Timothy Olanrewaju, Maiduguri
Before the Boko Haram insurgency hit the northeast states of Nigeria, life was normal for the millions of Nigerians now living in camps. But they were forced to flee their homes leaving the dead behind and taking refuge in unsure clusters of tents. But then, the insurgents would not let them be.
Land mines and explosives buried by the insurgents in the ground in vast swaths of the territory once controlled by them are yet to be located, exhumed and deactivated.
Today, the presence of the explosive ordinances make accessibility to camps in such areas difficult and risky for humanitarian workers or even military personnel. Indeed, internally displaced persons (IDPs) in those camps are the hard-to-reach people.
Some of the settlements now harbouring the victims are ‘domiciled’ in difficult terrains with little
or no access to water and medical facilities. Previously existing makeshift healthcare centres in the
refuge areas had been torched by the insurgents, leaving the people vulnerable to disease outbreaks.
One of these vulnerable persons is Saratu Mohammed, whose greatest nightmare is how to save
her one-month-old baby boy. She had lost the first child a year earlier at Barkam, a remote village in
Bayo Local Government Area in the southern part of Borno State.
At first, she appeared unwilling to discuss her past but she said the presence of health workers encouraged her to speak out.
“Three days after I was delivered at home in this village, a year ago, I lost our first baby,” she began her story in a rather pensive mood. There was a big silence around the small home that housed
the family of three. “My husband and I were very curious about my pregnancy because of my previous experience,” she added.
Barkam is a small, rocky community tucked away from basic amenities and the savanna nature
of most communities in southern Borno. There is no clinic or any health facility. Indigenes and residents rely on bicycle or motorcycle for transportation. The only road to the area is a footpath carved out of rocks and stones, making the one hour journey to the village by motorbike a tedious one.
So when Saratu went into labour early May, she said the task of getting her to the nearest primary health centre, located 14 kilometres away at Bayo, the local government headquarters, by her husband on his bicycle, was backbreaking.
“Unfortunately when we got there, there was no health worker except the labour ward attendant who was at work because he lived in the premises of the health facility,” she said.
Thankfully, she delivered safely, though the fear of losing the second baby still lived with her, especially with no vaccination to build the child’s resistance to minor ailments like malaria and
The intervention by the World Health Organization (WHO) mobile health team for the hard-to-reach areas however allayed Saratu’s fear as her son was vaccinated by the team during one of the visits to Barkam. Other community members were also treated.
Second “attack” after Boko Haram
Many of the people that fled their homes into locations far from their communities had heaved a
sigh of relief having survived the Boko Haram onslaught. But hardly had they settled down in their
new “homes” than diseases broke out, claiming lives in some cases.
The population in these settlements increased daily as hundreds of people fled their homes in
search of refuge.
The camps holding the IDPs are generally crowded, having little or no facilities and of very poor
hygiene. Officials from the state health services said they could not access such areas because the
roads were unsafe and accessing people there became difficult.
Consequently, outbreaks of malaria, diarrhea and cholera have become prevalent in such settlements, the reason for which the WHO launched the mobile health team for hard-to-reach areas. The target, according to WHO officials, is to give medical services to locals.
“This is why WHO developed the mobile health services with qualified workers to take health services to people, including IDPs difficult to reach. They can’t come out of their environment either because of security situation around them or the difficulty in the terrain.
Examples are Barkam or Gwoza. Our team took the vaccination to her and treated other community
members of minor ailments like malaria,” WHO Mobile Team Coordinator, Mrs Saratu Ayuba,
told Sunday Sun.
She said the organization constituted 113 mobile teams for Borno, Adamawa and Yobe states,
reaching the communities with canoes, bicycles, motorbikes, and donkey or sometimes trekking
“In the beginning, it was a team recruited to intensify routine immunization against polio where there were no health facilities but we later found out thousands of people were there in the communities with more health issues. WHO then scaled up the teams to move into settlements in 25 accessible LGAs. We were touched by the challenges as in most cases there are no hospitals, drugs or health workers to support them,” she explained.
The risky journey
The journey to Kukawa, Borno’s troubled town near Lake Chad by a WHO mobile team was a risky one. Kukawa, about 183 kilometres to Maiduguri, Borno’s capital is located along the Nigeria-Chad border.
