In northeast Nigeria, where armed conflict has forced millions from their homes, the UN's migration agency, IOM, is supporting the construction of quarantine shelters, as the region braces for an outbreak of COVID-19 which, it warns, would have 'devastating consequences' for those who have been displaced.
Displaced people there already face outbreaks of several deadly diseases, including cholera, malaria and measles, and fighting has severely weakened the health system: more than a third of facilities have been destroyed in attacks, and there is limited access to drinking water and sanitation infrastructure.
IOM fears an outbreak of COVID-19 would exacerbate the current situation, placing further stress on disrupted health systems, and potentially overwhelm the response capacity of international humanitarian agencies. A rise in cases is also likely to increase current projections of people in need.
Crisis on all fronts
COVID-19 is arriving in northeast Nigeria with the region some ten years into a brutal conflict that has led to around 7.9 million people in need of humanitarian assistance. 2019 saw an upsurge in violence, and more than 180,000 people fled their homes.
The renewed conflict has restricted humanitarian operations, with aid workers increasingly the focus of armed groups. Humanitarian offices and accommodation have been hit, and 12 aid workers killed in the last year. Only 15 per cent of Borno State is currently accessible to humanitarian agencies.
Despite the instability, the UN and partners are forging ahead with quarantine shelter construction, which will serve internally displaced people and host communities in the northeastern towns of Gwoza, Pulka, Bama, Dikwa and Monguno.
Each shelter will contain individual units with a latrine, shower, handwashing station and living quarters. To minimise the risk of virus spread, facilities will have separate entrance and registration areas, as well as restricted areas for health personnel.
"Given the rapidly evolving situation in Nigeria and across the world, we must ensure that the health of displaced and host communities is a central part of our response", said Franz Celestin, IOM Nigeria Chief of Mission.
Drastic increase in funding needed
As well as building quarantine shelters, IOM is relocating residents from congested camps to new facilities (around half of the camps in Borno are overcrowded); disseminating hygiene messages; and providing basic hygiene items.
"Camp decongestion has been a challenge, but it is now a priority. I call on all stakeholders to urgently contribute to efforts being made to decongest camps in respect of people's rights and dignity", said Edward Kallon, the Humanitarian Coordinator in Nigeria.
The existing Humanitarian Response Plan for Nigeria calls for $86.2 million for life-saving health services. IOM estimates that this requirement is likely to increase by one-third, if COVID-19 gains a foothold in the northeast.
The money will be needed for improved coordination, extra surveillance and contact tracing; as well as providing access to life-saving clinical care and treatment for COVID-19.
In addition, to control the spread, it will be necessary to buy and administer tests, and protective equipment for frontline workers; put in place additional prevention and control measures; share risk communication messages; and build additional quarantine shelters and isolation centres.