Why Nigeria Defeated Invisible Ebola and Fails Against Visible Boko Haram

On October 20, the World Health Organization officially declared Africa's most populous country ‘’Ebola free’’, 42 days since the last case was confirmed in Nigeria. The ‘’world class’’ swiftness and forceful response to quash the scary epidemic which killed seven of its citizens, pales greatly when compare to the dysfunctional response of the Government, so far in the face of Boko Haram, a terrorist group which has killed more than 1500 civilians, in just the first three months of 2014. Boko Haram, in fact, still holds more than 250 girls in captivity— even against the international outcry, and the Nigerian government’s recent announcement of having reached a deal with the Islamic militants for their release.

Much ink continues to spill on how the Government accomplished such an epidemiological feat which so far, seems to elude even the US, the most resource endowed healthcare system. But without understanding why Nigeria got everything right on ebola, little applicable lessons could be drawn from the unparalleled success.  Nigeria remains a country with many stories: at different point in time  and place, Islands of good governance surprisingly emerge pulling the whole system of government to deliver when particular interests are threatened. The Nigerian middle class has felt more threatened by ebola than Boko Haram, resulting in a successful coalition with the ruling class to prevent the scariest scenario imagined: an uncontrollable ebola virus outbreak in Lagos, Africa’s most populated city.

My House, My Car the Future

Nothing in recent memory has so far threatened to melt in a frightening manner the growing divides between rich and poor in Africa. Ebola introduces in an increasingly unequal Nigerian society a horrifying prospect: the random possibility of death. A poor, underclass and rural Nigerian has almost same chance of dying of ebola like an urban rich –-middle or upper class—citizen, everything being equal.  And for once, the ruling elites together with the affluent middle class don’t have the option to pay their way into safety and protection through flying abroad for treatment—while abandoning a crumbling health care system, neglected for so long through chronic under investment by the government.

The middle class perceives ebola as an existential threat to their way of life, which has risen spectacularly with Nigeria’s economic fortunes. While no standard definition of what constitutes  middle class exist, according to a recent study, the number of Nigerians earning 15$-115$ daily has swollen by six folds—  600 percent— since 2000 (Standard Bank, 2014). That is three times more than the average of the top economies in Africa, which were studied.  That one in ten Nigerian household is middle class, is no news. But taken in context, it is simply staggering, given how long it has taken to lift 23 million of its citizens into the middle class. This is more than the population of the three ebola hit countries, together.

While it is difficult to lump them all together, the emerging category of consumer class who have disproportionately benefited from economic growth are marked by their visible affluence. They have more than sufficient income after meeting their basic needs, enough to spend on cars, houses and leisure— the fruits of their sweat and in which they will do anything to protect jealously. According to a survey: 53 percent of them owned cars that were less than five years old; and 35 percent of their households have at least a family member with a foreign passport; Over 18 percent of them were planning to move to their newly completed self-owned apartment (Renaissance Capital , 2011).

Their numbers are projected to more than even triple by 2030. With most of them graduates, Nigeria’s middle class are not only the most informed segment of the electorate, they also wield significant influence on Nigerian politics as well as share similar interests with the ruling class, at least, to prevent the status quo from crumbling in a costly manner. 

Populated in Lagos and Port Harcourt, the two cities which were directly exposed to the deadly ebola trail, a coalition of middle class and ruling class interests, in those richest states of the Federation, shocked a muddled Nigerian government into steering an effective response against the virus.

Preparedness in waiting  

At the time when ebola first appeared, public health infrastructures generally were ill prepared. And even now, it’s not yet clear whether they have been effectively stepped up after the success so as to prevent any future outbreak.  In fact, the index patient from Liberia landed in  Nigeria when health workers were striking against their poor working conditions. The ruling elites have consistently underinvested in systems to protect the population against epidemics.

 Nigerian preparedness to deal with a crisis like ebola has been below the African average.  As of April 2014, Nigeria had implemented only 58 percent of minimum core capacities that countries have collectively agreed to put in place in order to better prevent and protect their populations against outbreaks of international public health concern (World Health Organization , 2014). That was below the African average of 60 percent. Progress in putting in place national preparedness plans was very slow with only 40 percent success against the agreed minimum. And regarding appropriate surveillance and control measures, only four percent of minimum requirements had been put in all the ports of entry, far below the African median of 35 percent.

