Emergency Response to Flood-Linked Outbreaks: A WASH Policy Priority for Nigeria

EMERGENCY RESPONSE TO FLOOD-LINKED OUTBREAKS: A WASH POLICY PRIORITY FOR NIGERIA A Policy Brief Ikiba, O. Joel EMERGENCY RESPONSE TO FLOOD-LINKED OUTBREAKS: A WASH POLICY PRIORITY FOR NIGERIA BY IKIBA, ONUOYA JOEL DEPARTMENT OF PREVENTIVE AND SOCIAL MEDICINE FACULTY OF CLINICAL SCIENCES UNIVERSITY OF PORT HARCOURT JULY/2025 Table of Contents 1.0 EXECUTIVE SUMMARY .................................................................................... 3 2.0 PROBLEM STATEMENT ..................................................................................... 3 3.0 BACKGROUND/CONTEXT ................................................................................ 4 4.0 EVIDENCE SUMMARY ...................................................................................... 4 5.0 POLICY OPTIONS .............................................................................................. 6 6.0 RECOMMENDATION ......................................................................................... 7 7.0 IMPLEMENTATION CONSIDERATIONS ............................................................. 8 8.0 CONCLUSION ................................................................................................... 8 REFERENCES ....................................................................................................... 10 1.0 EXECUTIVE SUMMARY Floods in Nigeria, worsened by climate change and poor infrastructure, have destructive health impacts, displacing millions and causing disease outbreaks like cholera and malaria (OCHA, 2022; Suhr & Steinert, 2022). The 2022 floods alone affected 4.4 million people, with contaminated water and inadequate sanitation increasing vulnerabilities, especially among women and children (Abdulrahim et al., 2022). Evidence shows that integrating Water, Sanitation, and Hygiene (WASH) into emergency responses can reduce outbreaks (WHO, 2024). As a priority, a national flood-health rapid response mechanism, combining prepositioned supplies, community training, and multisector collaboration is recommended (Almeida et al., 2021). This practical approach, aligned with Nigeria’s health security plans, is viable, cost-effective, and important to saving lives. 2.0 PROBLEM STATEMENT Floods are the most common natural disasters, affecting over 2.8 billion people worldwide and has caused over 200 000 deaths in the past three decades (Odiana et al., 2022). In Nigeria, floods have disrupted not only the natural environment but has affected human health and socioeconomic stability (Akinbobola et al.;2015 Adekola & Lamond, 2018). The United Nations Office for the Coordination of Humanitarian Affairs, OCHA noted that Nigeria faced one of the most devastating flood events in 2022, with more than 4.4 million victims nationwide, over 2.4 million people displaced, more than 660 deaths, and over 340,000 houses in frontline states destroyed (OCHA, 2022). Flooding asides damaging facilities, results in disease outbreaks that affect vulnerable populations like children, women, and displaced persons who are often exposed to contaminated water and lack access to sanitation facilities (Louw et al., 2019; Abdulrahim et al., 2022). While Nigeria has an established emergency health response system, its focus is on treatment rather than preventive measures, often neglecting proactive WASH interventions. For instance, the National Action Plan for Health Security (NAPHS) coordinated by the Nigeria Centre for Disease Control (NCDC) has outlined measures to address public health risks during flooding events, but gaps persist with its implementation, especially in fitting in WASH into flood emergency preparedness (NCDC, 2018). Therefore, mainstreaming WASH in national emergency health policy is vital to tackling flood-linked disease outbreaks. 3.0 BACKGROUND/CONTEXT Nigeria’s geography, with its Niger and Benue River basins, makes it prone to flooding. This in addition to climate change, uncontrolled expansion of urban areas, deforestation, and poor drainage infrastructure worsen the occurrence and impact of floods (Umaru & Adedokun, 2020). For example, the 2022 floods affected 33 of Nigeria’s 36 states, displacing over 2.4 million people and killing more than 600 (Adesola et al., 2024). Floodwater often contaminates major sources of drinking water such as open wells, boreholes, and rivers, resulting in widespread waterborne disease outbreaks (Dzodzomenyo et al., 2022). Also, in emergency situations like flooding, public health infrastructure is often absent and temporary resettlement camps are often overcrowded. This lack of basic sanitation facilities increases the risk of disease transmission (Shackelford et al., 2020). Yaya et al. (2018) have also pointed out that in Nigeria, there is a low level of community awareness on emergency hygiene practices and preventive WASH measures such as water chlorination and toilet provision are not applied due to poor funding and coordination. It is against these backdrop that WASH as a core pillar in Nigeria’s flood emergency response is needed. 