Environmental, social, and WASH factors affecting the recurrence of cholera outbreaks in displacement camps in northeast Nigeria: a rapid appraisal

In 2021, Nigeria witnessed a severe cholera outbreak that affected Borno state, in which more than 1,600,000 internally displaced persons (IDPs) resided at the time. This rapid appraisal explored factors that facilitate the recurrence of cholera outbreaks in sites hosting IDPs in Northeast Nigeria. Semi-structured interviews were conducted with water, sanitation, and hygiene (WASH), management, and healthcare personnel working in 10 displacement camps in Borno state. The interviews were complemented by transect walks and field observations, measurements of free residual chlorine levels, and publicly available data published by the International Organization for Migration Displacement Tracking Matrix. The recurrence of cholera outbreaks appears to be facilitated by substantial interactions between IDPs and host communities, and suboptimal WASH services in camps. Of particular concern, IDP camps are exposed to extreme weather-related events that damage facilities and subsequently affect WASH practices. WASH services in camps may likewise be severely hindered by an influx of new arrivals. In conclusion, we emphasize the importance of expanding WASH activities to host communities and developing site-specific WASH interventions and chlorination targets. Practical recommendations are needed for the prevention and control of outbreaks following extreme weather-related events and population influxes.

Automated summary

In 2021, Nigeria experienced a cholera outbreak affecting Borno state, where over 1,600,000 internally displaced persons (IDPs) were living. This study investigated the factors contributing to the recurrence of cholera outbreaks in IDP camps in Northeast Nigeria. Semi-structured interviews, transect walks, field observations, and data analysis were conducted. The findings indicated that interactions between IDPs and host communities, coupled with suboptimal WASH services and extreme weather events, facilitated the outbreak. Recommendations were made to expand WASH activities, develop site-specific interventions, and target chlorination efforts.