STRENGTHENING HEALTH SYSTEMS TO ADDRESS DISEASE RISKS POST-FLOODING; EVIDENCE FROM FLOODING IN LAGOS IN 2024

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

Flooding is a significant global concern that frequently causes destruction to communities, physical infrastructure, and social organisations (CRED, 2017). Flooding occurs when an excessive amount of water accumulates in bodies of water and then breaches onto dry land. Floods arise when the volume of water surpasses the capacity of its natural pathways and when bodies of water such as ponds, lakes, and dams are incapable of absorbing or retaining the excess water. According to Matthies et. al. (2020), they are the result of the interplay of rainfall, wind, evaporation, sea level, and local terrain.

Floods are caused by a combination of variables including intense precipitation, rapid snow melting, strong winds over bodies of water, abnormally high tides, tsunamis, dam failures or releases, and decreased vegetation due to bushfires (Oriola, 2023). Additional elements contributing to the problem include the illegal dumping of rubbish in waterways, unfavourable urban planning, socio-cultural practices such as waste disposal sites and shrines, construction in flood-prone areas, and the ongoing worldwide concern of climate change (Bareweni, 2019).

Multiple studies have investigated the epidemiological, social, structural, and economic consequences of flooding, as well as the harm it inflicts on human communities (Ahern et al., 2021).  Flood water typically contains a wide range of environmental pollutants, including agricultural and human waste. According to Perera (2022), floods contaminate water channels and wells, making tap water and well water unsuitable for human use. As a result, flood waters can include more than 100 varieties of pathogenic bacteria, viruses, and parasites (Olajuyigbe, 2020). While floods can have positive effects on biodiversity, ecological sustainability, soil renewal, and productivity improvement, they also give rise to long-lasting difficulties. The vulnerability and resilience of civilizations severely affected by floods extend beyond the immediate emergency and post-disaster phases. The floods have long-lasting consequences, resulting in significant damage and related issues (Tunstall et al., 2022).

A recent survey indicated that fewer than 50 percent of individuals have access to portable water and engage in proper sanitation practices (UNICEF and WHO, 2017). Therefore, flood catastrophes lead to a higher percentage of the population being exposed to polluted water, which in turn increases their vulnerability to diseases.  Flooding has a significant and enduring impact on health.  It is capable of causing a variety of long-term health disorders, ranging from acute infections to chronic mental health conditions (Rotowa & Durojaye, 2018).

The impact of the flood persists in people's psyche. The provision of relief materials only provides temporary alleviation for the immediate food requirements of the affected individuals. However, the psychological trauma, anxieties, emotional distress, mental instabilities, economic and social setbacks caused by flooding have enduring consequences that last for many years after the flood event (Adelekan 2020). Empirical evidence demonstrates that the process of recovering from a flood disaster necessitates the implementation of a rehabilitation strategy. The aftermath of a flood necessitates the establishment of a robust health infrastructure capable of addressing the immediate and long-term health requirements of the affected population (Etuonovbe, 2021). Therefore, it is crucial for the restoration and restructuring of society. 

Flooding has a negative impact on healthcare institutions and causes disruptions to services.  This has the potential to exacerbate the delicate state of the healthcare system and potentially undo the progress made in routine vaccination programmes (Adelekan, 2020). Immunisation and vaccination are two highly cost-effective methods for preventing illness and death in children caused by communicable illnesses like polio, measles, tuberculosis, and diphtheria. Vaccines and facilities has predetermined expiration dates and require specific environmental conditions. Any deviation from these settings can result in the vaccines losing their efficacy and perhaps causing harmful effects when administered.  Evacuating or displacing individuals from their homes has a negative effect on normal immunisation cycles, timetables, and overall healthcare service output (Inem, 2017). There is a significant amount of anxiety regarding susceptibility to disease in populations affected by flooding. These factors are not included in the relief plan specifically designed to tackle flood-related problems. Nevertheless, health care reliefs are not available until the completion of the initial two-week respite tasks (Oshodi, 2019). 

