Noma (cancrum oris) is a rapidly progressive gangrenous disease of the oral cavity and face — beginning as acute necrotising gingivitis in severely malnourished, immunocompromised children and progressing within hours to days to gangrenous destruction of lips, cheeks, jaw and facial bones. Without treatment, approximately 90% of cases die within 2 weeks. Survivors have severe disfigurement. It is caused by a polymicrobial infection (Fusobacterium necrophorum, Prevotella intermedia and others) in the oral cavity of children whose immune systems are devastated by malnutrition.

Why does noma occur only in severely poor children?

Noma requires the convergence of several factors all associated with extreme poverty: severe malnutrition (protein-energy malnutrition profoundly impairs cellular immunity — allowing normal oral bacteria to become life-threatening pathogens); concurrent infection (measles, malaria, HIV weaken immunity further); inadequate sanitation (facilitating the oral bacterial colonisation that triggers ANUG); dental disease and gingivitis (the precursor lesion); and absence of any healthcare access (allowing ANUG to progress unreated to noma). Remove any one of these factors — particularly through adequate nutrition — and noma does not occur.

Why was noma not on the WHO NTD list until 2023?

Despite devastating children across West and Central Africa for centuries, noma remained absent from the WHO NTD list — and thus invisible to global health financing and technical support — because: it occurs only in the world's most marginalised populations (extreme poverty); survivors are often hidden by families due to stigma; there is no diagnostic test, no specific treatment and no commercial interest; surveillance infrastructure is absent in endemic areas; and advocacy organisations were historically small. The 2023 WHO NTD listing, achieved through years of advocacy by Médecins Sans Frontières, Sentinelles, and academic partners, finally gives noma a global health home.

What does noma look like clinically?

Stage 1 (ANUG/oedema): painful gum ulceration with fetid odour, localised oedema. Stage 2 (discolouration): bluish-grey-black discolouration of the cheek skin overlying the gangrenous process below. Stage 3 (gangrenous sloughing): dramatic disintegration of tissue — lips, cheeks, gingiva falling away, exposing underlying bone; profuse foul odour; fever; severe pain (though paradoxically some patients have reduced sensation as nerve endings are destroyed). Stage 4 (scarring): if the child survives, the necrotic tissue separates and scars form — with severe disfigurement, trismus, and exposed bone.

Early ANUG/noma: high-dose penicillin (or amoxicillin ± metronidazole) immediately, combined with nutritional rehabilitation, local wound care, rehydration and treatment of coexisting infections (malaria, measles). These interventions can halt progression and save lives if started at the ANUG stage. Established gangrenous noma: antibiotics, wound care and nutritional support — but tissue already destroyed will not regenerate. Survivors: multiple staged reconstructive surgeries (available at only a handful of specialist centres globally: Médecins Sans Frontières Sokoto hospital, Noma Children's Hospital Sokoto, Sentinelles clinics).

Who is doing work on noma?

Médecins Sans Frontières (MSF/Doctors Without Borders) operates the only dedicated noma hospital in Africa (Sokoto, Nigeria — the highest-burden setting). Sentinelles (French NGO) provides reconstruction across West Africa. The Geneva-based Hilfsaktion Noma Foundation (HANS) coordinates advocacy and surgical missions. Academic research: several European universities (Amsterdam, Geneva, Bordeaux) study noma epidemiology and microbiology. The 2023 WHO NTD listing is expected to dramatically increase the organisations and funding engaged with noma.

How does GMJ News cover noma?

GMJ News covers WHO noma NTD listing 2023, the disease burden data, the malnutrition-infection nexus, MSF and Sentinelles reconstruction work, and the advocacy journey to NTD recognition. Noma exemplifies the deepest inequities in global health — a disease of pure poverty, entirely preventable, yet affecting hundreds of thousands of children annually — relevant to PHIG's global health equity mandate.

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Noma (Cancrum Oris)

GMJ News knowledge hub · last reviewed September 2026 · Georgian Medical Journal

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Noma (cancrum oris) — a rapidly progressive gangrenous disease of the oral cavity and face — is one of humanity's most devastating and stigmatising diseases, destroying facial tissues with ferocious speed in severely malnourished children aged 2-6 years: it kills approximately 90% of untreated cases within 2 weeks and leaves survivors with severe disfigurement requiring complex reconstructive surgery (WHO). With approximately 140,000 cases per year (massively underreported) predominantly in West Africa (Nigeria, Niger, Ethiopia, Chad), noma was added to the WHO Neglected Tropical Diseases list in 2023 — finally gaining the global attention its burden demands. Noma is entirely preventable through adequate nutrition, vaccination and treatment of early gingivitis.

