FACED with an increasing population of over 25 million people crowding within the smallest land mass in Nigeria, prioritising health and environmental matters should be a core mandate the Lagos State government should enforce. However, findings indicate overwhelming challenges of poor sanitary conditions, heightening cholera outbreaks and compromising public health safety of residents.

A tragic loss

The death of Chiemela came so shocking last year that it devastated his family. His father who couldn’t bear the shock of the loss of a son, upon receiving the sad news, followed suit. Since then, his mother has been traumatised by the death of her son and husband.

“Chiemela’s death really devastated his mother. Reaching her now over his son’s death could mean opening an old wound yet to heal,” a professor of medical microbiology, public health and medical laboratory science at the Abia State University Teaching Hospital, Ada Carol Ngwogu, told The ICIR. She was his supervisor.

Chiemela was a graduate of medical laboratory science from Abia State University before his untimely death. He died of cholera infection during the period of his internship programme at the Military Hospital Lagos.

He is was said to have contracted the infectious disease after he drank a  tiger nut drink, a locally made non-alcoholic beverage. Many of such drinks sold on the street are not registered with regulatory bodies and often fall short of the required hygienic standards. 

Chiemela started stooling and vomiting uncontrollably after drinking the tiger nut and retired to his hostel. His roommates weren’t around at the time to help him get immediate medical care. He was so weak that he couldn’t even pick up his phone to call for help. 

The cholera infection rendered him helpless till his roommates returned and carried him to the hospital, but unfortunately, Chiemela died.

“I told you that cholera can kill in hours because of its severity,” Ngwogu said as she painfully recalled the death of Chiemela, one of the graduate students assigned to her to supervise last year.

“That last outbreak in Lagos took the life of one of my students, my supervisee. The person had already graduated from medical lab science and was doing his internship in Lagos, in one of the hospitals,” she recounted.

Chiemela is just one among many victims killed by cholera during the outbreak in Lagos State last year.

Outbreak becoming endemic in Lagos

According to the Nigeria Centre for Disease Control and Prevention (NCDC), cholera is an acute diarrhoea disease caused by vibrio cholerae, a gram-negative rod-shaped bacterium. It is a potentially life-threatening, primarily waterborne disease.

On June 9, 2024, the Lagos State government declared a cholera outbreak. As of July 6, over 1,600 suspected and 70 confirmed cases had been reported in the state. Fifty-Eight people suspected to have contracted the disease have reportedly died.

The affected victims were children aged 0-4 years and persons aged 20-40 years, the United Nations Children’s Fund (UNICEF) said in a report covering the cholera incident between June 15 to July 8, 2024.

In early July, some parts of Lagos, including areas that reported cholera cases, experienced temporary flooding due to torrential rainfall. Across the country, Nigeria had recorded 2,102 suspected cholera cases from 33 states as of June 30, 2024, while Lagos State accounted for 49 per cent of the cases.

‘Cholera is a disease that has to be treated quickly’, how do you go about it?

Cholera, an acute ailment that causes severe diarrhoea, affects everybody – children, adults and the elderly, a public health specialist, Tope Ogunniyan told the reporter when he visited the infectious disease centre.

Ogunniyan, who works there, pleaded to speak as a medical personnel member and not to quote data authoritatively. He explained that people infected react to cholera by vomiting but that the main symptom is diarrhoea which leads to severe dehydration, a situation where the body loses so much water and affects its normal functioning system.

“If not quickly controlled, it can lead to death,” Oguuniyan said, pointing out that people contaminate cholera when they come in contact with food, drink, or water carrying the bacteria.

“It can affect anybody and kill them in hours after contracting the disease. By extension, it usually occurs in areas with poor sanitation, bad food habits and water storage or lack of potable water.

“Cholera is a disease that has to be treated quickly because it causes people to lose a lot of body fluids and the organs in the body shut down rapidly,” he explained, adding that it can be treated, but timely.