4.0 EVIDENCE SUMMARY There is need for a WASH priority policy to combat flood emergencies in Nigeria. The evidence, especially the 2022 floods which impacted about 4.4 million people, is reason enough. Data showed a high incidence of flood-linked diseases. In the BAY (Borno, Adamawa and Yobe) states, there was a 90% increase in cases of Severe Acute Malnutrition (SAM) (OCHA, 2022). There was also widespread report of cholera outbreaks which Siamalube et al. (2025) points out is endemic in many parts of Sub-Saharan Africa, and is driven by factors such as climate change, population displacement, and inadequate WASH infrastructure. This is why the Global Taskforce on Cholera Control (GTFCC) in line with the United Nations Sustainable Development Goals (UN SDG) placed priority on improving access to WASH which are vital in averting cholera outbreaks (Wen et al., 2025). Also, a systematic review by Suhr and Steinert (2022) showed that floods in sub-Saharan Africa, including Nigeria, increase the risks of waterborne diseases like cholera and vector-borne illnesses such as malaria and arboviruses, with nine of ten studies indicating increased susceptibility to infections post-flood. These findings underline the urgent need for integrated WASH emergency response measures, and disease prevention plans to reduce flood-linked outbreaks (Suhr & Steinert, 2022). Finally in this regard, the Nigeria Flood Impact, Recovery and Mitigation Assessment Report by (NBS, NEMA, & UNDP, 2023), provides strong evidence that flooding threatens WASH systems and influences high incidence of waterborne diseases with attendant health problems. It corroborates other sources that available WASH infrastructure and good response mechanisms are instrumental to reducing health risks, with improved community resilience and effective recovery for flood-linked outbreaks. Figure 1: Infographic depicting the impact of the 2022 floods and cholera outbreak in Nigeria 5.0 POLICY OPTIONS To curb flood-linked disease outbreaks through a WASH policy framework, these strategies are necessary: 1. An Ad hoc Emergency Response First, there should be an ad hoc emergency response plan to evacuate victims, provide health services and distribute hygiene kits post-flood. This approach is quick and cost-effective in the short term, but being reactive, it might trigger increase in health risks and may not be sufficient to reduce long-term vulnerabilities (Yates et al., 2018). Also ad hoc emergency response tend to rely on external aid, making it unsustainable (Asibey et al., 2022). 2. Strengthening Primary Health Care via WASH Integration Another policy approach will be to strengthen existing healthcare infrastructure at the primary level by including WASH services during floods. Alareqi et al. (2024) has attributed reduction in disease transmission to well-equipped health facilities with integrated WASH programmes in disaster-prone areas. The only barrier with this policy approach is that initial capital costs are high, but it offers lasting benefits and can boost community resilience. 3. Establishing a Flood-Health Rapid Response Mechanism The third policy option which aligns with the WHO’s response to health emergencies is to develop a coordinated national mechanism for rapid response. This captures things like prepositioned supplies, community engagement, and training, which has been shown to reduce morbidity and mortality during floods (WHO, 2024). A robust system as such will aid timely interventions, is scalable but will require sustained political will and funding commitments, which may pose a challenge. 6.0 RECOMMENDATION The most effective, feasible and scalable option among the three strategies is the establishment of a national flood-health rapid response mechanism with an effective WASH component. This is so because it allows for early intervention, has potential to improve health outcomes and will benefit from multisector collaboration (Almeida et al., 2021). Again, unlike reactive strategies, this model incorporates WASH readiness into health security planning. By prearranging supplies and training personnel, it reduces response time and the severity of outbreaks. This approach also aligns with Nigeria’s responsibilities under the International Health Regulations (IHR 2005) and complements existing frameworks like the NAPHS, a strategy which Kluge et al. (2018) have shown strengthens the health system. But for this policy option to work, it must be aligned with a national-level WASH emergency plan and have ample budgetary allocation. It would also need a synergy between the Ministry of Health, Ministries of Environment and Water Resources to ensure a unified response. 7.0 IMPLEMENTATION CONSIDERATIONS Feasibility: It is highly feasible with Nigeria’s existing disease surveillance systems and disaster management bodies like NCDC and NEMA, which can integrate WASH-focused emergency units with slight structural changes. Cost: Huge cost burdens can be reduced by leveraging existing partnerships with donor agencies like UNICEF. The budgetary framework should be structured at ₦23 billion/year (60% from FMOH, 30% from donors, and 10% from states). Monitoring: Monthly WASH compliance audits and disease reporting. Key Stakeholders: • Federal Ministry of Health: coordination and oversight. • Nigeria Centre for Disease Control (NCDC): surveillance and outbreak control. • Ministry of Water Resources: water safety and access. • National Emergency Management Agency (NEMA): disaster logistics and coordination. • State Ministries of Health: subnational implementation. • Non-Governmental Organizations: technical support and outreach. • Communities and Traditional Leaders: trust-building and local compliance. Timelines: • Short-term (0–6 months): Policy development, secure budget, and start training. • Medium-term (6–18 months): Prearrange supplies to pilot in 3 flood-prone states. • Long-term (18+ months): National scale-up and systems to monitor. 8.0 CONCLUSION Flood-linked disease outbreaks in Nigeria are predictable and avoidable. A strategic policy that integrates WASH into national health emergency responses can reduce the public health burden of floods. One such approach is a coordinated, well-funded WASH-health rapid response system that will not only save lives but also improve national resilience against future climate-