Globally, there is a rising trend in humanitarian crises with unprecedented human population displacement. By the end of 2023, there were 75.9 million internally displaced persons (IDPs) across 116 countries worldwide. These IDPs face heightened health risk and considerable contextual challenges, mainly due to crowded and poor sanitary living conditions, reduced food security, fragile health systems, and limited access to routine health care services. Furthermore, these crisis-affected displaced populations are disproportionately affected by the health and socio-economic impact of the coronavirus disease (COVID-19) and other emerging public health threats. For instance, between 1996 and 2016, over 840,000 suspected or confirmed cases of infectious diseases were reported among displaced populations from 128 outbreak events across 48 countries and territories.
In Northeast Nigeria, there are over two million IDPs, predominantly women and children, who experience repeated cycles of massive disease outbreaks with overwhelming morbidity and mortality. Amidst the complex humanitarian emergency and the volatile security situation in this region, MBBS, MPH, Saheed Gidado, and his team conducted three epidemiological studies among these displaced populations, enrolling over 5,000 participants, between June and December 2022.
In the words of Saheed Gidado, “these studies provide essential evidence to help strengthen disease surveillance and reduce morbidity and mortality among one of the most vulnerable populations in the world”. “By understanding the nuances of the complex factors that influence how IDPs seek and accept care, perceive disease risk, and decide whether to accept or reject vaccination, we can design tailored, more effective, and appropriate interventions to prevent diseases, protect health and reduce mortality, especially in the light of the emerging COVID-19 pandemic and other public health threats,” Saheed says.
The studies revealed that, despite the humanitarian context and the high-risk profile for disease transmission among the IDPs, many of them seek health care from non-facility service providers, practice home care, perceive the risk of COVID-19 as low, and refuse to accept COVID-19 vaccine to prevent severe diseases or deaths. The majority of the IDPs who decided not to accept the vaccine cited myths and misconceptions, vaccine safety concerns, and no “felt need” as the reasons for their decision. Several factors play crucial roles in enabling prompt disease detection and effective response to reduce morbidity and mortality. These are perception of disease severity, low level of formal education, poor disease knowledge, camp characteristics (official or unofficial), household distance from the nearest facility, duration of stay in the IDPs camps, among others.
This doctoral dissertation provides a crucial foundation for strengthening disease detection and response among displaced populations and underscores the urgent need for appropriate public health interventions. This includes the implementation of robust, culturally appropriate, context-specific health education and risk communication strategies tailored to the needs of this population in this setting. Furthermore, the research underpins the deployment of contextual interventions, such as mobile vaccination and outreach strategies to deliver vaccines, disseminate health information, and conduct other targeted activities to enhance disease detection and strengthen public health response. This is particularly important among IDPs in remote households, unofficial camps, and those with prolonged displacement, during and beyond the COVID-19 pandemic.