Flooding in Nigeria, especially in Lagos, has become a recurring event with significant consequences for public health. The floods that occurred in Lagos in 2024 emphasised the susceptibility of health systems to natural catastrophes and emphasised the immediate requirement to enhance health infrastructure and services in order to adequately handle the heightened disease risks following flooding. Lagos, a vibrant metropolis and financial centre of Nigeria, is highly prone to floods as a result of its position along the coast, dense population, and insufficient urban development (Amadi, 2022). Intense precipitation, inadequate drainage systems, and increasing sea levels synergistically contribute to the occurrence of extreme flooding incidents, causing significant disruptions to daily activities and overwhelming the current infrastructure (Oke, 2024). 

In the year 2024, Lagos encountered a highly intense flooding incident, resulting in extensive destruction and intensifying health hazards for its inhabitants (Oke, 2024). This study specifically examines the effects of the floods that occurred in 2024 on the health system in Lagos. It also investigates methods for enhancing the health systems in order to effectively manage illness risks. The objective is to evaluate the impact on health infrastructure, measure the disruption of health services, and analyse the rise in illness occurrence. The study aims to analyse these aspects in order to offer evidence-based suggestions for constructing resilient health systems that can efficiently handle health hazards after floods. Therefore, the investigation is necessary.

1.2 Statement of the problem

Flooding is a recurring natural calamity in Lagos, Nigeria, which has substantial consequences for public health. The floods that occurred in Lagos in 2024 were exceptionally severe, resulting in extensive displacement, infrastructure destruction, and an elevated susceptibility to disease epidemics. These incidents exposed the weaknesses in the health system and emphasised the immediate requirement to enhance health infrastructure and services in order to adequately manage disease risks after flooding.

Floodwaters possess the capacity to do substantial damage to the physical structures of healthcare institutions, medical equipment, and resources. The aforesaid damage can lead to the incapacitation of facilities, which in turn can result in a lack of essential health services (Theophilus et al., 2024). Aina (2022) asserts that floods can disrupt the regular functioning of healthcare facilities, encompassing outpatient services, emergency care, and inpatient treatment. The displacement of healthcare workers and patients exacerbates these disturbances further (Kolapo et al., 2023). 

Moreover, the financial limitations experienced by the health system in Lagos during and after the 2024 floods greatly impeded its capacity to adequately address the heightened health demands (Kunle, 2024). The health system faced a shortage of money to promptly and comprehensively respond to emergencies. The insufficiency has an impact on the accessibility of vital resources, including pharmaceuticals, potable water, and sanitation supplies (Paul et al., 2024). According to Paul et al. (2024), the destruction caused by floods to health institutions necessitated a significant amount of money for repairs and rebuilding. The constrained budget caused a delay in the restoration of health services in the impacted areas, resulting in an extended period of disrupted care. The availability of financial resources restricted the ability to provide incentives, training, and support for the health workforce. The increased workload and stress during the crisis had a significant impact on the morale and ability of healthcare personnel to cope (Kunle, 2024). The health system's dependence on foreign help and donor funds for emergency response led to doubts regarding the availability of financial resources. The health system's ability to respond effectively was further compromised by delays or deficiencies in external funding (Omotosho, 2024).

Oni & Femi (2024) state that logistical restrictions were a significant factor in preventing the health system from effectively responding to the heightened health demands following the flooding. According to their study, the health system was deficient in emergency transport trucks and equipment, which hindered the evacuation of patients, delivery of supplies, and access to isolated or seriously impacted areas. This constraint hindered the extent and efficacy of emergency response endeavours. According to Segun (2024), the floods caused harm or complete destruction to storage facilities for medical supplies, resulting in shortages and challenges in maintaining the proper temperature for vaccinations and other products that require specific temperatures. In addition, the flooding caused significant harm to transportation infrastructure, including as roads and bridges, resulting in the disruption of supply chains for vital products, including medical supplies and equipment. This impeded the prompt distribution of essential supplies to impacted regions (Ajibola, 2024). These constraints, along with others, significantly restricted and impacted the functioning of health systems during and after flooding events. By effectively dealing with these limitations, the healthcare system in Lagos and Nigeria as a whole can enhance its readiness to handle the health consequences of future flooding incidents and other natural calamities, hence enhancing health outcomes and resilience. Therefore, the investigation is necessary.

1.3 Objectives of the study

The primary objective of this study is to critically address disease risk post flooding in Lagos in 2024 by strengthening health systems. Specific objectives of this study are to:

To determine the extent of damage experienced by health facilities in Lagos due to the 2024 floods.

