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Floods lead to tremendous losses of property, infrastructure, business and increased risk of diseases. Floods are also the most frequent natural disasters, affecting over 2.8 billion people in the world and causing over 200 000 deaths over the past three decades. The World Health Organization categorised the 2012 flood disaster in Nigeria as the worst flood to have hit the country in the past 50 years. This study reviews flood disasters in Nigeria and how they have been managed over the past two decades. The extensive review of the literature is complemented by data obtained from Ajegunle, a community in Ajeromi-Ifelodun Local Government Area. Because of its proximity to water bodies, its large population and its small land mass, the Ajegunle community is highly susceptible to floods and outbreaks of waterborne diseases. The study also discusses the institutionalisation and development of disaster management in Nigeria. Further, it critically evaluates the disaster management framework and other current disaster management policies as well as the effectiveness and functions of the disaster management focus areas and government response. The study takes a historic approach to flood disasters, linking disaster management to human health with a special focus on flood-related infectious diseases, isolating waterborne diseases as being predominant. Quantitative and qualitative data were collected to develop an understanding of how the people of Ajegunle are affected by flood disasters. This study reveals poorly managed health reforms and argues that in spite of government’s disaster management policies, there is an absence of organised and coordinated institutional structures to plan and respond to flood emergencies. It also revealed that diarrhoea outbreak was the predominant waterborne disease associated with flood disasters. Although Lagos State has been said to have the best flood preparedness plan in Nigeria, it has failed to reduce the yearly flood disasters and their impact on the health of the people. The article suggests a holistic approach by the government to get stakeholders, especially the health sector, more actively involved in disaster management planning.
The research employed the quantitative and qualitative approaches. Ajegunle is comprised of 335 streets and 42 neighbourhoods (Asomba 2013). Five neighbourhoods, which include Aiyetoro, Okorogbo, Mba, Wowo and Alakoto were purposively selected for study. The areas were selected based on neighbourhoods that suffer the most flooding after heavy rainfall, have higher population density, have open market trading and high recorded waterborne diseases. Quantitative data were obtained from field-level questionnaires using closed-ended questions. The questionnaires had two sections. The first section comprised personal data with information on respondents’ age, sex, occupation, marital status, educational level, household size and annual income. The second section collected information about the impact of floods on the health of respondents, effects of waterborne diseases and government assistance. A total 280 questionnaires were distributed to 56 residents selected purposively based on availability and knowledge of floods from each of the five neighbourhoods. The qualitative data that depicted the perceptions held by the affected people in the community were obtained from key informant interviews with community heads, property owners, traders, taxi drivers, schoolteachers and nurses. In addition, on-the-spot assessments of the selected neighbourhoods were carried out by volunteers, who included a medical doctor, two teachers, a community pharmacist, three traders and two civil engineers. They assessed livelihood patterns, availability of pipe-borne water, infrastructure, proximity and conditions of healthcare facilities. Disaster management involves the coordination and integration of all activities necessary to build, sustain and improve the capabilities of communities to prepare for, protect against, respond to and recover from threats or actual natural or man-made disasters (NDMF 2010). Disaster management started in Nigeria in 1906 with the establishment of the Fire Brigade (now known as the Federal Fire Service), responsible for saving lives and property in addition to its primary function of firefighting and provision of humanitarian services during emergencies (Adelekan 2010). In 1972–1973, northern Nigeria suffered a devastating drought disaster with high socio-economic losses of lives and property worth millions of dollars. The impact of the disaster was so enormous that the government decided to create a response body to take care of disaster issues. This led to the creation of the National Emergency Relief Agency (NERA) by Decree 48 of 1976 (Shaba 2009). NERA was charged with the responsibility of collecting and distributing relief materials to disaster victims. However, based on the need for a holistic approach to disaster management, the name NERA was changed to National Emergency Management Agency (NEMA) to accommodate its expanded functions (Shaba 2009). In March 1999, NEMA was established through Act 12 of 1999 as amended by Act 50 of 1999. NEMA was given the responsibility of coordinating disaster management activities for the country (Nigeria-Government 2010) NEMA had roles and functions that were designed for a holistic approach to disaster management as stated in its mission statement. Their mission is: to coordinate and facilitate disaster management efforts aimed at reducing the loss of lives and property and protect lives from hazard by the leading and support of disaster management stakeholders in a comprehensive risk based emergency management program of mitigation, preparedness response and recovery. (NEMA n.d.b) The specific functions of NEMA include (1) disaster preparedness and mitigation activities; (2) notify, activate, mobilise and deploy staff as well as set up all necessary facilities for response; (3) evaluation and assessment of disaster damages; (4) management of funds for