Key messages

WHO NTD since 2023 — long overdue

Noma was added to the WHO Neglected Tropical Diseases list in December 2023 — a landmark recognition of a disease that kills 90% of untreated cases within 2 weeks and is entirely preventable yet remains among the most neglected and invisible diseases in global health.

90% mortality — devastating survivors

Noma kills approximately 90% of untreated patients within 2 weeks of onset through rapid gangrenous progression. Survivors — approximately 140,000 new cases/year — are left with severe facial disfigurement requiring complex reconstructive surgery unavailable in most endemic settings.

Disease of extreme poverty — children 2-6

Noma almost exclusively affects severely malnourished children aged 2-6 years in extreme poverty — in West and Central Africa (primarily Nigeria, Niger, Ethiopia, Chad, Guinea-Bissau) — where it is driven by malnutrition, immunocompromise, inadequate sanitation and lack of access to care.

Entirely preventable

Noma is entirely preventable through: adequate nutrition (preventing the malnutrition-immunocompromise that allows oral microbiota to become pathogenic); childhood vaccination programmes; treatment of early-stage gingivitis with penicillin; and safe water and sanitation.

Mycolactone-like mechanism — rapid tissue destruction

Noma begins as acute necrotising gingivitis (ANUG) in malnourished, immunocompromised children — progressing within hours to days to gangrenous destruction of oral soft tissues and facial bones. Fusobacterium necrophorum and Prevotella intermedia are key pathogens in the polymicrobial infection.

Reconstruction requires multiple surgeries

Survivors of noma have severe facial disfigurement — loss of lips, cheeks, nose, jaw. Reconstruction requires multiple staged surgeries (trismus release, bone grafting, soft tissue reconstruction) — available at only a handful of specialist centres globally and inaccessible to most survivors in endemic areas.

Key statistics

~140K

new noma cases/year (massively underreported)

WHO

90%

mortality without treatment within 2 weeks

WHO

2-6yr

typical age range of victims

WHO

Dec 2023

year noma added to WHO NTD list

WHO

Nigeria

country with highest noma burden globally

WHO

current approved specific treatments (prevention + early penicillin key)

WHO

Noma — estimated cases by country (approximate annual) — WHO

Source: WHO. Massively underreported across West and Central Africa.

Glossary of key terms

Noma (cancrum oris)
WHOA rapidly progressive polymicrobial gangrenous infection of the oral cavity — beginning as necrotising gingivitis and rapidly destroying gingiva, soft tissues and facial bones. Exclusively in severely malnourished and immunocompromised children in extreme poverty. Named from the Greek "νομή" (to devour).

Acute necrotising gingivitis (ANUG)
WHOThe initial stage of noma — painful ulceration of the gum margin with bleeding, foul odour and tissue necrosis. ANUG is common in malnourished children and is treatable with penicillin and local debridement. If untreated, ANUG can progress to noma in severely immunocompromised children.

Fusobacterium necrophorum
WHO/MicrobiologyA Gram-negative anaerobic rod — considered the key pathogen in the polymicrobial infection driving noma. Produces leukotoxin and other virulence factors causing tissue necrosis. Also causes Lemierre syndrome (septic jugular thrombophlebitis) and liver abscesses.

WHO NTD listing (2023)
WHONoma was officially added to the WHO list of Neglected Tropical Diseases on 16 December 2023 — a landmark advocacy achievement. This listing accelerates WHO technical guidance, research, reporting, drug access and international attention for a disease that had been essentially invisible to global health organisations.

Trismus
WHO/SurgeryInability to open the mouth — a common sequela of noma from fibrosis and adhesions between the oral mucosa, mandible and maxilla after tissue destruction and healing. Trismus profoundly impairs eating, speaking and oral hygiene. Surgical release (trismus surgery) is the first step in reconstruction.

Reconstruction for noma survivors
WHO/MédecinsNoma survivors require staged reconstructive surgery: (1) trismus release (release of fibrous bands); (2) bone grafting (mandible reconstruction using rib or fibula flap); (3) soft tissue reconstruction (local and free flaps for lips, cheeks, nose); (4) dental rehabilitation. Each stage requires specialist surgical skill and general anaesthesia — available at <10 specialist centres in all of Africa.