Barracks to her when they were reunited. Fati, who struggled at times to recall the timing of traumatic events, gave varying dates of her abduction and abortion. Her sister said Fati was kidnapped by Boko Haram between 2017 and 2018. Fati said she was held for more than a year before being rescued.

    Two young women, Felerin and Aisha, described undergoing abortions after being taken into custody by the Nigerian military. REUTERS/Paul Carsten and Christophe Van Der Perre

    Other women interviewed by Reuters offered similar accounts of captivity and rescue – including being raped by insurgents and escaping with the help of soldiers who took them into custody and transported them under armed guard to military facilities or civilian hospitals. Many said they were made to give urine or blood samples before receiving unspecified injections and pills.

    Six soldiers and guards confirmed that forced abortions took place at Giwa Barracks. Two of those witnesses, as well as a woman who said she had an abortion last year at the detention centre, also recalled a room where the terminations were performed that matched Fati’s description: a foetid, grey-walled space like a hallway, where women lay on floor mats amid cockroaches and mosquitos.

    The site has come under scrutiny before: In 2016, Amnesty International cited Giwa’s detention centre for “horrendous conditions” that it said led to the deaths of 149 detainees. In 2018, the group alleged that hundreds of women who fled or were rescued from areas controlled by Boko Haram during counterinsurgency operations had been arbitrarily detained at Giwa Barracks, including five who died. Neither report made reference to abortions.

    After Amnesty’s 2018 publication, Nigeria’s military accused the rights watchdog of “cooking reports from time to time to demoralise the entire military system and the nation as a whole.”

    In interviews, soldiers and women described conditions in military encampments or facilities as squalid: Pregnant women sometimes were kept outside in tents or under tarps during their abortions, where they bled into the dirt.

    Some women later told Reuters that had they been asked, they would have kept the babies. Despite the father’s brutality, “that child had done nothing wrong,” said Bintu Ibrahim.

    Eight others, including Fati, said they had not wanted to give birth. But several said they resented being tricked or forced into a frightening and potentially dangerous abortion.

    “They should ask for women’s opinions,” Fati said.

    In this photo distributed by the Nigerian military, an officer talks with women and children freed from Boko Haram in April 2015. REUTERS /Nigerian Military/Handout via Reuters

    Deception and death threats

    Most of the women Reuters interviewed said they were given no explanation for the injections and pills they received. Others, like Fati, said medics and soldiers passed off injections and pills as cures for weakness or disease.

    In reality, the medications were intended to terminate their pregnancies, according to documentation from hospitals and military facilities.

    Nigerian facilities often used misoprostol, which helps induce labour or contractions, according to the documentation reviewed by Reuters. The drug is also used to treat ulcers and post-partum hemorrhaging, and is widely available in Nigerian cities, including through unofficial abortion-drug distribution networks. Women sometimes were also given the progesterone-blocker called mifepristone, which in many countries is used in conjunction with misoprostol in medication abortions.

    Also given was the drug oxytocin, which is widely used during labour to stimulate contractions and safe to use when under medical supervision. Though experts say it is not recommended for abortions, it was sometimes given at military bases to trigger terminations, said two soldiers who performed the procedures.

    Using oxytocin to induce abortion is dangerous, several international medical experts told Reuters, particularly if it is injected intramuscularly, as soldiers involved in the Nigerian programme said it was. If the drug is administered too quickly, the results can be fatal, the experts said.

    The medications misoprostol and mifepristone are considered safe for abortions when the standard medical protocol is used, according to the World Health Organization and other authorities.

    REUTERS/Paul Carsten

    Women and soldiers described a room in Giwa Barracks where abortions took place: a foetid, grey-walled space like a hallway, where women lay on floor mats amid cockroaches and mosquitos.

    Unhealthy or at-risk women, and those taking these drugs later in pregnancy, should be supervised, the medical experts said, because of the increased risk of developing serious complications such as uterine rupture, excessive bleeding and infection, all of which require immediate treatment.

    Surgical abortions were done as well – by manual vacuum aspiration or dilation and curettage, according to multiple sources, hospital records and military lists of abortion procedures.