The ebola outbreak was therefore a wakeup call. It was a terrifying full stop to the growing trend where the ruling elites and middle class  Nigerians opt to travel abroad for health care. Nigerian politicians and senior civil servants are the largest market for medical tourism in Africa—  travelling frequently abroad for even routine medical check-ups  According to the Nigerian Medical Association, over 5000 Nigerians travelled monthly abroad for medical care, taking along almost half a billion dollars out of the economy every year. This is over 10 percent of all what the government spends on health care, for the entire 200 million populations. That is almost all yearly expenditure on healthcare in the ebola-hit Guinea and Liberia combined. Nigerians even travel to peer countries like Egypt, which received over 3500 Nigerians patients last year. The Nigerian government spends only $29 per citizen on health care. With only seven percent of the budget allocated to health, Nigeria spends just a little above South Sudan in percentage terms—  over 50 percent less than the continental benchmark (World Health Organization , 2010)

Fringe affair

Boko Haram has exploited in part the Government’s neglect and under-investment in social and economic development of the North east of the country, to create an able fighting force, which has given the national army a run for their money. The extreme Islamist group has taken swathes of territory in the North and unleashed a sustained campaign of violence against countless civilians including kidnappings. But unlike ebola, the middle class, predominantly living in the South, have not felt their interest threatened enough, to force the Government into mounting a sustained and effective counter response.

While the group has undertaken some sporadic attacks in Abuja, its impact has been localized in the poorer north, where 72 percent of the population live in extreme poverty compared with the 27 percent in the booming south. The insurgency has driven almost one million people from their homes and killed over 13000 Nigerians in the past five years. In 2009-2013, Boko Haram killed more people than Al-Shabaab and Al-Qaeda in the Arabian Peninsula together and was responsible for 5.9 percent of overall fatalities linked to terrorism (US State Department, 2014).  Only nine percent of all Boko Haram targets were directed at the military. Because of the risks of attacks, most people working across the agriculture value chain, the main stay in the North, fear moving outside protected areas.

 A whole generation of underclass Nigerians is emerging. More than 10.5 million children between the ages of 6 and 17 are not in school—that is one in six of the world’s out-of-school children. In the poorest areas of the country, only 30 percent of children even start primary school (The Economist, 2014).  Even in terms of numbers, Boko Haram has disproportionately killed more poor peoples, than rich folks.

Basic health indicators are dismal in the North. While Ebola landed in Lagos via airplane as a ‘’middle class disease’’, cholera has remained endemic in the North over the past years as a result of weak health system. In 2010 alone, 1500 peoples were killed. And in the first quarter of 2014, the Nigerian Centre for Disease Control reported 106 deaths from an outbreak caused by poor sanitation. And if ebola has to find its way again into the country through the ungoverned areas in the north, it is highly unlikely that government will repeat the success.

Not any price

To be fair, the Nigerian middle class is seriously concerned about security in particular Boko Haram’s limitless campaign of terror. Majority of them in a survey expressed dissatisfaction with the government’s performance in maintaining safety and security and in managing the Moslems and Christian sectarian divide, fueled in part by Boko Haram (Afrobarometer, 2014).

While the Middle class feel strongly about governance— the underlying causes of the government failure— it is not clear what price they are willing to pay for good governance. In fact, when asked to rank their concerns over the next 12 months by a Renaissance Capital survey, they listed electricity and unemployment (19-23%) as top priorities, with insecurity (5 %) and corruption (3.5 %).

When they perceived their interests to be sufficiently threatened, Nigerian middle class can wield a decisive impact on the Government, through joining forces with the ruling class. When necessary too, the middle class may also form coalition with the poor and underclass to stop or change the course of governments’ in (actions). For example, the 2012 successful Occupy Nigeria protest, which forced the government to reverse the highly unpopular proposal to abolish the inefficient $8billion a year fuel subsidy, which so far has disproportionately benefited the car-owning-middle and upper classes on a per capita basis. This is more than what the government spends on education.

While the same level of success was achieved with ‘’the textbook’’ response to contain ebola, the fortune of the middle class inspired mobilization remains a work in progress. Without their full commitment to the Bring Back Our Girls campaign, it is unlikely that the Nigerian government will do more for the release of the girls kidnapped by Boko Haram.

For all its many failings, Nigeria, Africa’s lodestar nation remains a country with many faces. Like a paradox, the good, the bad and the ugly of its governance exist side by side. But depending on whose interests get threatened as well as the opportunity presented and the strength of class coalitions formed, one story may stand out. And for ebola,  thank God, it was good governance at its best.  

Works Cited

Afrobarometer. (2014). Results form the Afrobarometer Round 5 Survey in Nigeria. Afrobarometer.

Renaissance Capital . (2011). A Survey of Nigerian Middle Class. Johanessburg: Renaissance Capital.

Standard Bank. (2014). ‘Understanding Africa’s middle class. Lagos: Standard Bank.

The Economist. (2014). Nigeria: A Divided Nation. The Economist.

US State Department. (2014). Country Reports on Terrorism 2013. Washington: US State Department.

World Health Organization . (2010). Health System Financing: the path to universal coverage. Geneva: World Health Organization.

World Health Organization . (2014). International Health Regulations (2005) Summary of States Parties 2012 Report on IHR Core Capacity Implementation. Geneva: World Health Organization.

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