Niamey—In a small camp set up on the outskirts of Gueskérrou, a locality in the Diffa region in Niger near the Nigerian border, Amina, 34, describes the conditions in which she has lived since fleeing insecurity in her home village. Now a refugee at this site, she was no longer certain her children could access essential health services. She recalls the unexpected visit of the vaccination team as an important moment for her family: “Health workers arrived with coolers of vaccines and registers. For the first time in a long while, I felt that my family had not been forgotten,” she explains.

This scene reflects the complex health situation in the Diffa region, which has six health districts, 83 integrated health centres and 186 health posts, 36 of which are closed due to insecurity. In this context, access to basic services remains uncertain for vulnerable families like Amina’s. With an estimated population of over 900 000, marked by the presence of internally displaced persons, refugees, and nomadic groups, the region remains exposed to the risk of poliovirus circulation.

Polio, a viral disease that can cause irreversible paralysis, continues to threaten children who have never received a vaccine—known as “zero dose”—as well as those insufficiently vaccinated. In some hard-to-reach areas of Diffa, the virus can circulate silently, putting the youngest at particular risk.

In response, the government, with support from the World Health Organization (WHO), has strengthened a set of essential interventions. This collaboration has resulted in continuous technical support for planning and monitoring activities, as well as targeted operations to maintain access to vaccination in the most remote areas.

For Dr Amadou Housseini, Regional Director of Health and Public Hygiene in Diffa, coordination among actors remains indispensable: “Regularly analysing data, supporting teams in the field and ensuring that every at-risk area is rigorously monitored are essential elements. It is this constant effort that has allowed us to reduce type 2 poliovirus cases to zero,” he notes.

Health worker Aichatou Kangueye, involved in vaccination activities for more than 12 years, describes fieldwork as a collective effort carried out under varied conditions. He explains: “Reaching remote areas requires good preparation and coordination with communities. Each trip allows us to reach children who otherwise would not have received any vaccine,” he says.

With WHO’s technical support, two environmental surveillance sites have been established since April 2016 to detect virus circulation in wastewater, according to Mahaman Salahadine, regional head of environmental surveillance. Teams have also benefited from strengthened skills for 73 surveillance and vaccination agents, as well as the provision of field-appropriate tools. In total, 583 surveillance site visits have been conducted to closely monitor the situation. Essential cold chain equipment, data collection tools and logistical resources have further enabled teams to reach hard-to-access localities and continue their activities despite constraints.

In parallel, eight vaccination campaigns and three major catch-up rounds were conducted between 2024 and 2025 to reach zero-dose and under-vaccinated children. Thanks to fixed, mobile, and advanced strategies, teams were able to vaccinate an average of 349,961 children per campaign in diverse settings: households, nomadic camps, markets, bus stations, water points, and cross-border villages.

According to Dr Jean Baptiste Nikiema, WHO Representative in Niger, progress in Diffa has been possible thanks to methods adapted to field realities, It is essential to adjust our actions to what communities actually experience because it is on this basis that we manage to protect children, even in hard-to-reach areas,” he says. Teams have adapted their actions by considering population movements, sometimes limited access to certain localities and information shared by communities. This approach—combining environmental surveillance, monitoring with health authorities and community participation—has enabled better coverage of the region and strengthened child protection in a sustainable way.

For families like Amina’s, these efforts facilitate access to services previously out of reach. Even in a fragile humanitarian environment, today Diffa shows that no child is beyond reach. Prospects for the coming years rest on strengthening surveillance, routine vaccination and campaign quality, with the shared goal of permanently eliminating polio.

In the camp where she now feels much safer, Amina envisions the future with newfound serenity. Knowing her children are protected from disease transforms her daily life and eases her worries. “Even in difficult times, something good can still happen,” she confides.