    One woman rescued from an insurgent camp in 2018 said she underwent a surgical abortion without even knowing it.

    The woman described herself as eight weeks pregnant at the time. She said soldiers took her to a civilian hospital for an abortion, but she refused to undergo the procedure.

    Then the staff told her they would do some “tests,” she said. “They were just using some metal and plastic objects,” said the woman, in her mid-twenties, who spoke on condition of anonymity.

    Only later did staff tell her they’d terminated her pregnancy, she said. She was shaken, she said, because “someone can die in the process of abortion.” She ran away from the facility soon after.

    The woman’s full name appears on an excerpt of a hospital abortion register reviewed by Reuters, which confirms she had a surgical abortion and that she absconded from the facility after the procedure. A second woman confirmed the authenticity of that same excerpt, saying it contained her own name and accurately described the procedure she had.

    In all, four soldiers and guards and one healthcare worker said women were forced physically to take medication or undergo surgical abortions.

    “We do this kind of procedure to them in order to save them from the stigma or the problem that will arise in the future” with a Boko Haram child, the health worker told Reuters. If women refuse to consent, “we normally leave them restrained by tying their legs and their hands on a bed.” And if “they’re restless on the bed, so that we cannot perform our procedure, we normally give them mild sedation so they will go to sleep,” the person said.

    Some soldiers and guards said their colleagues beat women into submission.

    “Slap, cane, gun – anything they could find,” recalled one soldier, who said he witnessed such violence.

    One guard said he observed women crying out while having abortions forced on them. “There are those who are given pills,” he said. “There are those who, they open their thighs and they put something in there and twist it, like those things butchers use, like scissors, they push it inside and twist it. You’ll see her scream as they’re moving it inside of her.”

    A woman, then 24, recalled being insulted and clubbed at the time of her medication abortion at a barracks in the northeast in 2018. “One of the soldiers beat me, saying that it’s a bastard child” from “a Boko Haram pregnancy,” she said. “He hit me with a gun.”

    Her name appeared on a 2018 list, reviewed by Reuters, of patients at that location. Interviews and other military documentation indicate she was one of thousands to receive an abortion at that military base alone.

    People displaced by the insurgency board a truck in the town of Geidam to travel back to their home states in May 2015. The war between the government and Islamist extremists has raged for 13 years, leading to economic collapse and hunger in much of the northeast. REUTERS/File photo

    Keeping count

    The clandestine nature of the programme makes it impossible to determine the total number of abortions performed. Reuters’ estimate is based on interviews with soldiers, guards, health workers and women who underwent abortions, as well as patient registers and other documents.

    The tally, at least 10,000, is attested to by three sets of sources: 155 individual procedures recorded in patient registers; at least 3,900 performed over several years by a soldier at one military base; and 7,000 or more in another area described by three soldiers and one guard. Reuters rounded down the sum to 10,000 because of possible overlap in some cases.

    Copies and excerpts of five patient registers seen by Reuters provide snapshots in time at five civilian hospitals. They list the abortion procedures performed on 155 women at different points over several years. Each list was confirmed as authentic by at least one health worker and, in most cases, one or more women whose names appear on them.

    Military documentation indicates abortions were done in far larger numbers.

    At a military base outside Maiduguri, two soldiers involved in the abortion programme said staff there performed thousands of procedures between 2016 and 2020. One said he himself did approximately 3,900 abortions, a figure he said he tallied for Reuters by checking programme records. The other soldier, whose tenure overlapped with the first, said he witnessed thousands more abortions during that period – recalling an average of around five procedures daily. Reuters is withholding the name of the base to protect the identity of the sources.

    Documents reviewed by Reuters tally up 5,200 abortions performed at the base between 2017 and 2019. The figures are noted on sheets of paper that bear the military base’s letterhead and contain the signatures of two officers. The tallies were prepared for Nigerian Army headquarters in Abuja, in part to procure funding, according to the two soldiers involved in the programme. Both soldiers said the total of 5,200 did not include women who died. Reuters could not locate the officers named on the documents or confirm the authenticity of their signatures.