disaster; (5) inform and enlighten the public; (6) formulation of disaster management policies and guidelines in the country and (7) distribution of relief materials to disaster victims by liaising with State Emergency Management Committees, non-governmental organisations (NGOs), regional and international bodies (NEMA 2004a; Shaba 2009). The organisational structure of NEMA is made up of five main departments and three units. These comprise the following: search and rescue, relief and rehabilitation, training, finance and administration, a public relations unit, legal unit and audit unit. The objectives of NEMA are achieved by collaborating with state government, local government, voluntary organisations, international agencies and 57 disaster response units scattered all over the country (Ndiribe 2010; NEMA n.d.b). In August 2006, zonal offices of NEMA were opened in the six geopolitical zones of the country to take disaster management to the community level. The functional State Emergency Management Agency (SEMA) backed by law with full operational capability was established in states to enhance proximity to the communities for the purpose of communication and coordination (NEMA 2004b). Local Government Emergency Management Committees were established in response to calls from communities with strong facts that disaster strikes are felt mostly in communities (Nigeria-government 2010). The synergy of the three jurisdictional organisations (federal, state and local government) centres on the principle of shared responsibility and the leverage to ensure proper integration and collaboration among stakeholders and reduce the likelihood and severity of disasters (NDMF 2010). The Grassroots Emergency Volunteer Corps was carved out to give communities the capacity to respond to threats themselves because these communities are at the forefront of the disasters, referred to as ‘disaster fronts’ (Shaba 2009). The involvement of different stakeholders and actors in disaster management made it essential to have a mechanism to collaborate and coordinate activities. This mechanism is provided by the NDMF, which serves as a regulatory guideline for effective and efficient disaster management in Nigeria. Other current documents that complement the NEMA Act include the Search and Rescue and Epidemic Evacuation Plan (NEMA 2011b), the National Contingency Plan of Nigeria (NEMA & UNICEF 2011) and Lake Nyos Disaster Response Plan (NEMA 2011a). The Search and Rescue and Epidemic Evacuation Plan is responsible for action plans in nine disaster scenarios, namely floods, fires, rail accidents, collapsed buildings, maritime-related disasters, oil spill disasters, aviation disasters, epidemics and road traffic accidents (Atala 2011). The Search and Rescue and Epidemic Evacuation Plan effectively coordinates at the scene of the disaster. The availability and promptness of personnel and materials at the scene leaves much to be desired. The National Contingency Plan of Nigeria focuses on hazards having the highest probability of occurrence and severity, such as floods, droughts, epidemics and communal conflicts. The contingency plan defines the modus operandi for the engagement of international assistance when it is required. The plan was tested and limited to a population of 10 000 and so has suffered a lot of setbacks, as it is not pragmatic and workable in a very high population (NEMA & UNICEF 2011). During the 2012 flood disaster, the contingency plan could not be implemented, as over 5 million people were affected. The limitation to the existing plan calls for a better plan that can accommodate the population of a state in the country to say the least. There is a need for all stakeholders and various actors in disaster management to exist in a coordinated and collaborative mechanism. The NDMF provides this mechanism, which led to its establishment in 2010 (Okoli 2014). NDMF defines coordinating structures that are measurable, adaptable and flexible and aligns key roles and responsibilities of disaster management stakeholders across the nation, describing specific authorities and best practices for managing disasters and explaining a paradigm shift in disaster management beyond mere response and recovery, offering a holistic approach to disaster management (NDMF 2010). The NDMF serves as a legal instrument to address the need for consistency among multi-stakeholders. It provides coherency, transparency and inclusive policy for disaster management in Nigeria. The framework was written so that government officials, civil society organisations, private sector, emergency management practitioners and community leaders can understand the concept and operating guidelines of disaster management in the country. The NDMF focuses on eight sections made up of seven focus areas and sufficiency criteria. These include institutional capacity, Coordination, Disaster Risk Assessment, Disaster Risk Reduction, Disaster Prevention, Preparedness and Mitigation, Disaster Response, Disaster Recovery, Facilitators and Enablers (Nigeria-government 2010). While the efforts of the Nigerian government are appreciated in the NDMF plan laid out, the response of NEMA falls short of effective disaster management requirements. The focus is mainly on drawing up response strategies rather than prevention and reduction because of financial, equipment, accommodation and mobility challenges (Aladegbola & Akinlade 2012). Inadequate funding is said to be a major cause for the failure of the NDMF. Proper, adequate and prompt government funding is very essential to determine the efficacy and effectiveness of the NDMF. Adequate material resources to carry out allocated tasks are lacking (Aladegbola & Akinlade 2012). Equipment and technology to predict, detect and mitigate disasters and the building of human capacity are needed (Adefisoye 2015). The Nigerian government’s failure to effectively manage disasters can be attributed to poor planning, response and management, taking into account the yearly flood disasters experienced in Lagos (Aladegbola & Akinlade 2012) and other coastal regions