Habeeb prays for ease each day the cold gets worse. Living with sickle cell since his birth, the 27-year-old battles the rain and the accompanying cold weather.
One of Nigeria’s many sickle cell warriors, Habeeb, works as a barber in a small shop in Ibadan, the capital of Oyo State. “I won’t lie. I don’t like the rain. I don’t pray for it. It brings me discomfort with the cold weather that comes with it,” Habeeb tells the reporter.
In Nigeria, the stakes are particularly high for sickle cell patients because of climate change, which is ushering in a new era of health problems around the world.
For Habeeb and many others, the battle against climate complications is an everyday fight for survival. SCD sufferers’ already precarious situation is made worse by unpredictable cold spells caused by unpredictable weather patterns. “During the colder months, I frequently catch the flu, which causes painful crises,” Habeeb explains.
Nigeria’s Sickle Cell Tally
Sickle Cell disease (SCD) is an inherited, life-long blood disorder characterized by deficient protein in red blood cells which carry oxygen to the body tissues. It refers to a group of inherited blood disorders that cause anaemia and blood vessel obstacles. It impacts millions universally, with 80% of the world’s sickle cell illness cases ensuing in sub-Saharan Africa.
Nigeria is recognized as the nation with the highest burden of the disease, with 25% of the inhabitants carrying sickle cell trait (SCT). It affects between 4 and 6 million of the approximately 50 million people worldwide who are afflicted by the disease.
The World Health Organization (WHO) estimates that 150,000 SCD children are born annually in Nigeria, with a 20-per-1000 live birth rate.
The sickled red blood cells, which have odd crescent-like shapes, can adhere to each other, obstructing blood vessels. These cells have shorter life spans than healthy red blood cells, leading to chronic anaemia in SCD patients. Additionally, sickled cells can damage the spleen—the organ responsible for filtering waste from the blood—making individuals more susceptible to infections.
Other symptoms of SCD include pain crisis, caused by blocked blood flow to parts of the body, anemia, jaundice, and stroke. Acute chest syndrome, a condition where sickling occurs in the chest, can occur as a result of infections or dehydration and can be fatal.
Climate Change and Increase in Illness
Due to climate change, Nigeria is encountering more extreme weather patterns, with intense heat followed by sudden cold periods. As a result of these transitions, there has been a substantial rise in the number of cases of the cold and the flu, which pose considerable menace to sickle cell patients.
In Habeeb’s case, the cold weather brought by the rain heightens his symptoms, making everyday tasks an enormous endeavor. “When it gets cold, I make sure my body is warm, and I wear socks and a long dress that covers all my body,” Habeeb shares. The cold, which can trigger painful sickle cell crises, forces Habeeb to take extraordinary precautions just to get through the day.
For Habeeb, the impact extends beyond his personal comfort; it affects his livelihood. As a barber, his small shop is his lifeline, yet he finds himself confined to his home on rainy days, anticipating the cold that will follow. “This doesn’t allow me to make money. Because I have to stay at home. I dare not go out during this weather,” he explains. His reliance on weather forecasts has become a necessity, dictating when he can safely venture out to work.
In addition to bringing cold, the erratic weather patterns also provide the ideal breeding ground for malaria’s primary vectors, mosquitoes. The increased moisture and humidity from rainfall lead to a rise in malaria cases, adding yet another layer of complexity to Habeeb’s already difficult life. “This period breeds malaria because of rainfall. I’ve had to take care of my living because of malaria. I know it’s not encouraging for my health,” Habeeb said.
Rain causes sickle cell crises, which further weaken the immune system and make the individual more likely to contract malaria. For sickle cell patients like Habeeb, the risk of malaria is particularly high. “Genetically, with sickle cell, one is prone to malaria,” explains Dr. Ola Ibrahim, a medical doctor. “These people are more prone to malaria because they don’t have the genetics to protect from malaria infection.”
To reduce the impact of malaria, Dr. Ibrahim further advised prompt treatment, and regular check-ups.
Cholera As an Emerging Threat
Nigeria is fighting a severe cholera outbreak as the rainy season progresses. The cholera epidemic in the West African nation has caused a great deal of damage.
The Nigeria Centre for Disease Control and Prevention (NCDC) reports that as of July 21, 2024, a total of 4,809 suspected cases, including 156 deaths, had been registered from 35 states nationwide.
When compared to the number of cases that were reported at Epi-week 28 in 2023, the number of suspected cases of cholera in the current year increased by 76%. Similar to this, there has been an 88% increase in the total number of deaths in 2024.
In January, 322 suspected cases and 3 deaths were reported by NCDC, while in February, 329 suspected cases and 9 deaths were reported. 314 suspected cases and 4 deaths occurred in March, while 158 suspected cases and 5 deaths occurred in April. May recorded two deaths and 127 suspected cases.
However, the situation took a dire turn in June, with suspected cases jumping nearly 20-fold. June saw a record-high 2415 suspected cases and 95 deaths, while July recorded 1144 suspected cases and 36 deaths.