It was once under Boko Haram siege until 2016 when military forces liberated it. But then, security is still a big issue here as the insurgents were yet to be completely cleared from the area. In the last three months,
Boko Haram has attacked military bases around the Lake Chad area. The state Ministry of Health had reported outbreak of acute water diarrhea – a milder condition than diarrhea at Kukawa. Within days, WHO and other health organizations moved into the area to step up treatment of patients.
Sadly, one Ali Bukar, lost his five-year-old boy before the arrival of the medical team to the small town, in February. Ali Bukar had been taking refuge at Baga, few kilometres away until early this year when he and his family decided to return to Kukawa, his ancestral home after the military declared
the town safe. He managed to survive the insurgents’ attack in 2014 but lost his young son to acute water diarrhea after returning to Kukawa, a state health official said on condition of
Upon the return of the natives to Kukawa, public buildings including the only primary health centre in the town had been destroyed by the insurgents. With high population movement of IDPs
returning to the area and no clean water, sanitation became very poor, resulting in the outbreak of cholera.
The state ministry of health said other diseases like chickenpox, rashes, skin infections and malaria also broke out in the area. Amid these health challenges, Bukar’s son died even before
health workers could reach the area. Kukawa like Barkam is one of the hard-to-reach communities in Borno.
The road is largely unsecured and in some instances, laced with mines or improvised explosives buried by the insurgents.
UN air support
With possibility of mines and explosives along the roads leading to these areas, air transport became the only solution to move health workers to volatile areas like Kukawa. The head of the WHO Health Emergencies Programme, Northeast, Dr Collins Owili, said many people are still trapped in such volatile areas.
“Although, some areas have become accessible, the only way WHO staff get to Monguno, Damasak, Gworza, Banki, Ngala and many other locations in the northeast, where people are still trapped and
living under inhospitable conditions is by UN Humanitarian Air Service helicopter or with military escort,” he said.
He said the air service helps WHO in collaborating with the state government and provides health
services to hard-to-reach people in these areas. Former Commissioner of Health, Dr Haruna Mshelia,
said Boko Haram has destroyed most of the hospitals or health facilities in such areas.
He said the air service helps the mobile health teams to reach difficult areas, thereby enabling the people to enjoy medical services.
“Our people in such areas can’t access health facilities because the hospitals and health centers have been burnt by Boko Haram though government is rebuilding most of these facilities. WHO and other partners came to bridge this deficit, hence we would have had serious health crisis in the state,” Mshelia told Sunday Sun shortly before the dissolution of the state executive early October.
He said health workers have been deployed to health facilities in the local government headquarters while the international partners give support to those in hard-to-reach areas.
About 2 million people have been displaced by the Boko Haram insurgency in the northeast states of Adamawa, Borno and Yobe with Borno having 1.5 million IDPs, the highest number of displaced people according to a 2017 report by the World Health Organization (WHO) and Displacement Tracking Matrix on northeast by the International Organization on Migration (IOM).
The WHO 2017 Annual Report on northeast health emergencies programme shows incidence of more than 5,300 reported cases of cholera mostly in IDPs camps in Borno State, four cases of wild polio virus in 2016 and meningitis in Yobe State. Health experts believe that lack of access to medical services was responsible for the outbreaks.
Again, Saratu Ayuba, the WHO mobile health team coordinator, said the difficulty in accessing health services could trigger more outbreaks. She said the mobile health team was initially recruited to intensify routine immunization for polio but WHO decided to scale up its operation to cater for other minor ailments among people in hard- to-reach areas.
She said the organization has 113 teams with 58 working in Borno, 35 in Yobe and 20 in Adamawa states. “Our job is to provide free medical services, treat minor ailments for the target population in all the hard-to-reach settlements, do health promotion and disease surveillance in these difficult areas,” she explained.
WHO representative to Nigeria, Dr Wondimagegnehu Alemu, said majority of the childhood deaths are preventable with “high impact interventions and treatable with low-cost medicines
which most children in the area and Nigeria do not receive.” But then there is another bigger challenge: the risk of fresh Boko Haram attacks, killing or abduction of health and humanitarian
workers in Borno.
“Sometimes our teams are under the risk of Boko Haram attacks during intervention,” WHO Health Emergency Communication officer, northeast, Chima Onuekwe, disclosed. He recalled how the
mobile team on hard-to-reach intervention was nearly ambushed by Boko Haram.
“The villagers helped our team to escape when they sensed threats by the armed group,” he said. Some locals said interventions by the United Nations agencies, international and national
organizations have helped in building their resilience in the lingering Boko Haram crisis entering its ninth year.
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