Assessment of Health Need for Internally Displaced Persons in Kaduna State
Chapter One
Objectives of the study
- To study the barriers to availability and accessibility of health facilities in the displaced areas of Kaduna.
- To study and identify the availability of private and public health facilities in the relief colony.
- To study the role of civil society in providing health facilities for the internally displaced people.
CHAPTER TWO
LITERATURE REVIEW
Understanding Internally Displaced People
According to the Guiding Principles on Internal Displacement, “(IDPs are) persons or groups of persons who have been forced or obliged to flee or to leave their homes or places of habitual residence, in particular as a result of or in order to avoid the effects of armed conflict, situations of generalized violence, violations of human rights or natural or human-made disasters, and who have not crossed an internationally recognized border” (www.internaldisplacement.org). Norwegian Refugee Council’s Internal Displacement Monitoring Centre (IDMC) estimates that by 2011, there are more than 26.4 million IDPs all around the world.
There are mainly three reasons for internal displacement i.e., ethnicity-related, development-induced and natural disaster (National Human Rights Commission, 2009).
Ethnicity based displacement takes place when a dominant ethnic community claims absolute and exclusive rights over a region as its exclusive ‘homeland’. When such exclusive claims are asserted, then conflicts, ethnic tension and violence takes place, which finally leads into large scale displacement of minority communities. Development induced displacement is caused mainly through the construction of dams, mining and similar other projects undertaken for economic development, and natural disasters induced displacement occurs due to floods, earthquake, tsunami etc (National Human Rights Commission, 2009).
Internally displaced people are often referred as refugees; however, there are few similarities and differences between both them both. The United Nations High Commissioner for Refugees (UNHCR), the General Assembly resolution 428 (V) of 14 December 1950 defines a refugee as “a person who, owing to a well founded fear of persecution for reasons of race, religion, nationality or political opinion, is outside the country of his nationality and is unable or, owing to such fear, unwilling to avail himself of the protection of that country” (Lebanese NGO Forum, 2006).
Refugees are people who have crossed international borders to find a safe residence. However, refugees are entitled to get international protection and assistance. IDPs and refugees are very similar in terms of the loss they suffer due to the displacement, like, loss of employment, property and all the existing social relations and networks. Thus they both are dependent on aids and assistance of government and humanitarian agencies (WHO, 2007b). So when refugee’s crosses international border then international treaties and laws are applied on their treatment, they are assisted with aid, relief and legal protection. This is not true in the case of IDPs. The state government/district authorities have the full power of discretion in the disbursal of any assistance, legal help or aid to the IDPs (Waldman, 2001).
Cernea (1996), points out that are several impacts of displacement like: lack of land, unemployment, lack of shelter, marginalisation, food insecurity, increased rates of morbidity and mortality, completely disconnected from access to common properties, social disintegration, and loss of access to community services and human rights violation (Cernea, 1999).
Displacement and its Impacts on Health
Displacement of people affects the public health system of the country and health status of its population. Displacement is associated with increased morbidity and mortality among the displaced people in terms of health status are, increase in the morbidity and mortality among the displaced people (Levi & Sidel, 1997). Displaced people living in relief colonies are also highly vulnerable to diseases cholera, dysentery, tuberculosis, acute respiratory infections and other viral diseases, such as measles and dengue occurring frequently among the displaced populations (Waldman, 2001). Internal displacement due to violence may impact public health in many ways, like damage to health infrastructure, interruptions to water and transportation facilities, shortage in the of health care personnel’s, shortage in food and severe economic decline (Zaryab, 2006).
CHAPTER THREE
RESEARCH METHODOLOGY
Study Design
The present study is a qualitative study and interview guides were utilized to gather the data.
Study Population
The present goal of the study is to assess and study the gaps and challenges in availability and accessibility of health care facilities and healthcare infrastructure among the internally displaced residents living in the displaced areas of Kaduna, Kaduna.
Chapter four
Data analysis
Data collected from the interview transcriptions, field notes and through interactions with the respondents were compiled together and analysed to derive results from the data. After a detailed analysis of the transcriptions, following seven themes and subthemes identified corresponding to the study objectives emerged:
- Challenges to availability and accessibility of health facilities in colonies
- Lack of availability of public hospitals and difficulties in accessing private hospitals
- Limited role of civil society organisations in healthcare
In addition to the main findings the study also identified a plethora of factors that were identified as determinants to poor psychological health and physical health. Determinant of psychological included the trauma from the violence experienced during the riots, stressors surrounding social and economic loss and uncertainty of future, determinants of physical health includes:
- Lack of infrastructural and health concerns of the colony
- Affected livelihood and living patterns
- Negligence of state in the provisions of healthcare
CHAPTER FIVE
DISCUSSION, CONCLUSION AND RECOMMENDATION
The literature review corroborates with the findings of the study, which affirms further that, internally displaced people undergoes various violations of human rights, especially their right to health has been denied on many occasions. As pointed out in the literature review, there have been no national policy or act to protect the rights of the IDPs, therefore the onus of the protection and sustenance of the IDPs lies mainly in the hands of local administration. The findings of the study reveal further that victims have been so far denied even basic access to health facilities; there have been rampant spread of infectious diseases due to the unhygienic environment. The Guiding Principles on Internal Displacement states about the provisions of essential food and potable water, basic shelter and housing, clothing’s, essential medical services and sanitations to the IDPs.
