This post is part of a series of interviews with subject matter experts on the northeast of Nigeria and the ongoing militant violence. TAP hopes these interviews will contribute to an issue-driven conversation on what relevant actors in the region can do to help stop the violence and improve well-being of Nigerians living in violence-prone areas.
Among the challenges in information sharing on the situation ongoing in northeast Nigeria is getting a sense of what the state government is doing to alleviate suffering of the population under its aegis, and what support is needed on the well-being of Nigerians living in the area. The Borno Commissioner of Health Min. Salma Anas-Kolo talked to TAP 10 days ago about her work in service delivery in Borno State, sharing insight into the challenges of internal displacement, the state of public health, and the ways in which state and federal governments are working together in healthcare. She talks about the overcrowding at the displacement camps and the cholera outbreak in the camps as a result. She also addresses the state’s provision of mental health services to 57 girls from Chibok Local Government Area of Borno State who managed to escape their abductors, and the challenges the state is facing in terms of human resources and support.
Can you give us some idea of what is going on and how exactly the ongoing insurgency in Borno State is affecting service delivery?
In Borno, [the health ministry] operates services at the three levels of healthcare. The basic one which is the primary healthcare. with the coming of this administration that is the one we focus on because it is the one closest to the people. We strengthened the health system in order to provide quality service to the people across the local governments and that has been effective. Twenty-two general hospitals in the twenty-two local government areas, and then three tertiary hospitals including the University Teaching Hospital established by the Federal Government. All are working effectively especially the primary health facility. But unfortunately, especially in the last two months and because of the severe insurgency attacks, a lot of population has shifted especially in the northern Borno and some parts of Southern Borno. This has also affected health workers. They have also relocated due to the insurgency while some have lost their lives. Of course this has its negative effect of the health service delivery in the state.
Does this mean that there is a lot of displacement going on?
Yes, our major challenge now is the internally displaced persons. In three local governments in southern Borno, we are experiencing internally displaced persons with 80% as children and women. This [challenge] is not only limited to Borno; Gombe State too has internally displaced persons. Within Maiduguri township itself there are a lot of internally displaced persons coming from the other local governments. We have over three thousand persons. Currently we are experiencing cholera outbreak. We were able to contain it last week but unfortunately it resurfaced again two days ago, so we are mobilizing our teams because we recorded over one thousand cases of cholera within one week.
With all of this going on, how are your linkages with NEMA? Is that going on? What kind of support are you getting from other State agencies?
We have been receiving support from the Federal Ministry of Health and National Primary Health Development Agency. So these are the two government and health agencies that have been providing support. And also some of our development partners, particularly the UN agencies. But we are still waiting for the desired support from NEMA. I am glad to mention that in Gombe state the state emergency agency has been supportive, especially with the internally displaced persons that have relocated to Gombe. But we looking forward for support from NEMA at the moment.
These IDP who are still in the northeast part of Nigeria, how safe are they?
Well, one cannot talk about safety because there are gaps in the security, but efforts are ongoing to ensure safety of the IDPs. They are located in the NYSC camp. They are provided with some level of security. Those who are in Biu that I visited recently also have some level of security. The local government provided a civilian security outfit.
Has there been in any attack of the camps?
There has not been any attack.
Any attempt of radicalization in the camp?
No, because we are really making a lot of effort, tried to resettle them. We have tried to provide enough relief materials: food, clothing and even some level of education, like for the ones in Maiduguri.
Considering the large size of Borno and the villages scattered far and wide, how do you respond to emergencies? Is there a structure in place?
What we did in Borno was to set up emergency response teams. We even set up a full department in the Ministry of health. So when there are emergencies, we send the team nearest to the area, send a lot of medicine and other materials to enable the nearest hospitals to cope, also ambulances. Within the Maiduguri township, whenever there is emergency, we have that emergency response that has been very effective. We have strengthen the general hospital in Biu and the one in Bama to be able to cope with the emergency response.
But one of the major challenges like I have said is the human resources. We do not have enough medical staff, especially medical doctors. Two years ago we had 35 but with the coming of this administration we are able to do massive recruitment for medical doctors. The same thing for the nurses. We recruited about three hundred nurses and a lot of them deployed to the rural communities. With [the abduction of the girls] in Chibok, if you would recall, we started providing rehabilitation services and we started training a lot of health workers for psychological support and counseling. We have trained almost forty health workers. Because of the insurgency a lot of them were displaced and we are now left with only four counselors. So this is the implication. We have been suffering a lot of setbacks.
I want to get a little clarification. Can you tell us where the responsibility of the state begins, where it ends and where that of the federal government begins. A lot of people do not understand this, particularly from the health angle.
From the health angle, you cannot be putting blame on one another. It is a collective responsibility. In the health sector we have been working harmoniously, jointly between the local government, the state and the federal government. So it has been a joint responsibility.
If I can give you example: despite the insecurity, we have been able to control polio transmission. This year alone we have not had a single case of polio. And that is the indication of the strength of the services, the effectiveness of collaboration between the State, the local government and the federal government. So in the health sector, we cannot say we cannot blame anyone.
