Boko Haram And Public Health: The Grave Consequences. (Part 1) By Abubakar Musa
If there’s anything more harmful than any kind of disease, it’s been in the midst of a war or a violence. But more worst is experiencing both the violence and any kind of disease at the same time. For those familiar with the happenings in Nigeria, the North-East region of the country needs no introduction. For the novice, however, North-East is the part of the country ravaged by the activities of an insurgent group generally refers to as BOKO HARAM – a Hausa statement that, literally, means “Western education is sinful” and whose activities, though in existence since 2001, dated back to 2009 when their leader, Muhammed Yusuf, was extrajudicially killed. While there are many social ills begging to be attended to, the very one that strucks my mind is seeing countless innocent citizens – children and adults alike – losing their lives in avoidable circumstances.
The causes of these deaths are numerous, ranging from poor security strategy, inadequate evacuation policy, unintelligent buildup, poor IDPs camps, poor relief and emergency responses, poor health and public health plans among many others. The issue of health/public health is, of the lot, as troublesome as any other, impacting negatively on the region’s population.
During the early destructive days of the sect, there were widespread warnings by the United Nations (UN) and the World Health Organization (WHO) against potential outbreaks and public health concerns across the region. As expected, the warnings were intentionally overlooked, plunging the region into uncertainty of epidemics and dangerous health trend. The increasing cases of communicable diseases in the region and among the region’s populations displaced into the neighboring states and countries confirmed the UN and WHO earlier concerns. Unavailability of preventive and control measures are index, as highlighted by the WHO, that could (and which eventually did) bring about potential risk outbreaks.
From the destructive days of the boko haram crisis, the region’s health care system, though relatively functional, has been greatly weakened, if not totally collapsed. About 47% of the region’s hospitals are out of the equation in terms of functionality, while the relatively functional ones are as far a distance between your two eyes. More than 15,000 health workers had deserted the region and about 2900 either lost their lives or are yet to be found. While it’s much a significant number that fled those states – causing a magnificent deficit in able health hands and reducing the presence of those to be attended to – the little that are available are either without efficient tools to carry appropriate diagnosis and treatments or are being traumatized whenever in efforts of doing so. According to the United Nations High Commissioner for Refugees (UNHCR) reports, over 40,000 Nigerians from the North Eastern part of the country are seeking asylum in neighboring Chad, Cameroon, and Niger Republic; while millions are scattered across the country. Though seeking asylum and moving to less volatile areas are common happenings during violence and wars, 90% that moved in this case, are living in over crowded, less ventilated, and unsanitary conditions.
Deterioration of health issues, couple with significant rise in temperature within the region, places the risk of epidemics high on the index. Regrettably, Nigeria’s Early Warning System (EWS) for diseases outbreak is unsurprisingly efficiently poor. This and other ignored social factors are resulting to the miraculous shooting in figures of the many communicable diseases across the region. Hepatitis, for example, rose from a very few hundred counts in 2009 to over 3500 cases in October 2013; equalling over 200% increase (IHV report 2013). Between that period to date, the number must certainly have more than doubled, raising more concerns on the healthcare system efficiency. For cholera and meningitis, the stories are even worse within the same time frame. Fresh cases of vaccines-preventable diseases such as measles and polio were witnessed within the region due to extremely, but not limited to, dwindling vaccinations coverage. If you’re familiar with Nigeria’s public health index, this represents a massive blow to the appreciable successes recorded in curtailing such diseases prior to the insurgency.
For maternal mortality, out of every 100,000 live births, 430 are lost – 78.9% of these deaths occurred among unbooked women and more than 90% were referred to as obstetric emergencies. Grandmultiparas suffered the highest with 36.8%, followed by teenage mothers, while P1-4 are the least. Lack of professional antenatal, skilled birth attendants, community mobilization, and health education accounts for the huge figures (Audu BM, Takai UI, Bukar M, Trends in Maternal Mortality at UMTH, Maiduguri, Nigeria). Now, of the deaths, 78.9% are due to unbooking for antenatal, making it difficult for faults that may lead to complications to be detected earlier and appropriate actions taken. In a society muddled by violence, movements are highly difficult, more so far distances. 90% of women that conceived between 2009 to date hardly attend antenatal due to fear of explosions and gunfire by the insurgents or intimidation by security agents at checkpoints or deserted streets.
Going through the various states across the region, it’s glaring for for one to see scary injuries unattended, while the few that are attended to, follow up schedule is a big flop. Additionally, all risk factors that promote the transmission of communicable diseases in emergencies are present in the current boko haram violence. Compounding an already incapacitated health care system is unavailability of drugs, which has already exacerbated an outbreak of various epidemics. Where drugs become available, they’re always looted either by the insurgents or community mobs for reasons only them can explain. Malnutrition is one beast of a condition so deadly. It flourishes under conditions of famine weak immune system, displacement, lack of resources and or poor distribution, complex emergencies and mass population movements. There’s nothing mentioned above yet to characterize the current boko haram crisis, making those cities safe heaven for malnutrition to exhibits its deadly attacks on innocent children and adults alike.
In some states within the region, children that graced the World from 2009 have had no vaccinations, while those lucky to have had, such schedules are marred by skipping of routine doses, making the overall potency of the vaccines ineffective. By implication, setting rife various conditions for epidemics which have no respect for state or national boarders. In various streets that cut across states, apart from rubbish pilling up, sewage is being seen running into streams, making the swamps grow in abundance. These are conditions that do not only breed all sorts of communicable diseases, but predict their outbreaks. Even though there aren’t reports of targeted healthcare facilities by the insurgents, the rampage of destruction against other buildings had damaged health facilities attached to such buildings. Residential buildings of health workers and health facilities that are in close proximity to security offices couldn’t be used due to fear of being caught in barrage of shooting attacks and or bombings. The impacts on service provisions are no less disturbing. Though immunization schedules and other health advocacy efforts are only averagely rendered, the coverage and participation are the worst in the region’s history. Poor link and communication systems for supportive supervisions between peripheral facilities and public health offices are abysmal – forcing committed health workers in both rural and urban areas to work in isolation. The first contact point for basic health care is, from institutionalized perspective, very poor with no personnel to attend to the very few courageous patients that turn up. In many insurgents dominated and or targeted areas, health and project officials are very reluctant to undertake field travels due to vulnerability to intimidation, abduction, and even dead from both the insurgents and the security personnel. Consequently, monitoring activities are confined to only safe and accessible areas where both travels – to and fro – and activities are possible on the same day, creating room for huge errors in functionalities and zero result outcomes. A huge setback for technical compliance and evaluation.
Delivery of essential commodities into the region is becoming increasingly difficult for reasons not better than roadblocks, checkpoints, destruction of airport towers, and the suspicious perception of attacks. In many of the states, ban of motorcycles, supplemented by restrictions of government’s vehicles movements, is necessitating the use of commercial transports for distribution of health commodities. These, together with other mitigating factors, are causing increased costs of transportation and the uncertainty of supplies reaching on time which in turn, trigger the maintenance of extra stocks at offices……to be continued.
Abubakar A. Musa