Medicine

Nigeria: COVID-19 Cases on the Rise Ensure Emergency Preparedness for Displaced, Vulnerable People

ABUJA, Nigeria, March 25, 2020/ — The Nigerian government should
ensure that its response to the COVID-19 pandemic is rooted in respect
for human rights by ensuring access to standard health care services,
clean water, and other basic necessities to the most vulnerable
communities, Human Rights Watch said today. The services should be
available on an equitable basis to those in low-income neighborhoods
and internally displaced people’s camps.

Nigeria has 44 confirmed COVID-19 cases as of March 24, 2020, a sharp
increase from 8 cases last week. There are currently eight cases in
Abuja, the Federal Capital Territory, and 29 in Lagos, the country’s
commercial hub. One death has been recorded, and 2 of the 44 patients
have fully recovered. As in other parts of the world, the actual
number of cases is most likely much higher, due to limited testing and
the way the virus spreads, with many who may be carrying the virus not
showing any symptoms.

“The rise in COVID-19 cases brings into focus the gaping holes in
Nigeria’s healthcare system and concerns about the government’s
ability to respond to the pandemic,” said Anietie Ewang, Nigeria
researcher at Human Rights Watch. “At this critical time, the
authorities need to provide timely and accurate information on the
country’s preparedness and address inconsistencies that may increase
the vulnerability of its citizens, especially those most at risk.”

On March 18, Tedros Adhanom Ghebreyesus, the director-general of the
World Health Organization (WHO), stated that the number of cases in
Africa was most likely higher than reported, and urged African
countries to “wake up” to threat posed by the virus. WHO had
previously highlighted the threats posed by COVID-19 in Africa, given
the shortcomings in health systems in the region, and implored
countries to invest in emergency preparedness.

Nigeria’s healthcare system is plagued with chronic underfunding and
limited infrastructure. The government repeatedly falls short on its
2001 commitment under the Abuja Declaration to spend at least 15
percent of its budget on health. In 2018, only 3.9 percent was
allocated, and in 2020, this marginally increased to 4.5 percent.
According to the Nigerian Medical Association, the country has only
about 40,000 doctors to provide care for an estimated population of
almost 200 million. The physician-to-patient ratio,according to the
WHO, is one doctor for 2,500 patients. The WHO recommended ratio is
one doctor per 1,000 patients, meaning Nigeria has less than half the
doctors it should to adequately respond in a non-crisis situation.

The Nigerian government has taken some important steps to curb the
spread of the virus, including by responding quickly to the country’s
first known case and employing extensive efforts to trace other
suspected cases or people who may have come in contact with the
initial cases. The government also undertook extensive documentation
and health checks for passengers entering the country before the March
20 ban on international travel. Since March 18, the authorities in
various states and in the Federal Capital Territory began shutting
down schools and banning large gatherings. The government has also
provided daily updates on the epidemiological situation and response.

However, the rise in the number of registered cases in recent days,
after weeks of relatively few reported cases, is a worrying sign that
the authorities must prepare to respond to the worst of the crisis.

With only five testing laboratories in the country, three of them in
Lagos, the capacity for quick testing is limited and currently only
available to those who have recently traveled internationally or had
contact with those confirmed or suspected to have the virus.

It remains unclear how well-equipped hospitals are to treat a large
influx of people with the virus. Shortages of ventilators to help
patients breathe have been recorded in other countries responding to
the virus.

While the Nigeria Center for Disease Control has rolled out a public
health advisory and sensitization campaigns to inform people about the
need to practice social distancing and to encourage personal hygiene,
including hand washing with running water, this may be difficult in
low-income communities and in internally displaced people’s camps,
where people live in congested spaces with little or no access to
basic necessities, including water.

Due to the humanitarian crisis as a result of the Boko Haram conflict
in the northeast, over 1.8 million people are internally displaced and
over 7 million need urgent life-saving assistance, including food,
health care, and water. The health situation in the camps is dire,
with acute malnutrition and high mortality rates. In January,
humanitarian workers recorded a notable increase in incidents of acute
water diarrhea and skin infections linked to the poor hygiene
conditions in camps in the Monguno Local Government Area of
northeastern Bono State. Acute respiratory infections were also
reported throughout December and January in camps and host communities
across the state. Camps in the region have also suffered recent
cholera, measles, and lassa fever outbreaks that claimed many lives.

Given these underlying poor health conditions and lack of access to
essential services in the camps, displaced people face an especially
high risk of COVID-19 mortality. Some steps have been taken to help
prevent the spread of COVID-19 in the camps, but much more needs to be
done. On March 23, the Borno State governor imposed a four week ban on
visitors to all camps in the state, and an isolation center has been
set-up to prepare for the pandemic response.

On March 15, in Enugu state, a woman suspected to have the virus
reportedly died in the isolation center of the Enugu State University
Teaching Hospital before her test results came back negative. Her
daughter, in an open letter to the governor of the state, blamed her
mother’s death on the state’s poor quarantine conditions and the
stigma her mother faced, which prevented her from getting the medical
help she needed for previous conditions unrelated to the coronavirus,
according to local news reports. In response to this case, the state
government released 20 million naira (about US $53,000) to upgrade the
isolation facility.

Nigerian authorities should urgently ensure that other isolation
facilities across the country have the resources they need to
adequately treat and support other patients under quarantine, and that
health care workers and others are trained and sensitized not to
stigmatize suspected COVID-19 patients, Human Rights Watch said.

On March 17, the National Association of Resident Doctors, Medical &
Dental Consultants Association of Nigeria, and the Nurses and Midwives
Association in the FCT embarked on an indefinite strike to protest the
authorities’ failure to pay allowances and salaries due to members
since October 2019. Members of Nigeria’s House of Representatives
intervened to assure them that their demands will be met, and the
strike was called off on March 23.

“The Nigerian authorities need to assess each state’s preparedness to
respond to the pandemic, provide information, and take quick steps to
adequately prepare to save lives, while also taking important
practical steps to curb the spread of the disease,” Ewang said. “These
steps should take into consideration existing vulnerabilities and
inequalities that impede access to basic necessities such as running
water, which is critical to keep people alive.”

Source: Human Rights Watch (HRW)