in Nigeria. Annual flooding is experienced in Lagos usually from the month of July to October with increasing frequency and severity of impact (Nkwunonwo, Whitworth & Baily 2016). Responses to emergency calls have been very poor. Notable ones are the flood disasters in 2011 and 2012, which point to poor coordination of activities (Adefisoye 2015). Flood management in Lagos is being queried in terms of effectiveness and management policies (Adelekan 2016), lack of early warning and evaluation systems (Nkwunonwo et al. 2016) and lack of data and poor data scale. In the 774 LGAs in Nigeria, response initiatives are worst and emergency services are dysfunctional because state governors failed to ensure that democratic structures are institutionalised at the grassroots level of the 36 states and 774 local councils (Onwabiko 2012). Most of the states with SEMA have not assumed optimal operation since their existence (Adefisoye 2015). According to Adefisoye (2015), there is a lack of full backing by the law added to the non-conformity and non-compliance of its provision at the LGA. Research revealed that the functions of NDMF are not carried out especially in the SEMA and Local Government Emergency Management Agency (LEMA) because NEMA is not empowered by law to punish them (Adefisoye 2015). Lately, the NDMF has incorporated operations such as improvement of general flood awareness through the National Orientation Agency, flood warning via Nigeria Hydrological Services Agency and integration of local, state and government emergency management agencies (Nkwunonwo et al. 2016). Despite all this, the NDMF is criticised as weak as the roles of this institution are not clearly defined (Adelekan 2016; Nkwunonwo et al. 2014). Healthcare service delivery is a vital factor for the sustainable development of any nation (Briggs-Iti 2012). Nigeria’s healthcare has suffered various downfalls according to the Health Reform Foundation of Nigeria (HERFON n.d). Healthcare is greatly underserved in Nigeria. Health centres, personnel and medical equipment are inadequate, especially in rural areas. This was evident during one of the visits to Ajegunle. While reforms like the Nigeria Health Insurance Scheme (NHIS) put forward by the Nigerian government are operational at the national level, they are yet to be implemented at the state government level (Monye 2006) and by extrapolation the local government level. According to the 2009 communique of the Nigerian National Health Conference (NNHC 2009), healthcare systems remain weak as presented by lack of coordination, inadequate and decaying infrastructure, inequality in resource distribution, fragmentation of services and deplorable quality of care. A lack of clarity of roles and responsibilities among different levels of government compounds the situation. Healthcare provision in the country remains a primary function of the three tiers of government – federal, state and local (Adeyemo 2005). Primary healthcare system is managed by the existing 774 LGAs in Nigeria with support from their respective ministries of health in the states and private medical practitioners (Omoruan, Bamidele & Phillip 2009). There are also sublevels of primary healthcare at the village, district and LGA levels. The Ministry of Health at the state level manages secondary healthcare system. Patients from primary healthcare are referred to secondary healthcare. The teaching hospitals and specialist hospitals provide tertiary healthcare. At the tertiary level, the government also works with voluntary organisations, NGOs and private practitioners (Adeyemo 2005). The Nigerian healthcare system has weathered several infectious disease outbreaks and chemical poisoning occurrences over decades (HERFON n.d). Several studies have reviewed the Nigerian healthcare system and offered possible recommendations to improve the state of healthcare in the country. Several healthcare reforms have been launched in Nigeria by the federal government to revitalise the worsening state of health over the years (Awosika 2005) – for example, the 10-year development plan from 1946 to 1956, the Primary Healthcare Plan of 1987 and the NHIS, established in 2005 by Decree 35 of 1999. The primary healthcare plan made little impact on the healthcare sector as it continued to suffer major infrastructural and personnel inadequacies as well as poor public health management (Welcome 2011). According to the review by Welcome (2011), the NHIS has hardly attained any success, as there is continued limited healthcare delivery, no equitability and lack of access by the majority of Nigerians as reflected by high infant mortality, poor maternal care, low life expectancy, periodic outbreaks of the same diseases and inadequate control of the various outbreaks. The inadequacy of the healthcare delivery system in Nigeria could be directly attributed to the following demographics of the Nigerian population. About 55% of the Nigerian population lives in rural areas and approximately 45% lives in the urban areas (Omoruan et al. 2009). About 70% of the healthcare is provided by the private sector and 30% by the government (Omoruan et al. 2009). Over 50% of the population live below the poverty line of less than $1.90 a day and cannot afford the high cost of health services (Omoruan et al. 2009). No adequate and functional surveillance systems have been developed, thus there is no tracking system to monitor the outbreak of communicable diseases (Welcome 2011). Disease outbreaks occur long after flood disasters, especially in densely populated areas. Healthcare is typically withdrawn a few weeks after the disaster – not long enough for the impact of the disaster to be felt on the health of the people. Several factors exacerbate proper management of the health impact of floods, such as the media and anxiety of healthcare practitioners, which lead to panic, confusion and misplaced public health activities (Kouadio et al. 2012). The project complied with the research ethics requirement granted by the University of the Free State.
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