Environmental, social, and WASH factors affecting the recurrence of cholera outbreaks in displacement camps in Northeast Nigeria: a rapid appraisal

Abstract

In 2021, Nigeria witnessed a severe cholera outbreak that affected Borno state, in which more than 1,600,000 internally displaced persons (IDPs) resided at the time. This rapid appraisal explored factors that facilitate the recurrence of cholera outbreaks in sites hosting IDPs in Northeast Nigeria. Semi-structured interviews were conducted with water, sanitation, and hygiene (WASH), management, and healthcare personnel working in ten displacement camps in Borno state. The interviews were complemented by transect walks and field observations, measurements of free residual chlorine levels, and publicly available data published by the International Organization for Migration Displacement Tracking Matrix. The recurrence of cholera outbreaks appears to be facilitated by substantial interactions between IDPs and host communities, and suboptimal WASH services in camps. Of particular concern, IDP camps are exposed to extreme weather-related events that damage facilities and subsequently affect WASH practices. WASH services in camps may likewise be severely hindered by an influx of new arrivals. In conclusion, we emphasize the importance of expanding WASH activities to host communities and developing site-specific WASH interventions and chlorination targets. Practical recommendations are needed for the prevention and control of outbreaks following extreme weather-related events and population influxes. HIGHLIGHTS Challenges to the prevention and control of cholera in displacement camps are especially pronounced following shocks.; Strategies are likely to be more effective when targeting both camps and host communities.; Site-specific chlorination targets are needed to maintain adequate free residual chlorine levels throughout the year.; Interventions must be contextualized and developed through a participatory approach.;

Keywords

• acute watery diarrhoea
• epidemics
• faecal–oral diseases
• forcibly displaced people
• water-related diseases
• west africa