    Three soldiers and a guard who were deployed in the Maiduguri area in the past decade provided Reuters with estimates of how many women they had escorted for abortions. In separate interviews, each said he had helped transport between 7,000 and 8,600 pregnant women to military facilities for the procedures. The figures may overlap as some sources may have been part of the same transports at times.

    The programme was a large-scale operation, with complex logistics requiring careful coordination. Transport staff provided an overview of how it worked over the years.

    A guard who observed abortions describes what he saw. REUTERS/Christophe Van Der Perre

    Reuters spoke with eight soldiers and guards involved in transporting women for abortions. Batches of pregnant women held captive by insurgents were often picked up in rescue operations and placed into trucks. Some of the women were separated out in the field from other rescued people, the sources said. For other women, the winnowing came later, while enroute to or after reaching military or civilian facilities. Some were visibly pregnant; others were identified through urine tests or based on their recollection of their last menstrual period, these sources said.

    Soldiers said they were ordered to keep careful track of the pregnant women. “We count them one after another and then write it on a paper to send to commanders,” one soldier said.

    At military facilities, some of these soldiers and other guards said they accompanied the women inside and directly observed abortions. Even when they didn’t see the terminations, they said, women told them about their procedures afterward or emerged from the facilities no longer visibly pregnant. In addition, four of the sources said they saw or buried the corpses of women who died during or after abortions.

    Witness accounts and records suggest Reuters’ estimate of at least 10,000 abortions performed since 2013 is likely to be an undercount.

    For instance, among the 33 women interviewed by Reuters, 17 spoke of having abortions in groups ranging from a handful to 50 or 60 at a time, suggesting each woman’s experience represents a sliver of a larger total.

    In addition, according to one set of records, the number of women transported for abortions performed in the Maiduguri area alone exceeded 15,000. Reuters derived that total from detailed contemporaneous notes kept by a guard and his colleague operating in the area. Their notes break down the numbers of pregnant women the two helped transport to Giwa Barracks from March 19, 2013, to February 24, 2019.

    The notes were provided by the guard. Reuters was unable to determine if these tallies overlapped with others cited in this story.

    Some abortions were performed at civilian hospitals, including State Specialist Hospital in the city of Maiduguri, which is the command centre of the government’s war on Islamist extremists. REUTERS/Christophe Van Der Perre

    Cries, then silence

    Among those forced to undergo an abortion was a girl named Hafsat.

    She arrived at an army base in March 2019, a skinny teen of 14 or 15, clad in a turquoise dress and covered in mosquito bites, according to a soldier present that day.

    The soldier said he and other troops injected Hafsat and three others with oxytocin while they lay on the ground outside the army clinic.

    Within an hour, the soldier said, he heard cries and turned to see Hafsat bleeding heavily from between her legs. He grabbed her a cloth to stanch the blood.

    Hafsat began crying out for a man named Ali, and for her mother. “Half an hour later, maybe, she just went quiet,” he said. “She died.”

    The soldier said he and his comrades wrapped her in her turquoise dress and buried her. The memory haunts him.

    “I can’t forget her name,” he said.

    The details of the soldier’s account were corroborated by a second soldier at the base, who said he also witnessed the girl’s abortion and death.

    In all, eight sources, including four soldiers, said they witnessed deaths or saw corpses of women who died from abortions performed at military barracks or administered in the field.

    REUTERS/Paul Carsten

    Abortions have been conducted in at least five military facilities and five civilian hospitals in the northeast. Some women, including the one in this picture, told Reuters they underwent abortions at Maimalari Barracks, the main military base in Maiduguri.

    Deaths of any kind often are not recorded in Nigeria, and Reuters found few records that explained pregnant women’s deaths. Witnesses said it was common for women who underwent abortions as part of the programme to suffer significant blood loss. Two health workers said some women lost so much blood they needed transfusions.

    Aisha, in her mid-twenties, was one such patient.

    “I didn’t know if I would survive,” she told Reuters. “It was a lot of blood.”

    One death is documented in a 2019 report from Maiduguri’s State Specialist Hospital, verified by a guard. The report, reviewed by Reuters, said a woman had been brought in dead from Giwa Barracks after bleeding because of an abortion. The guard said he witnessed the procedure and the death, and was the one who delivered her corpse to the morgue.

