In 2013 women heading out for a routine polio immunization exercise were reportedly gunned down at this primary health center in Kano, the largest city in Northern Nigeria, by Boko Haram militants. Photograph: Ameto Akpe.

Almost a decade ago, Muslim clerics in Nigeria’s northern region deemed polio vaccines “an anti-Islamic American plot” to control the population. Even though Nigeria is one of only three countries where polio remains endemic—Pakistan and Afghanistan are the other two—the idea continues to be propagated by cultural, religious, and (some Nigerians say) political voices. It exemplifies the lingering anti-Americanism that impedes some development projects in Nigeria.

Most polio cases in the country arise in the predominantly Muslim population of northern Nigeria, where there is a significant distrust and aversion for the West in general and America in particular. My conversations with a wide swath of people from across the sub-region while researching the impact of U.S. soft power in northern Nigeria, reveals that these sentiments are not merely held by an uneducated minority.  A university graduate from Northern Nigeria told me that none of his children has ever received the polio vaccine – “and none of them will ever receive it.” The campaign to eradicate polio in Nigeria is seen as a pro-western initiative, funded by American and European development partners. “These Westerners have never really denied that what is in the polio vaccine can cause infertility and there are tests that prove this. Yet they keep pushing us to give [it to] our children,” he said. “Why are they so interested?” Revelations that fake vaccination campaigns were used by American intelligence to track Osama Bin Laden in Pakistan have fueled this sort of response.

Recently, distrust has exploded into more radical expressions, driven especially by the emergence of the extremist Islamic group Boko Haram (whose name translates roughly as “Western education is sinful”). In 2013, several health workers and other civilians in Kano, the largest city in northern Nigeria, were gunned down in broad daylight by Boko Haram militants—men in motorized rickshaws who repeatedly shouted “God is great” in Arabic as they carried out the attack.

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Nigeria, with a population of around 170 million, is demarcated along religious lines. The southern part of the country is predominantly Christian, while the northern majority is Muslim. And in the north, as in much of the rest of the Islamic world, public displays of anti-Americanism are common. In 2001, there were open celebrations following the 9/11 attacks, and a decade later few applauded Americans for the killing of Osama bin Laden. These sentiments have morphed into what is now a deeper level of malice against all things Western, Christian, and democratic. Internal tensions between Muslim communities and the often more Western-friendly Christian communities are even palpable today. Increased number of attacks on churches, in the past couple of years, as well as raids on perceived rival clusters and government enterprises, have led to many injuries and deaths.

It will take more than clean water and medicine to change the mindset the average northern Nigerian has toward America.

In 2008, the United States Agency for International Development (USAID) launched a 5 year “strategic program” to channel most of the Agency’s aid dollars – centered on education, health care, and good governance projects – to two northern states, Bauchi and Sokoto, which have some of the worst human development indices in the country. The U.S. mission in Nigeria declined to comment on its administration of the USAID’s program but its website says the aim of its focus on the northern region is to achieve a more “significant impact” of USAID-Nigeria’s resources.

Some analysts, however, have described this move as concerted effort by the United States to improve its image in the Muslim-dominated space.

According to this view, supplying aid to donor-dependent health systems is one way the world’s richest economy cajoles other nations to support its policies or leanings. This is a strategy popularly referred to as “soft power,” and USAID is one of America’s main vehicles for exercising it. Joseph Nye, who coined the term, describes soft power as “the ability to influence the behavior of others to get the outcomes you want” through attraction rather than intimidation. But there continues to be arguments over whether aid is an effective channel of soft power.

Ibrahim Hafiz, a political commentator and retired civil servant, says it would take more than clean water and medicine to change the mindset the average northern Nigerian has toward America. “Until American policies stop being so anti-Islam, these feelings of hate and distrust will remain not just here but across the Muslim world,” said Hafiz, who himself is a Muslim northerner. American policies regarding Iraq, Afghanistan, and Iran, are perceived as hostile and discriminatory.

