Samuel Ojima Adejoh, Irina Kuznetsova & Surindar Dhesi
To cite this article: Samuel Ojima Adejoh, Irina Kuznetsova & Surindar Dhesi (2022): Internally
displaced people in Lagos: environmental health conditions and access to healthcare in the context
of COVID-19, Critical Public Health, DOI: 10.1080/09581596.2022.2096427
To link to this article: https://doi.org/10.1080/09581596.2022.2096427
ABSTRACT
The paper documents environmental health conditions and healthcare
access challenges faced by internally displaced people (IDPs) from Borno
State living in informal settlements in Lagos, Nigeria, in 2020, during the
early stages of the COVID-19 pandemic. This qualitative study with 32 IDPs
suggests a high vulnerability to COVID-19. Their accommodation often
lacked basic sanitation including water and toilet facilities; overcrowding
and high population density restricted ability to adhere to social distancing;
and IDPs experienced serious consequences from lockdown, as the
majority depended on daily wages, and did not receive food packages or
other support from the State. Finally, there were obstacles to accessing
healthcare. We highlight the importance of an integrated approach, consolidating
the efforts of communities, non-governmental organisations,
environmental and public health, and international organisations to
address the health and well-being issues of IDPs in urban informal settlements.
Introduction
Africa supports a disproportionate number of internally displaced people (IDPs): worldwide, around
40%of all IDPs are in Africa, where nearly 17 million people fled their homes by the end of 2018
because of wars, violence, and climate change (Internal Displacement Monitoring Centre [IDMC],
2019a). The ongoing Boko Haram insurgency in Nigeria caused mass population displacement,
resulting in 2.2 million officially registered IDPs by December 2018, with most lacking food, adequate
health assistance and shelter (IDMC, 2019b). There are 32 official, government-run camps for IDPs in
Borno, and about 200 unofficial settlements in Maiduguri and beyond (IDMC, n.d.). Whilst there is
evidence that in South and Eastern Africa urban-dwelling refugees report higher health and environmental
satisfaction than their camp-dwelling counterparts (Crea et al., 2015), there is little direct
data on the living conditions and health care access of IDPs living in urban informal settlements and
alongside local populations in Nigeria. This paper aims to fill this gap, by mapping the environmental
health conditions and health care access of IDPs from Borno State living in Lagos in 2020. This was
prior to the introduction of vaccines in Lagos in 2021: a point when preventative public health
measures were crucial in controlling the pandemic.
In general, ‘migration and health are inextricably linked’ (Abubakar et al., 2018), and the health
needs of refugees and IDPs are typically poorly met (Miliband & Tessema, 2018). Poor and overcrowded
living conditions lacking basic facilities can impact health in terms of ability to prepare safe
food, manage pests and avoid infection and injury. Sustaining good personal hygiene, adequate ventilation and distancing to limit the spread of communicable diseases is often impossible (World
Health Organization Regional Office for Europe [WHO], 2019): issues essential to the prevention and
management of COVID-19 (World Health Organization [WHO], 2020). Further, pandemic response
measures such as lockdowns and social distancing were likely to create challenges for IDPs in Lagos,
both in terms of environmental health conditions – many live in informal housing – and income,
given the reliance on small, daily cash wages (Ukomadu & Akwagyiram, 2020).
Evidence from sub-Saharan Africa shows that public health services are frequently poorly equipped
for epidemics including tracking new conditions (Huber et al., 2018). Access to the healthcare system in
Nigeria is limited by a lack of resources – both financial and human as there is a shortage of medical
staff (Odusola et al., 2016) – and by the poverty of the population who cannot pay for services. Access
to healthcare is based on out-of-pocket (OOP) payments or insurance schemes, limiting access. OOP
payments are a common means of accessing the healthcare system for over 90%of the population in
Nigeria (WHO, 2015), and a key contributor to household poverty (Aregbeshola & Khan, 2018).
Accessibility of healthcare for IDPs in this respect is likely to be similar to other groups that experience
multidimensional poverty, which, at least in North-Eastern Nigeria, comprise 17% of the population
compared with 23% of IDPs living in poverty (Admasu et al., 2021, p. 12).
However, IDPs are excluded from the measures to increase healthcare access in Lagos. Lagos State
Government set up the Lagos State Community-Based Health Insurance Scheme (CBHIS) in 2007 to
broaden the State Health Insurance Framework to provide social health protection coverage for the
poor, informal sector population as well as underserved communities. Under this arrangement, the
scheme is to be scaled up to every local government in the State to create the stimulus for demand for
health insurance across the State (Lagos State Primary Health Care Board, 2020). However, vulnerable
groups, including IDPs, may never benefit from the scheme as they are not formally recognised and
may not be financially capable of making OOP contributions. On 27 March 2020, the Lagos State
Government introduced a food relief package ‘to cushion the effect of the lockdown on the poor and
most vulnerable people in the state’ (Okon, 2020); however, it has reportedly not been delivered to
many people in need and officials often neglect those who live in informal settlements (Olajide, 2020).
To explore issues of healthcare access and environmental health conditions of IDPs in Lagos during
the COVID-19 pandemic, we conducted a qualitative study to understand people’s lived experiences.