Ogunniyan explained further that to manage a cholera patient is to quickly restore the lost fluid which most health centres can administer. However, he warned that some primary health centres may not have the personnel or facilities to quickly respond to severe cases.

“Treating cholera does not require a specialist centre, it can be treated at a private or public health centre. But the major thing is to restore the body fluids which can be done by giving the person a drip.

“But when giving the patient drip, the medical personnel must ensure that the accurate quantity of fluid the body loses is restored,” Ogunniyan advised. 

He pointed out that where critical issues mostly arise is if there is an epidemic. In this case, people can be spread across various health facilities for proper monitoring and treatment.

“When there is an outbreak of cholera it results in diarrhoea. Although other ailments can cause diarrhoea. For cholera, the frequency and amount are much. 

“That is why any infected person must quickly rush down to the medical centre for treatment,” Ogunniyan advised, explaining that cholera contracting is not necessarily a case of lacking personal hygiene, but could be from things people buy, facilities they use, and their exposure to the environment.

It breaks out in an environment where hygiene is poor, where people’s sewages are not demarcated from drinking water and not necessarily at a particular time of the year.

In the rainy season, poor sewage, refuse disposal and contaminated rainwater can carry the bacteria into various places and contaminate foods not well stored or other items people use, compromising peoples’ health.

Dangerous for densely populated city

For a state like Lagos with a large population, Ngwogu, a professor of medical microbiology, public health and medical laboratory science at ABSUTH, said the cholera outbreak portends danger. 

“Cholera itself is often described as a disease of poverty and overcrowded vicinity. It’s contagious for a city like Lagos with a large population.

“When people don’t have a good water source or lack it, or water is not adequately distributed, they tend to scout for it from the limited sources. In that way, many people are affected if the water has been contaminated with the organisms,” she said.

Ngwogu averred that the danger of cholera is that when a person infected with it stools or vomits in an open place and flood carries it to other places, it becomes infectious to other people. 

“It is a gastrointestinal waterborne disease that comes as a result of poor sanitation and sanitary conditions, she said, adding, “Acute cases of cholera are so contagious that in a few hours, the person is gone. You can imagine somebody stooling and vomiting, the person is losing all water; all the fluid and electrolytes in the body system. 

“Those are the things that keep the body working properly. So, before you know it the body can no longer function. Imagine that our blood is 80 per cent water. When a person loses this, in hours the person will die.”

Low budgetary allocation worsens cases

Lagos State currently has a population size of over 25 million people, and according to a report from the state, its population is projected to hit 32.6 million by 2050, and over 80 million by 2100, citing a report by Global Cities Institute at the University of Toronto.

The state is faced with significant environmental challenges that make it highly prone to public health matters. The challenges include poor drainage systems, refuse disposal, lack of potable water, and other infrastructure deficits compromising sanitary conditions for residents.

The challenges are evident in places not limited to communities in Ojuwoye in Mushin, Iwaya in Yaba, Oworonshoki in Kosofe, and suburbs like Eti-Osa, Agege, Alimosho, Ojo, Ikeja, Badagary, Oshodi-Isolo, Lagos Island, and Lagos Mainland.

Across vicinities are issues of dirty markets, littered streets, blocked drainages, open defecation and indiscriminate waste disposal which the state has been failing to promptly address to restore a clean, hygienic environment for the residents.

According to the 2021 Water, Sanitation and Hygiene National Outcome Routine Mapping (WASHNORM) statistics, only 15 per cent of households in Lagos have access to safely managed sanitation services and only 35 per cent have access to hygiene services.

Amid the environmental challenges, Lagos has yet to prioritise spending on infrastructure, health and environment, despite governor Babajide Sanwo-Olu’s promises and mantra on THEMES agenda.

The mantra stands for, traffic management and transportation; health and environment; education and technology; making Lagos a 21st-century economy; entertainment and tourism; and security and governance.

With less than three years to complete his second tenure in office, Sanwo-Olu hasn’t kept his promise of improving the health budget to 15 per cent which he promised during his governorship campaign in March 2019.

