Reports indicate that over 130 people are suspected to have contracted cholera in Oyo State, with nine confirmed cases. Most of the suspected cases have been traced to six local government areas, including Ibadan North West, Ibadan South West, Ido, Akinyele, and Atiba.

The Oyo State Commissioner for Health, Dr. Oluwaserimi Ajetunmobi, confirmed the outbreak, noting that six patients admitted to the Infectious Disease Centre in Olodo have since been discharged.

In a statement issued through his media aide, Idowu Ayodele, in Ibadan, Oseni, who represents Ibarapa East/Ido Federal Constituency, expressed concern over the cholera cases.

He emphasised that cholera, a waterborne disease that thrives in unsanitary conditions, can be curbed with proper preventive measures.

“We must uphold good hygiene standards and ensure our water sources are clean and safe for consumption,” the APC chieftain said. “Cholera is preventable, but it requires the collective effort of every individual in the community.”

Oseni underscored the importance of regular handwashing, proper waste disposal, and treating drinking water as essential steps to minimize the risk of infection. He also warned against consuming food from unhygienic sources, stressing that cholera-causing bacteria can easily contaminate both water and food.

The lawmaker further called on local authorities and health workers to intensify public awareness campaigns about the symptoms of cholera, which include severe diarrhea and vomiting—both of which can lead to dehydration and death if not treated promptly.

“By being proactive in our hygiene practices and seeking medical help at the first signs of illness, we can collectively prevent the further spread of cholera,” he stated. “Let us prioritise the health and well-being of our people by taking this threat seriously.”

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Many displaced people live in vastly overcrowded camps with poor water and sanitation facilities, limited supplies of hygiene essentials such as soap and water, and often no individual space at all.

Functioning health infrastructure in Borno is scarce, and the capacity to refer patients is extremely limited. With so many people already vulnerable to outbreaks of disease, essential humanitarian assistance must be maintained; water and sanitation facilities must be improved in camps for internally displaced people; and frontline health workers, on whom the population will depend, must have access to personal protective equipment.

Médecins Sans Frontières (MSF) has been working in Borno state since 2014, and during that time we have witnessed the deplorable living conditions of the internally displaced, many of whom already suffer from illnesses endemic to overcrowded settlements, such as water-borne diseases and respiratory tract infections like pneumonia, which has been identified as a significant threat when coupled with COVID-19.

Maintaining lifesaving operations

COVID-19 has had a devastating effect on healthcare systems, economies and populations worldwide and it poses a substantial threat in Borno. However, even if COVID-19 were not present in Nigeria, the need for humanitarian assistance in Borno would still be massive.

In just over a month, rainy season will commence, bringing with it a surge in cases of malaria and malnutrition. In Maiduguri, Ngala, Pulka and Gwoza, our hospitals run 24 hours a day, seven days a week, and during the rainy season they will all be full.

In 2019 alone, MSF teams treated more than 10,000 patients for malnutrition in Borno and more than 33,000 confirmed cases of malaria; over 40,000 patients were admitted to MSF’s emergency rooms.

The effect that COVID-19 will have on our patients must not be underestimated, but if the chaos caused by this pandemic is allowed to curtail humanitarian assistance, the results will be catastrophic.

We are extremely concerned about the spread of COVID-19 and the potentially disastrous impact it will have on the most vulnerable. As the virus spreads in Nigeria, our priority is to maintain our operations which save thousands of lives every year, and to protect our patients and staff.

To do this, our medical and logistical teams have reinforced infection prevention protocols, informed local communities on the best prevention measures against COVID-19, installed hand washing points in local communities, established isolation zones and adapted our triage processes.

At a time of unprecedented global demand for medical supplies, the procurement of personal protective equipment for healthcare staff poses a substantial challenge. However, it is a challenge we must face in order to protect frontline medical workers and continue treating our patients.

Clean water: a precious and limited resource

In Pulka, where MSF runs a comprehensive hospital with outreach activities, surgical capacity, maternity care, and treatment for sexual and gender-based violence, the situation is dire. Pulka is a garrison town; a population centre controlled by the Nigerian military.