Of course the federal government has a bigger role to play in terms of the leadership and also the effective coordination of whatever support is coming. If that is weak we wouldn’t be able to harness the support that is coming from the federal government and the local government. For us in the health sector I would say we do appreciate the support of the federal ministry of health, especially through the minister of health and also the support of national primary healthcare development agency.
Sexual violence has really come to the fore especially with the kidnapping of the girls, I wonder what your view is in terms of the state to deal with sexual violence both psychological and physical means.
Sexual violence has always existed in the northern part of the country, especially in Borno, and has led to the abduction of the girls. Even before the massive abduction of the girls, it has been ongoing in the population of Borno State, especially in Northern Borno. We have been making efforts and we have been mobilizing support through our partners especially UNFPA to support us. We have been implementing activities in the area of awareness creation in order to discourage sexual and gender based violence. We have a programme through the Ministry of Women of Affairs that have been implementing activities. But you know. it has to take a long time because it has to do with the attitude and then the educational level. You may recall that the illiteracy level in the north especially among women is not impressive. These are some of the contributory factors. But we are still not relenting. The state government at the moment is committed to ensure gender equality and also to promote the education of the girl child.
Are there any specific programs that you are implementing for victims of sexual violence? In Nigeria, we are not always good about mental health, and I’m sure there issues of trauma for people who have experienced violence on an almost daily basis. Who are you partnering with on this?
We are committed to ensuring that we address the issue. We set up a rehabilitation committee, and I chair that committee. It is supposed to rehabilitate and provide psychosocial support and post-traumatic treatment. So far, we have been doing that. For the 57 girls that have escaped, they have all been rehabilitated and we have provided them psychological support and trauma management. And that’s to all of them, including their parents. We have identified experts and trained people, especially health workers and other volunteers. We have also collaborated with the psychiatric hospital when there is need for further treatment. But part of the gaps that we have is the dearth of mental health services, and this is where we’re seeking support from our partners to support the state, not only at the highest level, but primary health, too. We have UNFPA to support us, too, on GBV. And we’re getting some support there. This is quite new to us as well.
Does this question of human resources apply in this case as well?
Yes, because we are training health workers and volunteers, but the major challenge like I have said earlier is that we are losing a lot of human resources because of the insurgency violence. So as we train people, a lot of them are also leaving. Our hope is to keep it going, and that we are able to retain the health workers and the skills to provide the required services.
What support to do you need? Is there any support that you need on ground that you are not currently getting, aside from the human resource issue?
Management of the IDP camps, for example. There are better ways of managing the camps. To date, we don’t have that expertise on ground, also on how to better resettle families. We don’t have to wait until the end [of the insurgency]. Of course, human resources are inadequate to cope and provide emergency response services. We have been mobilizing the International Red Cross Society to support us, but more support is needed.
You know when there is overcrowding, there is likely to be outbreak of diseases. As I said earlier we now have a cholera outbreak. We are doing our best at the state level, but we need additional support for drugs and medical supplies.
Women are the most affected. If you visit the camps, you’ll see that it’s mostly women, a few young men and mostly elderly men. So there is need for support with reproductive health kits and dignity kits for women. I saw 3 pregnant women. So there are enormous gaps.
Also as you said, there is need for more psychosocial support and counseling. And it is not a one-time event, it needs to continue. For all populations affected, we need to scale up massively to bring more to the people.
The health system needs strengthening. We are doing our best but we need to do more to strengthen all the health systems, including health system services, to be able to cope with the increasing demand.
Girls that do get pregnant, the children that they’re pregnant with, are they taken to half-way houses, their homes, what happens to them?
What happens is that we give them psychosocial support and we screen them. These screenings are across board: HIV, malaria, hepatitis, pregnancy, etc. When they are pregnant, we inform them and their parents, and we inform them enough to make their own decisions on what needs to be done. We have trained a lot of health workers on abortion care as part of comprehensive reproductive healthcare services, so based on their decisions we are able to assist them.
Can you give us a statistic on the number of girls that have been pregnant as a result of sexual violence lately? Do you have those numbers?
The only one we have recently is the one that we met and found her to be pregnant. That is the only one that I can say of the 57 that we worked with that escaped.
The IDP camps, I’m sure, need support, and people would want to know how to best support. If you live outside of the north or Abuja, who would you direct your relief materials?
Each IDP camps have a committee and chair, and they all have emergency response teams for health-related issues. In Maiduguri, they have a committee set up by the Governor and headed by the Commissioner of Women’s Affairs. So we can share with you contacts of these people when you want to provide support for the camps. The state governor also provides – and here is another area we need support – a food program. Borno State is agrarian, and with the insurgency there has been no farming activity taking place. We have also been providing relief in terms of clothing, mobilized a lot of second-handed clothes, and this is an ongoing activity also. We have done such relief drives to Biu and Maiduguri.