A cursory look at the Lagos State budget in 2024 showed it allocated N162.08 billion for health, which represented 7.15 per cent of its approved N2.27 trillion in that year. In 2023, it allocated N149.06 billion for health, which represented 8.42 per cent out of the N1.77 trillion overall budget for that year.

The allocation has been of concern despite Governor Babajide Sanwo-Olu’s promises to raise the health budget to a double-digit percentage.

In March 2019, during one of his governorship campaigns, Sanwo-Olu promised to raise the budgetary allocation for health from 8.6 per cent to 15 per cent. He had earlier in February 2019, also promised to ensure available and sustainable management of water and sanitation for the residents of Lagos as contained in the United Nations’ Sustainable Development Goals (SDGs).

Despite his yet-to-be fulfilled promises, Sanwo-Olu further made health and environment one of the pillars of his THEMES agenda, since assuming office in May 2019, however, health and sanitation infrastructure have remained inadequate to meet the needs of the people.

Residents resort to self-help

Faced with environmental challenges, including a poor drainage system in the neighbourhood community in Iwaya, a resident, Somide Samson, has to rely on self-help.

Iwaya is a residential and commercial neighbourhood in the Yaba local council development area, a council carved out of the Lagos Mainland LGA and bounded by the Lagos Lagoon, Makoko (a slum) and the University of Lagos. 

The neighbours he shares a fence with have evacuated their belongings as the building was seen enmeshed with still water that had turned into a coloured scum on the surface.

When it rained, the neighbourhood would experience flooding into their houses. The canal would overflow with dirty waters, carrying all manner of unhygienic substances and spread into many houses.

“You can see I’m trying to fence this place to prevent water from entering my house,” Pa Samson, a pensioner said.

“The constructed canal is not good enough. This is our gutter, and the water comes from the canal. The people who constructed the canal blocked our gutter from flowing into it. I asked why, and they said the water coming from here will not enter here,” he lamented.

It was observed that the canal is even blocked at both ends with floods of plastic waste at one end and water hyacinths at the other end from the lagoon.

Olusola Akinsomi, a resident in Onike, corroborated that many places within his community have been turned into landfills as a result of the negligence of the Lagos Waste Management Authority (LAWMA), a parastatal saddled with ensuring among others the collection, removal and disposal of waste materials.

“Omotola and Owodunni streets have turned into dump sites. Down in Iwaya, which we call extension or Balogun extension, has also become a dump site,” he pointed out.

Akinsomi recounted an incident in October 2024 when a heavy downpour caused terrible damage as it flooded many people’s houses, blaming losses on the negligence of the state authorities.

“On the other side of Iwaya called Makoko, the canal is blocked with moulds and sand. Now, the canal is here, but it is not serving its purpose because it is not well constructed and has not been completed.” Akinsomi, an estate surveyor, complained.

Their woes are compounded by the fact that officials of the LAWMA rarely come into the community to pick up refuse. This has been endangering the health of the residents in the community, giving room for dumping of refuse materials at the gutters and canals.

Many places, he said, have been turned into dump sites, including a National Union of Road Transport Workers’ garage, lamenting the plight of the people living in those slums when it rains. 

“Towards the other side of Iwaya that goes to Makoko, the canal is also blocked with sand. So, there is serious flooding here. If you had been here at that time, many houses were hit, and school pupils had to leave because of flooding in their compound.

“People couldn’t go out. Mattresses were floating in the rain, especially those that were very close to the canal on the other side. It was a terrible sight. Still, the canal is here, but it’s not serving its purpose because it was not fully constructed,” Akinsomi lamented.

There are other environmental issues, including poor building construction, Akinsola said, blaming the Lagos government for lacking an effective monitoring system on environmental issues across the state.

“How can the government allow construction on muddy ground with a bad foundation”, he asked. 

According to him, the LAWMA workers pick up refuse, maybe once or twice a month, and expects the people to pay for such services.