It is now home to approximately 63,000 people, 78 per cent of whom have been displaced at least once since 2015. There are 27,000 people living in overcrowded camps for internally displaced people in Pulka, with limited access to basic services, including water, food and healthcare.

In both Pulka and Gwoza (a neighbouring garrison town), the transit camps for new arrivals are overcrowded; in Gwoza, the transit camp population is triple the recommended capacity; and in Pulka, communal shelters host people for months or even years when they are designed to be a temporary solution for just two weeks.

In a recent water and sanitation assessment, MSF found that the daily provision of water per person in Pulka was just 11 litres, far below the minimum humanitarian standard requirement of 20 litres required for health and hygiene. Of these 11 litres, only an average of two litres was chlorinated and safe to drink. Quantities as low as 4.5 litres per person have also been recorded in previous surveys.

In Maiduguri, the capital of Borno state, the water and sanitation is not much better. Between 1999 and 2011, MSF responded seven times to outbreaks of cholera in Maiduguri, and in 2018, more than 4,000 people were diagnosed with cholera in 18 local government areas in Borno, Adamawa and Yobe states.

“In all the settings for internally displace people where MSF has operations in Borno state, gaps in essential water and sanitation facilities exacerbate the threat posed by COVID-19,” says Siham Hajaj, MSF head of mission

“These gaps, combined with the levels of overcrowding, and endemic health issues with a lack of corresponding health infrastructure, underscore the vulnerability of the population. There is no doubt about the danger posed by COVID-19. However, one thing we know for sure is that other diseases and medical conditions will not relent. We cannot afford to let this pandemic disrupt other medical assistance – the continued provision of medical services at this time is essential and it will save lives.”

COVID-19 is not the only threat facing people in Borno state, but its presence in Nigeria highlights the extreme vulnerability of so many who have already endured the horrors of war, disease and malnutrition. For them, social distancing is an abstract luxury, and frequent hand washing diminishes a precious resource.

In the face of this pandemic, the ramifications of Borno’s fragile health infrastructure are clearer than ever. It is imperative that humanitarian assistance be maintained for this population. Failure to do so will cost lives.

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“Displaced people are suffering due to relentless rains and wind battering their homes the last few days. Large numbers of families, who fled from conflict months ago, are left homeless while others are forced to share overcrowded tents with neighbours or relatives,” said Eric Batonon, Country Director for NRC in Nigeria.

According to NRC’s assessments, over 6,800 people living in displacement camps in Maiduguri have been impacted by floods in recent weeks. In Dikwa, 500 people have been rendered homeless due to flooding and have set up home in disused registration centres.

“They are essentially displaced within a displacement camp,” Batonon added.

“My home is completely destroyed. My floor has turned to mud and water is everywhere. The rain keeps coming and we do not have any choice but to wait for it to stop or share with others,” said displaced mother-of-four Fatima Mohammed (30).

The Adamawa State Government officially declared an outbreak of cholera in three local government areas during the rainy season. The total number of cases reported as of August 16 stands at 633. Four people have so far lost their lives to the disease. Due to recent heavy rain and flooding, more cases could be confirmed over the coming weeks.

“Displaced people are living in sub-human conditions across the region. There are no sanitation or drainage facilities in most camps. People are going to the toilet in open spaces because there are no facilities for them to use and now that the camps are filled with stagnant flood water, water-borne diseases like cholera quickly spread,” Batonon added.

The United Nations and partners have appealed for $848 million to address the needs in northeast Nigeria this year. About eight months into the year, less than 40 per cent has been received.

“Additional financial support is urgently needed to reach the 6.2 million people targeted for humanitarian aid in 2019. People will die if they don´t receive urgent assistance now,” Batonon said.

Furthermore, heavy rain periods present opportunities by armed groups to infiltrate and target displacement camps. On Tuesday night (August 20) in Dikwa, a female suicide bomber detonated a bomb, killing herself and injuring four civilians. This was the first attack of its kind in the area since December 2018.

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