    Reuters also reviewed four death certificates for women listed as having died at Giwa Barracks on the same day in 2013. Each recorded the cause of death as “miscarriage bleeding.” The same guard who verified the 2019 death report said he also saw these women die from their abortions.

    The case of Hafsat, the girl who bled out at the barracks, points to another feature of the programme: Many of those given abortions were girls, below Nigeria’s 18-year-old age of majority.

    Hafsat was among at least 39 girls who underwent abortions between 2017 and 2020 while under the age of 18, according to copies of patient registers from four hospitals. The youngest girl listed was 12.

    Of the 33 women who told Reuters they underwent abortions, eight said they were under 18 at the time. Nine other sources, including health workers, soldiers and a guard, confirmed the procedures were done on minors. Three of those sources said they performed or witnessed hundreds of underage abortions.

    One young woman told Reuters that she underwent an abortion a few years ago when she was 13. A health worker gave her an injection and told her it would make her sleep, she said. When she awoke, she was bleeding. “The blood, there was something in it,” she said. “It kept coming out, but they said, ‘Don’t worry about anything.’”

    She said she did not know she had been given an abortion until after she was released and spoke to her grandmother, who confirmed the girl’s account to Reuters.

    According to the girl, the older woman told her: Don’t tell anyone about what they did to you.

    For the good of society

    Four health workers told Reuters the abortion programme was, on the whole, for the good of society.

    “This child is already sick from conception,” one health worker said, referring generally to the foetuses of women impregnated by insurgents. He also said people would keep insisting, “‘He is a terrorist, he is a terrorist.’ There is power in words. They tend to bounce back on the child.”

    Four soldiers and guards in the programme, including the two soldiers who saw Hafsat’s death, described themselves as guilt-ridden over what they and their peers had done. One soldier wept as he described his ongoing night terrors from seeing the corpses of women and girls at his facility, some as young as 13.

    But some said they were compelled to follow orders from their commanders and risked punishment if they did not. Sometimes, their remorse was mixed with a sense of powerlessness and resignation.

    “I know it’s a sin against humanity, and against God,” one Muslim soldier said. “It’s not allowed in my religion. I feel so bad about it. But there’s nothing I can do, because of the orders.”

    In time, the soldier said, his involvement in the programme – including digging graves for women who died – became routine.

    “I got used to it,” he said.

    The women and girls who survived kidnappings, rapes and abortions said they often endured a different kind of misery as they tried to restart their lives.

    Almost all are poor, living in a society ruined by war, strapped for food and medical care. Some have settled with family members or friends nearby, or live in camps for people displaced by the conflict. Some end up alone.

    One woman said she couldn’t stay in her city, Yola in Adamawa state, because she was seen as tainted. “I went to one of my father’s relatives. When I got to his house he chased me away, saying he couldn’t stay in the same place as someone who came from the hands of Boko Haram, so I left there.”

    Fati moved back to her hometown of Monguno with her parents. She recalls being hopeful there, as a girl. The daughter of farmers, she was studying Islam, and her family had found her a man to marry. She dreamed of becoming a doctor.

    “My life was filled with enjoyment, in the beginning,” she said. She wanted to help people.

    Now, she said, her sense of safety has been destroyed, her ambitions crushed. She doesn’t want to be a doctor anymore.

    “I’ve changed my mind about them,” she said. “Doctors are heartless.”

    Having endured kidnapping, rape and abortions, some women found that even family members treated them as outcasts because of their association with Boko Haram.

    Abortion: A safe procedure turned dangerous

    Abortion, when performed under widely accepted clinical guidelines, is considered a safe medical procedure, according to specialists in the field.

    But the secret abortion programme led by the Nigerian Army in the country’s northeast departed significantly from what experts consider accepted medical practice, Reuters found.

    Nigerian military authorities deny the programme has ever existed. Abortion is illegal in Nigeria except to save the life of the mother.

    Women given abortions in the Nigerian programme were in the custody of armed soldiers. A Reuters investigation found that some did not even know they were pregnant, and some were deceived or physically forced into abortions that sometimes resulted in injury or death. Abortions are considered to be forced when they are performed without the prior, informed and free consent of the women, according to the European Institute for Gender Equality and the U.N. Committee on the Elimination of Discrimination against Women.