On the other hand, Hafiz notes, “The Chinese are increasing their influence in northern Nigeria; they are conducting businesses and building enterprise. America should ask itself why do we not feel this way about China. Why is there not the same outburst of anger and distrust against the Chinese here in the North?” Indeed findings published in 2013 by the Pew Research Center confirm that Nigerians give a higher favorability rating to China than the United States. When people were asked “Is it more important to have stronger ties with the United States or with China?” 37 percent said China while only 17 said the United States; 33 percent said both countries, 3 percent said it is not important to have strong ties with either country and 10 percent had no opinion.“Meanwhile,” Pew’s Director of Global Attitudes Research, Richard Wike explains,“45 percent of Muslims think it is more important to have close ties with China, while just 12 percent say close ties with the US are more important.” He told me that 27 percent of the Muslims polled volunteer that both countries are equally important; 3 percent say neither, and 12 percent do not know.

Nigeria is a major recipient of China’s increased investments in sub-Saharan Africa over the past decade. Wike said, “It is certainly clear China is being seen to be having an increasing role in the world affairs and its economic relationship with African nations is being looked upon favorably.” The United States and China are the two main contributors to Nigeria’s Foreign Direct Investment. A lot of China’s investment goes into major infrastructure projects, and several Chinese companies are active in Nigeria’s manufacturing sector. In contrast, there are only two American companies in the country’s manufacturing sector, according to a 2013 report  by the U.S. State Department. In the past, Western nations have been criticized for focusing on giving Africa fish instead of teaching them how to fish. China on the other hand seems to give fewer overtures and more hard cash across the continent.

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Meanwhile, as tension in the country continues to escalate, Nigerian government officials have accused northern leaders for failing to condemn the actions of Islamic extremists and radical rhetoric of some Islamic clerics in the polity. “It’s as if our leaders are afraid or just unwilling to discuss the issue,” Hafiz argues. Instead, political leaders in the region sometimes appear to stoke the flames as part of a strategic power struggle. It is no secret that northern leaders are at loggerheads with the current southern Christian-led national government of President Goodluck Jonathan and continue to make strong and intentional moves to ensure power returns to the north in 2015, when the next presidential election is due. The cycle of violence being perpetuated by Boko Haram has thus become the issue northern elites point to as an example of Jonathan’s failings.

Indeed, studies by Lisa Blaydes of Stanford University and Drew Linzer of Emory University suggest anti-American sentiments are rooted less in a country's Islamic identity than they are in the degree of power struggle between Islamic and secular leadership. So the core basis of the sour feelings toward America would appear to be “competing political factions” that exploit existing grievances against anything American.

Some have suggested that foreign aid should be delivered with more subtlety and that public information campaigns, which run now and again on local radio stations, should be more substantive in trying to counter misgivings and reservations about what Nigerians refer to in pidgin-English as “the white man’s medicine”. In response, the U.S. mission in Nigeria no longer brands its projects with its logo and the usual “from the American people” boldly splashed beneath. Taiwo Olawale, project manager with WOFAN, a local non-governmental organization that collaborates with USAID to provide water-pumps, says this preemptive measure, which started in 2013 was aimed at protecting communities where these projects are sited because it could, “make them vulnerable to attacks by those who hold extreme views about the West.”

There have also been calls for countries like the United States to change the “architecture of aid delivery” in regions where these sentiments remain. Japan, for example, described as a “subtle partner” to the continent, has pursued a system of aid delivery that centers on provision of grants and loans that focus on local ownership through its donor agency, the Japanese International Cooperation Agency (JICA). USAID has begun to apply this strategy as well in its assistance to improving maternal health care in Bauchi and Sokoto states.

Dozens of polio cases continue to be reported in northern Nigeria, and Islamic extremists remain a major impediment to Western aid and development projects. The nature of anti-Americanism is undoubtedly complex and dealing with the barriers it creates would take a combination of pacification and public relations efforts; if American aid truly aims to change hearts and minds, understanding the true dynamics of the prevailing feelings is crucial to moving forward.

This reporting was made possible by a grant from the Pulitzer Center on Crisis Reporting. More on Ameto Akpe's work as the 2013 Persephone Miel fellow can be found here.