“The people have to find a way to dispose of their refuse into the canals which are not cleared and yet to be completed. For me, majorly, that’s what’s happening within this community,” Akinsomi said.

He also cast blame on local governments, expected to be the first point of call on environmental matters, for lagging behind in community development.

“If one of their priorities is ensuring proper waste management, then the environment will be better for all the residents to live in without suffering any of the public health diseases,” he said.

“But the government has been reactive in responding to reoccurring environmental issues in the state,” Akinsola maintained, adding, “If they are proactive, we should have a safer environment to operate.” 

At Oworoshoki, a community in the Kosofe local government area, Wasiu Adeleke Segun, living in Ferry, one of the slums, told The ICIR that the government needs to clean up many environments within the state as it is affecting the health of the people. 

He believes that people living in shanties and suffering similar living conditions are looking for money to feed and not to pay hospital bills.

“Government, help your nation, give us better things. We need social amenities such as hospitals, water, good roads, electricity, because health is wealth,” Segun urged the state authority.

Low enforcement, negligence

The Lagos State government seems not to be enforcing its environmental law as a majority of its provisions are openly flouted.

In March 2017, the Lagos State Environmental Management Protection Law was passed into law. It consolidates all the laws and regulations applicable to the management, protection and sustainable development of the environment in the state. 

It delves into more modern cosmopolitan environmental issues like littering, dumping of untreated toxic and or radioactive material into public drains, street trading and hawking.

It further prohibits urinating and defecating in open and public drains; discharge of waste matters and wastewater into the public drain or environment and dumping of refuse on the road and into the public drain.

Others include unhygienic toilet facilities, and non-provision of toilet facilities at home, hotels, restaurants/bars.

‘Providing potable water, a challenge’ 

“We’ve never gotten that universal coverage for potable water which has been a major issue across the board,” the executive director of Development Communications (DevComs) Network, Akin Jimoh, averred.

Cholera comes and goes but is usually found in instances where the hygiene situation is not really good enough, said the boss of DevComs, a non-governmental organisation promoting public health among others.

“When we look at the source of water, how do you treat the water? What do we do after we’ve treated the water and so on?

“Those days, there used to be a public water supply, where are they now? So, having universal coverage in terms of potable water is very key at any point in time. If we don’t have that, what else can you do? Jimoh quarried.

“Recently, I was at Abesan Estate, [a low-income housing estate]. The people there have a first-class water supply, but they don’t use it because every building has a borehole,” he said.

Measures to prevent outbreak

The Lagos State government must first and foremost look into the issue of sanitary conditions in the state, Ngwogu suggested.

“What is the cause or reason why people defecate outside or in an open place? It is because they don’t have good toilets or can’t find any good public toilets.

“Nobody will see a neat toilet that has a good water source and defecate outside or in an open place,” she asserted.

She said the state agencies saddled with the responsibilities of public health environmental issues must also start visiting residents and offices to ensure sewage disposal and other toilet facilities are well in place.

“Government agencies need to visit houses to find out the sanitary conditions of the people, especially in the slums and shanties. They should also note that cholera is not restricted to people living in slums as those people go to offices in Victoria Island and other commercial centres,” she said.

Government silence: Commissioner, medical centre decline enquiries

In the course of the fieldwork, several efforts were made to get data and other enquiries from the Lagos State authority to match the UNICEF report but to no avail. 

The state commissioner for health, Akin Abayomi, didn’t respond to emails, calls, texts and WhatsApp messages sent to him, despite follow-ups and reminders. When the reporter visited the Mainland Hospital, the state’s Infectious Disease Hospital in Yaba, he was told to direct his enquiries to the state health ministry.

Similarly, the Federal Medical Centre (FMC), Ebute Metta, Lagos, didn’t grant The ICIR request to speak with its health practitioners at the forefront of treating and mitigating the spread of the cholera disease.

The chief medical director, Adedamola Dada, didn’t approve the request to engage the hospital’s research unit for enquiries and data on the cholera outbreak, despite initial and follow-up letters acknowledged by his office.