Aishatu Ella-John* Ifechi Anikwe* and Ifeoma Malo*
The recent floods in Nigeria, which began in August 2022, have led to the displacement of over 1.4 million people in 33 out of the 36 states of the country. This year, Nigeria, known for its seasonal rain and accompanying flooding, experienced the worst case of flooding in a decade. The flooding of 2012 reportedly killed 363 people and displaced over 2.1 million persons when the Niger and Benue rivers overflowed their banks.
The reasons for the flood are multifaceted and range from state governments' failing to prepare early for seasonal floods to the breach and release of excess water from the Lagdo dam in Cameroon, which runs the course of communities downstream along the River Niger and River Benue. Nigeria lacks a buffer dam to prevent this overflow and has failed to build one despite needing one as far back as 1982. The combination of heavy seasonal rains, poor urban planning, and inadequate flood mitigation infrastructure has made parts of the country more vulnerable to these flood disasters.
The effects of the disaster were quite evident in the disrupted fuel supply and 23% food inflation that arose due to washed-out farmlands and supply chain disruptions. Another inevitable effect is the outbreak of diseases in flood-affected communities. According to UNICEF, "more than 2.5 million people in Nigeria need humanitarian assistance — 60 percent of which are children — and are at increased risk of waterborne diseases, drowning and malnutrition due to the most severe flooding in the past decade."
Several states have already reported hundreds of suspected cholera and diarrhea cases. Waterborne diseases, respiratory infections, and skin diseases have also been rising, especially among children. These diseases and their spread are further exacerbated by the fact that many flooded communities, entire hospitals, and healthcare centers are submerged and non-operational.
Also added to the challenge occasioned by the floods is the mental and physiological challenges, including hypertension, which are some of the health challenges expected to rise with the recently reported flooding in Nigeria.
Health Impacts of Floods;
When flooding happens, data and public attention are mainly directed toward economic and physical impacts; however, the effect of flooding on the health system and the health of the affected population cannot be understated.
Flooding directly leads to drowning, damages to existing health infrastructure, reduced or total lack of access to health facilities, and the outbreak of diseases; waterborne diseases like cholera and typhoid and vector-borne diseases such as malaria and dengue fever are listed health challenges that accompany floods.
There are also secondary health impacts from contaminated water sources by sewages and saltwater in some environs.
In response to Nigeria's recent flooding crisis, UNICEF reports that children and adults are most at risk of illnesses through waterborne diseases, drowning, and malnutrition.
Data released by UNICEF indicates:
- 34 out of the 36 states in the country were affected by the floods,
- 1.3 million people were displaced. Over 600 people are believed to have lost their lives, and over 200,000 houses were either partially or fully damaged.
- UNICEF warns of cases of diarrhea and waterborne diseases, respiratory infection, and skin diseases
- According to Dr. Charles Umeh of the University of Maiduguri Teaching Hospital, mental health issues have also been linked to the effects of losses incurred from the flooding.
- In Borno, Adamawa, and Yobe alone, a total of 7,485 cases of cholera and 319 associated deaths have been reported as of 12 October 2022.
- NCDC data-sheet for Cholera outbreaks in Nigeria shows a 500 percent in reported cases of Cholera from June 2022, from 420 cases to 2428 in August and 4153 cases in September, to August and September when the floods happened. Between August and September, there was a 42 percent increase in reported cases.
- As of 2 October 2022, a total of 10,745 suspected cases, including 256 deaths (CFR2.4%), were reported from 31 states in 2022.
- Of the suspected cases since the beginning of the year, the age group 5 -14 years is the most affected age group for both males and females.
- Of all suspected cases, 48% are males, and 52% are females. Eleven states — Borno (3663 cases), Yobe (1632 cases), Katsina (767 cases), Taraba(675 cases), Cross River (649 cases), Gombe (470 cases), Jigawa (417 cases) and Bauchi (304 cases) account for 86% of all cumulative cases. Fifteen LGAs across six states, Yobe (4), Borno (4), Taraba (3), Cross River (2), Gombe(1), and Zamfara (1), reported more than 100 cases each this year.
- The listed states are the states most affected by the flooding.
- Flooding also interrupted the flow and administration of immunization vaccines, which may lead to increased childhood diseases.
The World Health Organisation — WHO has recommended a few steps to protect community health during floods:
- Knowing your community’s evacuation route and warning signals and identifying areas prone to flooding or landslides.
- Chlorinating or boiling all water for drinking and food preparation
- Promoting good hygienic practices and safe food preparation techniques
- Avoiding walking or driving through flooded areas and standing water.
- Throwing away any food that has come in contact with floodwater.
- Safely cleaning your home if it has come in contact with floodwater.
- Protect against mosquitos
Additional Tips for developing countries:
- National Emergency Management Teams should provide canoes for flooded communities.
- Immunization can be continued at designated displaced persons camps.
- Community Based First Aid training for Cardio- Pulmorary Resuscitation — CPR, snake and insect bites as community members are usually the first responders.
- Alongside flood warning, information on expected diseases and infections should be shared with the public with prevention tips.
- Distribution of free mosquito nets in Internally Displaced Persons Camps
- Ensure that temporary camps are kept in sanitary conditions
Nigeria, even without the flooding, was already facing a medical crisis as the country, in the past couple of years, has witnessed large numbers of Medical Brain Drain with medical professionals (including nurses, doctors, medical support officers, and medical scientists) migrating in large numbers to other countries for better opportunities. The country currently has an estimated one medical doctor/per 100,000 population, which means that the outbreak of diseases will overburden the strained medical system due to the flooding.
Unfortunately, the Government has no immediate action plan to address the current brain drain or prevent further floodings and disease outbreaks.
President Mohammadu Buhari, on 25 October 2022, gave a directive to Ministries, Departments, and Agencies to come up with a plan to prevent future floods in 90 days; this directive came at the height of the crisis, which seemed to portray no sense of urgency at the period where states like Bayelsa where 300 Communities were reported to have been submerged in the floods.
As we await the 90-day action plan as instructed by the President, we remain hopeful that the action plan will include a health impact assessment and a comprehensive action plan on healthcare in flood situations. Non- Governmental Organisations, Civil Society Organisations, Community Based Organisations should play a part in the interim in providing awareness on the health impacts of floods, engaging community health practitioners to act as a stopgap when medical institutions are inaccessible from flooding, and, most importantly, including health impacts in the loss and damages debates as it relates to climate change.
The Following Helplines can be reached in flood-related health impact reporting:
NEMA Nigeria — 0800CALL NEMA (0800 22 55 63 62)
Nigeria Center for Disease Control — 080097000010
Compiled by Aishatu Ella-John
Supported by Ifechi Anikwe
Reviewed by Ifeoma Malo
Special Appreciation to Prof Saad Ahmed and Dr. Shakir Balogun