    Reuters briefed five doctors who specialise in abortion about its findings on the medical practices employed in the programme. None was directly familiar with the programme or able to comment specifically on it. But they agreed to assess the potential risks to patients that would be posed by the practices described by Reuters.

    Reporters also reviewed guidelines on abortions issued by the World Health Organization (WHO) and the United Kingdom’s National Institute for Health and Care Excellence, among other authorities.

    A U.S. file photo of a misoprostol pill. The drug is among the medications that have been used to end pregnancies in the Nigerian military’s abortion program. REUTERS/File photo

    Among the potential risks and concerns raised:

    The women often were in a debilitated condition – malnourished, injured or otherwise unhealthy before being taken into military custody.

    In such cases, they could be vulnerable to anaemia, vitamin deficiency and other afflictions that make it harder for the body to cope with bleeding or any complications during an abortion.

    For the malnourished, low haemoglobin levels mean “it doesn’t take much blood loss to have severe harm,” said Andrew Weeks, a British consultant obstetrician who specialises in maternal health and has worked in East Africa and runs clinical trials in the UK, Uganda and India.

    A drug called oxytocin was commonly used for abortions at military facilities, Nigerian soldiers and guards told Reuters. The drug, a potent hormone, is not recommended for abortions by the WHO and other experts.

    Worldwide, oxytocin is widely and effectively used to induce labour, expel the placenta or stanch post-labour bleeding. During labour, the drug is supposed to be administered carefully through a controlled intravenous (IV) drip, closely supervised by trained medical personnel.

    Staff at Nigerian military facilities gave women one or more intramuscular injections of oxytocin in quick succession to induce abortion, according to soliders and documentation. “Sudden uncontrolled injections risk uncontrolled and continuous contraction of the uterus, which could lead to the uterus rupturing, resulting in catastrophic internal bleeding and grave risk to the woman’s life,” said Benjamin Black, a British obstetrician-gynecologyst who specialises in abortion care.

    Some of the drugs employed in the Nigerian abortion programme – misoprostol and mifepristone – are commonly and safely used throughout the world. But the experts cautioned that too high a dosage of these medications later in pregnancy can overstimulate the uterus. Especially for women who have had multiple previous pregnancies, such stress can lead to a rupture.

    “If the uterus ruptures, there’s nothing you can do to stop the bleeding other than doing an operation,” Weeks said. “If it occurs out in the bush, the natural outcome is death.”

    Overstimulation can also exhaust the uterus so much that it cannot contract enough to stanch bleeding. In this case, as well, women can easily bleed to death if not quickly treated. Reuters could not determine the dosages of misoprostol and mifepristone that women were given by the army.

    Pregnancies in the Nigerian programme were also terminated surgically, by manual vacuum aspiration or dilation and curettage (D&C). While surgical abortions by skilled clinicians are typically safe, education and practice are needed. After the first trimester, a foetus will have developed a calcified skull and a larger placenta that must be removed.

    “Then it becomes a specialist skill for a specialist doctor,” said Weeks. In contrast with manual vacuum aspiration, which involves suction of foetal tissues, D&C is riskier because it involves scraping the uterine wall. That poses the risk of puncture. The WHO has recommended against using D&Cs for abortions since 2012.

    Some women were advanced in their pregnancies – as many as eight months along. The experts said the risks of complications rise significantly as a pregnancy progresses.

    The WHO recommends that women undergoing abortions after 12 weeks’ gestation have immediate access to a healthcare facility and that all patients remain under observation until the foetus and placenta have been cleared from the uterus.

    Especially in military barracks, sources told Reuters, supervision from trained medical professionals during and after abortions was limited. That would leave at-risk women more vulnerable to dire complications – such as heavy bleeding, incomplete abortions or infection.

    Women in the Nigerian abortion programme typically were not afforded the right to “informed consent,” according to the accounts of women themselves and soldiers. This requires a health provider to explain a procedure and its risks before seeking permission to perform it. Informed consent is an internationally recognised principle in medicine intended to protect patients’ autonomy and well-being.

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