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A securityman administers sanitiser to a visitor to a state hospital in Lagos, on February 28, 2020.  © PIUS UTOMI EKPEI/AFP via Getty Images

(Abuja, 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 Borno 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.”

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