Africa Health Report findings has revealed that, from 2023 to August 2024, 15,000 refugees have returned to Nigeria, adding to the existing health crisis in a region grappling with vulnerable conditions. A government official in Gambaru, a town bordering Cameroon, confirmed the return of the refugees and heightened fears of sudden rise of diseases. In a detailed report our Correspondent, Hussaini Ibrahim Kafi in Kano narrates the return, and potential risk of diseases outbreak, public health threats, against the backdrop of Cholera epidemic in the country of their refuge.
Looming Health Crisis
In north-eastern Nigeria, a looming health crisis is intensifying as thousands of refugees from neighbouring Cameroon begin their return. Many of these refugees had been living in the Minawao refugee camp in Cameroon and are now heading back to Borno State, which is already grappling with precarious conditions. The region is battling an ongoing cholera outbreak exacerbated by recent floods, and the return of refugees increases the risk of the disease spreading further.
According to the UNHCR’s 2023 report, about 120,000 Nigerians displaced by the insurgency of the Boko Haram group are currently residing in northern Cameroon.
Our correspondent learned that refugees are crossing a 300-meter bridge separating Gambaru in Nigeria and Fotokoi in Cameroon. “We found a looted and burned city, now a shadow of its former self,” said Abacha Mari, one of the refugees.
Environmental and Infrastructural Challenge, Shortage
This humanitarian challenge unfolds against the backdrop of severe environmental and infrastructural damage. Borno State is already reeling from the aftermath of devastating floods that submerged Maiduguri and surrounding rural areas. The floods have displaced thousands, overwhelmed local health systems, disrupted water supplies, and created ideal conditions for waterborne diseases like cholera to spread.
Yobe in Similar Conditions
The situation is similarly dire in Yobe’s rural areas, including Gujba, Fune, Machina, Nangere, and Nguru local government areas. These areas are struggling with severely damaged infrastructure, making it difficult to provide safe drinking water and sanitation services.
Dr. Gana, a leading public health expert, explained that the destruction of roads, bridges, and healthcare facilities has affected efforts to control the disease.
Watery Diarrhea
The region has seen a surge in cases of Acute Watery Diarrhea (AWD), a key symptom of cholera, with the situation worsening as the rainy season continues.
“Cholera thrives in conditions where water sources are contaminated and sanitation systems are inadequate,” Gana said.
He stressed, “With infrastructure already in disarray, providing clean water to affected communities is even more challenging. The return of refugees only complicates the situation.”
As more displaced persons return to Borno State, the risk of further cholera transmission rises. These returnees may bring diseases from their time in refugee camps, while the fragile healthcare system and poor sanitation conditions in their home regions leave them highly vulnerable. Many refugees are coming from camps like Minawao, where sanitation standards are often horrifying, heightening the potential for disease outbreaks.
Floods and the Escalation of Waterborne Disease
A recent report from Médecins Sans Frontières (MSF), a leading international humanitarian organization, underscores the risks of further cholera and malaria outbreaks following the catastrophic flooding. MSF, which has been providing medical assistance in the region, has already reported cases of cholera in flood-affected areas. Dr. Issaley Abdel Kader, MSF’s Head of Mission in Nigeria, said, “We have observed cases with clinical signs of cholera since the floods. Without increased support—especially in water, sanitation, and hygiene—the number of cases will likely rise.”
Floodwaters have left vast areas submerged, turning standing water into a breeding ground for cholera-causing bacteria. Water systems have been compromised, and many communities are now relying on unsafe water sources, further fuelling the disease’s spread. The ongoing floods, compounded by slow and scanty responses, put both returnees and the general population at risk.
The cholera outbreak is further aggravated by the region’s vulnerability. Local healthcare systems, already overwhelmed by years of conflict and displacement, are under immense pressure from the additional strain of the floods. The rise in cases of Acute Watery Diarrhea signals the urgent need for a more coordinated and robust response.
The Return of Refugees: A New Layer of Risk
Governor of Borno state, Prof. Babagana Umara Zulum has called on the federal government and relevant agencies, such as the North-East Development Commission (NEDC), to facilitate the safe return of refugees to their homes. “Thousands of Borno indigenes taking refuge in Chad, Cameroon, and Niger Republic are willing to return to their ancestral homes to cultivate their farmlands,” Governor Zulum explained. However, he stressed that while the desire to return is strong, a coordinated effort is essential to ensure refugees’ safe repatriation, particularly concerning public health.
The governor emphasized the need for adequate support in reintegrating displaced people, including restoring basic services like healthcare, clean water, and sanitation. He warned that without sufficient planning and resources, the return of refugees could worsen the already critical health crisis.
Refugees Endure Harsh Camp Conditions
Many of these refugees have endured years of hardship in neighbouring countries, where conditions in camps were scarcely better than those in the conflict zones they fled. The Minawao camp in Cameroon, for example, has been plagued by overcrowding, poor sanitation, and limited healthcare access. Now, as refugees seek to return home, they face heightened vulnerability. Their return could potentially introduce new cases of cholera, malaria, and other infectious diseases already circulating within refugee populations.
The Role of Humanitarian Organizations
In the face of overwhelming challenges posed by both the return of refugees and the cholera outbreak, international humanitarian organizations are playing a crucial role in providing medical and logistical support. Médecins Sans Frontières (MSF) and other organizations are on the ground, treating patients, supplying medical aid, and improving water, sanitation, and hygiene (WASH) conditions in affected areas.
However, Dr. Issaley Abdel Kader of MSF emphasized that while their efforts are vital, more substantial support is needed from both the Nigerian government and the international community. “The scale of the need is vast, and without sufficient resources, the outbreak could spiral out of control. We need to strengthen healthcare systems, improve water access, and equip communities with the tools to protect themselves from these deadly diseases.”
A Call for Immediate Action
Experts agree that a coordinated response is essential to prevent further loss of life. Public health officials have called for urgent measures to improve water supply and sanitation systems, enhance public health education on cholera prevention, and increase the capacity of local healthcare centers to manage the influx of cases.
The Nigerian government, in partnership with local and international organizations, must act swiftly to address the cholera outbreak and provide essential support to returning refugees. The success of the refugee repatriation process depends on the government’s ability to restore stability, improved infrastructure, and mitigate public health risks posed by diseases like cholera and malaria.
As the crisis continues to unfold, one thing is clear: the health of both returning refugees and the broader population of northeastern Nigeria hangs in the balance. Immediate and comprehensive action is needed to prevent the further deterioration of this devastating public health emergency.
