At a time of unprecedented global demand for medical supplies, the procurement of personal protective equipment for health care staff poses a substantial challenge. But it is a challenge we must face in order to keep frontline medical workers safe and continue treating our patients.
Clean water: A precious and limited resource
In Pulka, where MSF runs a comprehensive hospital with outreach activities, surgical capacity, maternity care, and treatment for sexual and gender-based violence, the situation is dire. Pulka is a garrison town, a population center controlled by the Nigerian military. It is now home to approximately 63,000 people, 78 percent of whom have been displaced at least once since 2015.
There are 27,000 people living in overcrowded IDP camps in Pulka with limited access to basic services, including water, food, and health care. In both Pulka and Gwoza (a neighboring garrison town) the transit camps for new arrivals are overcrowded—in Gwoza, the transit camp population is triple the recommended capacity and in Pulka communal shelters designed as two-week accommodations host people for months or even years.
In a recent water and sanitation assessment, MSF found that the daily provision of water per person in Pulka was just 11 liters, far below the minimum humanitarian standard requirement of 20 liters required for health and hygiene. Of these 11 liters only an average of two liters was chlorinated and safe to drink. Quantities as low as 4.5 liters per person have also been recorded in previous surveys.
“You have to get up early if you want to get enough water,” said Ajia Adam, an internally displaced woman living in Pulka. “I have seven children, and sometimes the water just isn’t enough for us to drink—sometimes we have to beg our neighbors for drinking water. Every day women at the borehole fight over it—we know there won’t be enough for everyone.”
Social distancing is a luxury
In Maiduguri, the capital of Borno state, the water and sanitation situation is not much better. From 1999 to 2011, MSF responded seven times to outbreaks of cholera in Maiduguri, and in 2018 more than 4,000 people were diagnosed with the waterborne disease in 18 local government areas in Borno, Adamawa, and Yobe states.
“In all the IDP settings where MSF has operations in Borno state, gaps in essential water and sanitation facilities exacerbate the threat posed by COVID-19,” said Siham Hajaj, MSF head of mission in Nigeria. “These gaps, combined with the levels of overcrowding, and endemic health issues with a lack of corresponding health infrastructure, underscore the vulnerability of the population.”
COVID-19 is not the only threat facing people in Borno state, but its presence in Nigeria highlights the extreme vulnerability of so many who have already endured war, disease, and malnutrition. For them, social distancing is an abstract luxury, and frequent hand washing diminishes a precious resource. In the face of this pandemic, the ramifications of Borno’s fragile health infrastructure are clearer than ever. It is imperative that humanitarian assistance be maintained for this population. Failure to do so will cost lives.
