Strong response to polio in the North East, stuttering response to health and nutrition

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Following the detection of three new polio cases in Nigeria, The Nigerian government and its partners have mounted a massive, largely well-coordinated response. The Nigerian Government rapidly released an unprecedented N9.8B to support the response. Together with support from several international partners, this will fund an intensive outbreak response which includes five rounds of vaccination and the strengthening of surveillance.

This will hopefully put Nigeria on the path to eradication again after the country had been declared free of polio for the past two years. Thousands of Nigerians have been again mobilised to support the response, being done in collaboration with the Armed Forces in parts of the country where access is still a problem due to conflict and insurgency. All the neighbouring countries, members of the Lake Chad Basin, have been asked to synchronise activities for a massive regional response.

Children displaced by the Boko Haram insurgency attend a class at Maikohi secondary school camp for internally displaced persons (IDP) in Yola, Adamawa State. The Boko Haram insurgency has restricted access to places in Borno State, limiting polio immunization efforts. Photo Credit: REUTERS/Afolabi Sotunde
Children displaced by the Boko Haram insurgency attend a class at Maikohi secondary school camp for internally displaced persons (IDP) in Yola, Adamawa State. The Boko Haram insurgency has restricted access to affected communities, limiting polio immunisation efforts. Photo Credit: REUTERS/Afolabi Sotunde

After two years of being polio-free, the three new cases in Borno brought a huge sense of disappointment to many of those working in the public health space, as the eradication of polio from Nigeria had until then seemed to be at least within sight, if not within grasp, after a long, hard-fought battle to get off the list of endemic countries for polio. Testing  of the viruses in the detected cases suggests that the viruses are closely linked to a wild polio virus strain that was last detected in Borno in 2011. While that may seem surprising to some, it is no secret that access to many of the areas in Borno in recent times has been limited by the Boko Haram insurgency, making vaccination an extremely difficult exercise.

Now that more areas are being freed, access is improving, surveillance strengthening – leading to the detection of these three cases. There is no doubt that the polio re-emergence has brought a new set of expertise to public health in Nigeria and with the intensive response mounted, many in the public health space  seem confident that Nigeria has the ability to get ahead of the curve and eliminate polio from within its borders and the continent.

Polio surveillance is improving following the resurgence of cases in the NorthEast. Photo Courtesy cracong.org
Polio surveillance in the NorthEast is improving after the opening up of those areas previously held under insurgency. Photo Courtesy cracong.org

This, to be honest, is good news. No one can deny that. At the same time, however, there is another humanitarian and health emergency in the North East, one that seems not to be getting as much support in Nigeria. The emergency itself was declared after the foreign press broke stories of severe malnutrition in many of the IDP camps in the North East. Since then, UN bodies and other agencies have been launching appeals to support the region. The World Health Organisation (WHO) has categorized the emergency as a level 3 incident. The  UN High Commission for Refugees (UNHCR) has just launched a  scale up plan to meet the increased humanitarian and protection needs of displaced individuals in the region. The latest Displacement Tracking Matrix (DTM) report of August 2016 released by the International Organisation for Migration (IOM), estimates that 1.87 million people have been internally displaced by the Boko Haram insurgency in the Northeast, 77 percent of whom are being hosted in Borno State. While the Nigerian government appears quiet, the fund raising on our behalf is well under way. UNICEF has started an appeal looking to raise $115M. UNHCR is seeking $40M.

Malnutrition in NorthEast Nigeria has become a greater challenge than the polio epidemic. Photo Courtesy: dailymail.co.uk
Malnutrition in NorthEast Nigeria has become a greater challenge than the polio epidemic. Photo Courtesy: dailymail.co.uk

The urgency of the situation in the North East was brought to the world’s attention by some excellent reporting by Phoebe Greenwood of the UK Guardian. Her heart-wrenching video  on the situation in Northern Nigeria suggested that hundreds are already dying every day from hunger in a food crisis caused by seven years of the brutal Boko Haram insurgency. Filming this story could not have been easy as Nigerian government authorities maintain tight control over media access to the region.

Despite all of this, there appears to be a significant apathy in Nigeria that is hard to explain. It might be the lack of reporting in the Nigerian press or the lack of pictures that highlight exactly how dire the situation really is. It may be that we are just tired of all the bad news out of Nigeria that we have chosen to shut this one out. It may be that we that we hope that the problems will go away.

If there is one thing that we can all be sure of, it is that we will pay a price for our inaction as a country, if we do not do more to engage now.

There are no quick fixes. A report of the North-East assessment conducted by the Special Duties Unit of the Federal Ministry of Health suggests that overall, due to the insurgency, 800 health facilities have been destroyed in Yobe, Adamawa, Gombe and Borno. Many areas are still effectively inaccessible and everywhere accessibility improves, many new people are found with various levels of malnutrition.

Aid Worker and Photographer Fati Abubakar tells positive stories of Borno on her instagram page @bitsofborno. Photo Credit: Fati Abubakar, Courtesy: thisisafrica.me
Women rush to a food distribution point. Aid Worker and Photographer Fati Abubakar tells positive stories of Borno on her instagram page @bitsofborno. Photo Credit: Fati Abubakar, Courtesy: thisisafrica.me

The mothers and children in Borno need us more than ever. We as a Nigerian government, as Nigerian organisations, as Nigerians, have to take the lead in the response. The Government of Borno appears to be doing their very best, but this is not a Borno problem, and the response should not be a Borno response. Barring the press has contributed to this to some extent – which makes Fati Abubakar’s pictures extremely powerful in telling the human story of suffering and hope in Borno.

We must find it in us to arouse the consciousness of the country to the unfolding situation in the North East. Many children have not been to school in years. Most health care workers have left. We cannot leave them to their own means.

Now is the time for citizens, civil society and government to come together and work together to bring hope and healing to Nigerians in the North East.

Now is the time.

Discussion3 Comments

  1. The social and economic determinants of health drive much of the health status in Nigeria. However, much like the elephant in the room, playing a huge role in Nigeria is the religious and belief systems which dictate decision making by the person, family and society. We need to apply science to understand and assess the interface of religious and belief systems with health and disease, health services and any planned interventions. That way the health system can apply what is good, ignore what is harmless and eliminate what is harmful in religious and belief systems determinants. To do this health must partner with religion.

  2. Dr. Amina Ahmad-Shehu

    It is really heartwrenching to see the pathetic situation of the Internally Displaced Persons; and there seems to be a weak or non-existent system for concerned citizens and organizations to key into. That I believe is one of the reasons why Nigerians appear apathetic to the situation in the IDP camps in the North-East. If the routes of engagement can be be made known, I’m sure there will be many who will reach out with help; financial, technical etc.

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