Key findings of study
The interactions between the respondents brought out several key findings; there is no doubt in saying that the internally displaced people are facing many hurdles in accessing health facilities in their relief colonies. The first key finding to the study is that indeed the IDPs are vulnerable people in terms of social, political, economic reasons; however they are doubly vulnerable due to the lack of adequate health infrastructures and facilities in the relief colony. There is a complete absence of a hospital, clinic, medical store or visits of medical officers to the colony. This forces the colony residents to hire private vehicles to visit the nearest health centres, again this geographical distance hinders the IDPs greatly in accessing the health facilities. The hindrances are twofold, one is that the people have to travel long distance to visit the hospital and second they have to spent considerable money in transportation costs (due to the lack of public transport systems).
The repeated complaints and requests to the local authorities to establish a clinic or hospital in the colony have been meted with cold response from the officials. There have been repeated requests to lay proper roads in the colony so that residents part of the transportation problems could be solved, like for example during the rainy seasons, the clogging of the roads hampers the people to travel to hospitals. The colonies also have a history of contagious diseases. During a visit to the colony, any person could notice the poor drainage and waste disposal systems of the colony. Due to the lack of any sewage systems, the residents openly let the drain water into the roads. Secondly, there are no proper waste disposal systems in the colony, due to these poor infrastructural facilities the colony has become a breeding ground for mosquitoes, flies and insects, which causes many diseases to the colony members.
The role of civil society in the colony has been very minimal. The study findings state that except for the initial stage of the rehabilitation work like building houses for the IDPs, none of the NGOs are cared for the welfare of the colony members. In the period of twelve years of time, there have been no organisations that have come up to work for the improvement of the health status of the people, despite the lack of hospitals, clinics and frequent occurrences of endemics in the colony. On the contrary the residents feel that they have been exploited by few of the organisations, who had assured them rehabilitation support, but have never done anything for the residents until now.
Implications of study in social work practice
The model on barriers of health accessibility among the internally displaced people has been developed for future researchers to expand the knowledge base on the health accessibility concerns of IDPs. The model shows the various barriers exist in the relief colonies that hinder the IDPs to achieve higher utilisation of health services. The first barrier is such as, infrastructural issues like absence of clinic, hospital, water availability, lack of sewage facilities and waste disposal systems, next is livelihood problems like shift of occupational skills, low wages and malnourishment due to food scarcity, then the ineffective public health service system which is corrupt and occupied with negligent medical staff, government negligence is experienced due to the lack of national policy on IDPs, then absences of civil society in health social work and lastly geographical barriers like remote location and rising transportation costs to travel to hospitals and clinics.
Recommendations
- In almost all the interviews most of the residents expected basic and primary health facilities in their colony. Therefore the residents must be provided with at least a clinic or a hospital and a medical store in the colony to meet at least basic health care facilities without travelling to long distances.
- Residents of the colony have to travel long distances to access health care facilities and for that they hire private vehicles, by paying high transportation costs to visit the hospitals which are located far away from the colony. Therefore, the municipal authorities must recognise the colony within the jurisdiction of the city limits and facilitate public transport systems facilities towards colony.
- There must be provisions for clean water for the residents, because at present residents have to pay for the water and they are forced to utilise polluted water causing various illnesses and diseases.
- The civic authorities must provide proper sewage and drainage systems to dispose of bathing, cleaning, and washing water, because at present the residents are letting off the water openly into the streets.
- There must be some initiatives from the state government to provide better livelihood options by providing the victims with bank loans to start new business ventures or vocations. As the resident’s income levels increases, they could have balanced diets to lead a healthy life.
- The people residing in the colonies must be recognised as people displaced due to conflicts are internally displaced peoples (IDPs) and then they must be provided equal treatment, rehabilitation and assistance as per the international humanitarian guidelines as scheduled for the IDPs.
- Nigeria until now have no national policy or act for the protection of the IDPs, in this context when lakhs of people are living as IDPs in this country, it’s high time the central government formulate policies that govern and protect the rights of the people who are internally displaced.
Conclusion
The present study has brought out various insights into the plight of the internally displaced people who are living in relief colonies. IDPs have been living in the relief colonies more than a decade, however, till now they have been denied many rights, including the most basic and fundamental right to health. Colonies of Kaduna have no clinics or hospital therefore entire population depends on the city hospital. Due to the rising costs and lack of public vehicles, even health care access is limited to the availability of money in most of the households. Despite thousands of IDPs exists in Nigeria, there must be prompt efforts in developing and implementing a strong act on the internally displaced people, so that their rights and privileges could be protected from further distortions or violations.
Reference list
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