Eating contaminated food, and drinking unhealthy water results in acute diarrhoea known as cholera. Without proper and immediate treatment, this can result in fatal intense dehydration.
For those with sickle cells, dehydration is a typical catalyst for vaso-occlusive emergencies, a painful outbreak brought about by clogged blood vessels. Dehydration brought on by cholera can result in more serious health problems.
“Cholera poses a severe risk to sickle cell patients,” explains Dr. Ibrahim. “The lack of hydration from cholera can prompt incessant and extreme pain crises, confounding their treatment and recuperation.”
Dr. Ibrahim further advised drinking three to four litres of water per day. “Those with sickle cell disease are more likely to be dehydrated. So when they lose water because of the cholera infection, it affects them much faster than people without SCD. They need to drink lots of water.”
Dr. Ibrahim underscored the importance of proper sanitation and rapid medical attention. “In order to stop the disease from circulating, it is important to ensure that people have access to safe drinking water and food.”
Heatwaves in Nigeria’s Climate Struggle
While cold weather is a known adversary, the impact of heatwaves is equally devastating. Heat waves make people more likely to become dehydrated, which thickens the blood and makes sickle cell formation worse. This leads to frequent and severe pains, requiring medical attention. In Nigeria, where access to reliable electricity is limited, managing the heat becomes an almost impossible task for sickle cell patients.
Successive clinic visits, drugs, and the need for temperature control at home lead to mounting costs for families. Living in constant fear of the next health crisis comes with a financial and emotional cost.
The heat is a constant affliction for Aisha, a 21-year-old sickle cell warrior. “The heat drains my energy. Some days, I can barely stand,” she says, describing the pain that comes with each heatwave.
When temperatures soar, Aisha finds herself fighting life, as she’s constantly faced numerous hospitalizations. “I spend a lot on medications during the heat periods. We know accessible electricity is not much available in this country.” This leads to Aisha struggling to focus on her studies due to the looming threat of a sickle cell crisis.
Dr. Ibrahim warns that heat creates a perfect storm of suffering for sickle cell patients. “Sickle cell patients are particularly susceptible to extreme heat. We see an increase in hospital admissions during heatwaves. Heat stress triggers sickling, which can lead to acute chest syndrome, stroke, and even death,” he explains.
“Preventative measures are crucial. When heat is extreme, they need to cool off and get some air. Also they need to stay hydrated.”
Championing Advocacy
Amidst this, the warriors are finding hope and resilience. Timilehin Ishola, a 22-years-old warrior is leading millions of people with the same condition as hers. “I want to help people like myself,” she says with determination.
She created the Journey of a Sickle Cell Warrior, a webpage where she shares her experiences and provides motivation for many others. Her story serves as a beacon of hope for many others facing similar battles. Now, according to her, she has found a niche to express herself.
“I have had sickle cell all my life. I knew something was different even when I was a child. I was a special needs child, exempted from activities and frequently absent from school. I got sick a lot and was often admitted to the hospital,” Timilehin says.
“One of those things that always keeps me motivated is that I know I’m here for a reason. I tell myself always that I’ll live a good and fulfilled life. On days when I just want to give up, I think of my advocacy journey and the people who look up to me. Knowing that I inspire people out there through my sickle cell journey keeps me going.”
Through her advocacy, Timilehin aims to remind other sickle cell warriors that they are not alone. Her words resonate with countless individuals who see their struggles reflected in her narrative.
Government’s Response
There is a need for the Nigerian government to find ways of guaranteeing the population receives the help needed to survive. Experts called for governmental policies and reforms to better improve patient care. “We can’t talk about policies which will result in the betterment of patient care without talking about regulatory reforms. The government should strengthen regulatory frameworks so as to ensure the quality and safety of healthcare services,” Nneji Tobechukwu, a pharmacist, told the reporter.
Tobechukwu added; “More governmental funds should be allocated to the healthcare sector. The government should also ensure that healthcare is affordable and accessible to all. There is now an increase in prices for both medications and medical procedures. Patients are unable to pay for their medications and medical treatments because of the economic crisis.”
“In addition, extensive public health campaigns and initiatives ought to be carried out by the government to inform the general public of the significance of regular medical examinations, healthy lifestyle choices, and preventative care. To help patients live healthier lives and ensure better health outcomes, there must be increased awareness.”
In the midst of this, the Nigerian government has unveiled a new clinical palliative plan aimed toward improving medical services access and lightening citizens’ monetary weights. The drive, initiated by the Federal Capital Territory Administration (FCTA), gives free clinical treatment, medical procedures, and food supplies to patients.
Health and Social Welfare Minister Muhammad Pate additionally emphasized the government’s commitment to further improving healthcare services.
“In the last year, we have expanded primary health care centres through direct facility financing to 8,800 centres across all 36 states,” Pate said.
He also highlighted the enrollment of over two million Nigerians in health insurance programs funded through the Basic Health Care Provision Fund (BHCPF).