Recently, the Mandate Health Empowerment Initiative (MHEI), an NGO announced that it would carry out trauma intervention for Internally Displaced Persons (IDPs) in the North-East, beginning first quarter of this year. This move … by a non-governmental organisation is a welcome move contributory to the health care delivery needs of the hapless victims of insurgency and other related armed attacks leading to humanitarian crises in the north-east and even the middle belt regions of Nigeria. In this cover story, Editor of PharmaTimes, MORGAN NWANGUMA examines the level of medical health needs as well as the urgency of special intervention for the populations in the IDP camps across the affected states.
On a daily basis, so many lose their lives in Nigeria simply because of inadequate healthcare facilities or services. In recent years we have been saddled with the responsibility and burden of living with a new phenomenon, an internal refugee crisis given rise by incessant terror attacks, with people trooping into camps. This is the humanitarian challenge called IDPs.
The internally displaced persons in Nigeria are not really the only ones that are confronted with the miasma of inadequate healthcare system; most Nigerians are. But again, most of these victims of mindless attacks are the less privileged members of society, dwelling mostly in the rural parts of the country. They can barely afford decent medical attention or go to good healthcare facilities, and be attended to by qualified professionals.
In the North-east axis of the country especially, the government ought to have a well thought out plan for healthcare sector interventions that will span a given period of say, half a year or so. This should be adequate enough to cater for the magnitude of humanitarian crises and the emergencies that are likely to still emanate. Consequent upon this, the federal government had initiated a National Heath Sector Response to Humanitarian Crisis Plan aimed at dealing with the problems of the North-east. These were developed by the federal ministry of health as well as the six states of the North- east region in conjunction with the Bornu State Ministry of Health.
But experts say the situation requires more than what is currently on ground; more action is needed on the intervention level, including psycho-social support. These actions are needed to curtail the rate of morbidity and mortality, as well the effects of trauma. This is not only targeting times of emergency, but also to heal emotional wounds and shock as they begin to face the future – in the regions that cut across especially Borno, Adamawa and Yobe States, being the most critically affected states in the on-going crises. But a lot depends on the availability and also correct management of the funds.
Studies have proven that people in the IDP camps have a major problem accessing basic healthcare services in terms of both personnel and basic amenities. In the research carried out in 2014 by the Nigerian-based NOIPolls indicates for instance that 7 in 10 IDPs i.e. 70 percent cannot access healthcare, with only 30 percent being able to gain access to healthcare. It is only Yobe State in which surprisingly about 72 percent of victims in IDP camp confirmed that they actually were able to access healthcare personnel as well as facilities.
There is no gain saying that Borno State is the one with the most critical situation here for obvious reasons. Only about 10 percent of the IDPs are able to adequately access medical facilities and personnel. Most of the time the people are not adequately enlightened and as such do not have a good knowledge of basic hygiene and sanitation – making them highly susceptible to infections and diseases. In addition, the environments in which they find themselves are not hygienic enough, and when they get infections they resort to traditional methods or self help which usually do not help matters.
But in the country, the end of the current armed insurgency and all manner of conflicts does not seem to be in sight, what with the continued ‘soft target’ attacks we get from time to time from the Boko Haram terrorists, and the rampant Fulani herdsmen menace especially in the middle belt areas. Even as the insurgency in the North-east slowly continues to abate, the case of marauding herdsmen seems to be festering, and so insecurity remains an issue for all, inclusive of healthcare personnel.
Thus the ongoing crisis in the North-east has overtime led to an unprecedented humanitarian crisis due to destruction that has negatively impacted on some 6.9 million people spread especially through Adamawa, Borno and Yobe States. Amongst the population so affected include some 5.9 million people who have been utterly displaced and traumatised, and staying in designated camps. They include children under 5, females of reproductive age, elderly people, as well as the host communities mostly living under harsh impoverished conditions. They are all very vulnerable and therefore deserve some measure of urgent health intervention.
Most of the time, health facilities in the conflict affected areas are either non-existent or have been badly destroyed, and healthcare personnel threatened by insecurity thereby rendering them inadequate and incapacitated to perform their desired functions. Going by the report issued by Health Resources Availability Monitoring System (HeRAMS), about one third of more than 700 health facilities in Borno State have been rendered impotent. And out of what is left, about a third is not even functional in any way.
Yet, so many volunteers and non-profit organisations (NGOs) have continued to rally round the affected zones, making sure that the less privileged in the areas are enlightened on many health related issues, and their needs catered for. It would be recalled that unfortunately, a very dedicated student who served as a volunteer with one of the foundations running an Emergency Education Programme (EEP) in one of the IDP camps died in the cause of her duty due to malaria attack.
She was admitted to a hospital near the IDP camp but later discharged without adequate treatment, to enable her withstand the disease. Obviously there was a dearth of professional manpower or medicament and facility, or a combination of these, which would have gone a long way to save her life.
The IDP camps are marked sometimes with disease prevalence, and a high mortality rate, coupled with extreme malnutrition which has continued to suffocate the populations. Once in a while we get to hear of outbreaks of one epidemic or the other in various parts of the country such as the recent return of Lassa fever, or polio and other childhood diseases such as measles. Apart from these, malaria has always been an ongoing occurrence and concern – leading to major incidences of morbidity, as well as being the major cause of death among children aged between 0 and 5 years.
For the same reasons highlighted earlier, one often hears of increased rates of respiratory infection which is a marker for possible cholera and meningitis epidemic in the various locations. With a high population and congestions in the IDP camps, health authorities and workers alike have a herculean task maintaining adequate disease surveillance, and responding to alerts as well as outbreaks.
As a result of the foregoing, the capacity of the state governments and health partner’s have become strained and greatly whittled down in terms of having to respond to exigencies because they continuously experience an increase in humanitarian needs. In Borno State for example, secondary healthcare is almost completely non-existent except within the State capital – Maiduguri. In the same vein, access to primary healthcare delivery is at an all time low in most of the localities. Yet, a very important but silent need arises going by the traumatic experiences the IDPs have been forced to go through.
Even though the crises at the moment seem to be waning, they have impacted greatly on the victims in the regions so much so that beyond medical support, trauma and psychological intervention is also highly called for. In the words of Mr. Ameh Zion, MHEI President, “We have sought partnerships with several organisations to carry out several projects in 2018, and we have secured a partnership with the Presidential Initiative for North-east to achieve this.” He stressed that his organisation is also earmarking training of trainers in their agenda, adding that, “this project will be carried out in collaboration with the FCT Primary Healthcare Board. We hope to replicate this in the six geopolitical zones of the country but for now we will start with North Central.”
This is a wake-up call therefore challenging government to expedite action while upping the ante in ensuring adequate delivery of healthcare services in the country. This is most expedient pertaining to the case with rural dwellers, wherein healthcare facilities are highly inadequate. State governments in which IDPs are located must make certain that the health needs of these unfortunate ones are taken care of to their fullest ability to do so.
And so there is great need to invigorate and further strengthen the health system. It is important to restore efficient, equipped, and properly manned health facilities so as to take care of vulnerable populations. Experts also say governments and private sector stakeholders must begin at this time to de-emphasise the use of mobile services in the health sector of the future.