To analyze the extent to which health services were disrupted and the impact on healthcare delivery.

To investigate the incidence and spread of infectious diseases in the aftermath of the flooding.

To evaluate the challenges faced by healthcare workers during and after the floods.

To assess strategies employed to mitigate the impacts of flooding on the health system and address disease risks.

1.4 Research Questions

The following research questions will be answered in this study:

What is the extent of damage experienced by health facilities in Lagos due to the 2024 floods?

What is the extent to which health services were disrupted and the impact on healthcare delivery?

What is the level of prevalence of spread of infectious diseases in the aftermath of the flooding?

What are the challenges faced by healthcare workers during and after the floods?

What are the strategies for mitigating the impacts of flooding on health facilities and preventing disease outbreaks?

1.5 Research Hypotheses

The following research hypotheses will validate this study;

Ho: The level of prevalence of spread of infectious diseases in the aftermath of the flooding in 2024 is low.

Ha: The level of prevalence of spread of infectious diseases in the aftermath of the flooding in 2024 is high.

1.6 Significance of the study

Engaging in the examination and enhancement of health systems in order to effectively tackle the dangers associated with diseases. Implementing post-flooding measures in Lagos in 2024 is crucial for strengthening public health outcomes, bolstering disaster resilience, and fostering sustainable development. The results aid in developing the ability to adapt, decreasing susceptibility, and guaranteeing fair availability of healthcare in response to growing climate-related difficulties. 

Furthermore, the study's evidence reinforces the call for policies that enhance the resilience of health systems to withstand and address the impact of floods. This involves the incorporation of disaster risk reduction into health policy, the improvement of cooperation between the health and disaster management sectors, and the allocation of resources for the development of resilient health infrastructure.

In addition, the promotion of preventative health behaviours such as safe water storage and sanitation practices is highly dependent on effective communication and community engagement, particularly in the context of floods. Examining community health education efforts provides insights into methods for empowering communities in disaster preparedness and response. 

Furthermore, future academics will employ it as a comprehensive analysis of the existing academic literature. Therefore, anyone who have an interest in this area of research can rely on this work as a trustworthy and thoroughly assessed source of knowledge.

1.7 Scope of the study

Broadly, this study focus is to critically address disease risk post flooding in Lagos in 2024 by strengthening health systems. Specifically, this study seeks to determine the extent and types of damage experienced by health facilities in Nigeria due to the 2024 floods, analyze the extent to which health services were disrupted and the impact on healthcare delivery and investigate the incidence and spread of infectious diseases in the aftermath of the flooding. Further, this study will focus on evaluating the challenges faced by healthcare workers during and after the floods and it also seeks to assess strategies employed to mitigate the impacts of flooding on the health system and address disease risks.

The study is carried out in Ikeja, Lagos.

1.8 Limitations of the study

Like in any human attempt, the researchers encountered several small limits during the investigation. The primary constraint was the dearth of comprehensive literature on the topic, given the scarcity of data pertaining to strengthening health systems to address disease risks post-flooding; evidence from flooding in Lagos in 2024. Therefore, a substantial investment of time and effort was required to identify the suitable materials, books, or information and to collect data. 

Moreover, this study is limited by its diminutive sample size and restricted geographical range, concentrating just on Lagos. Hence, the findings of this study cannot be extrapolated, thereby necessitating additional research. 

Furthermore, the researcher's restraints were predominantly attributable to financial limitations, as they are a student without a means of revenue to support themselves. The research location's high transportation costs, impacted by current inflation in Nigeria, made it difficult to afford transportation fees.

In addition, the researcher encountered a time limitation as a result of the necessity to do this research while simultaneously meeting the responsibilities of attending lectures and engaging in other educational pursuits.

1.9 Definition of terms

Flood: Flood is an overflow of water onto normally dry land. The inundation of a normally dry area caused by rising water in an existing waterway, such as a river, stream, or drainage ditch. Ponding of water at or near the point where the rain fell. Flooding is a longer term event than flash flooding: it may last days or weeks.

Flood pattern: Flood pattern" refers to the correlation and relationship between various parameters, such as rainfall and temperature, that contribute to the occurrence and severity of floods.

Urbanization: Urbanization is the process through which cities grow, and higher and higher percentages of the population come to live in the city.

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