The silent crisis: Bridging emergency care gaps in Nigeria’s underserved communities

By Courage O. Idahor

“He would have survived if we had gotten there five minutes earlier.”

Those words have echoed through far too many hospital corridors across Nigeria. They speak to a silent crisis of grossly inadequate access to emergency care in our underserved communities. And behind every “if only” is a mother who bleeds to death in labor. A child who dies from severe malaria before a doctor arrives.  A road crash victim left on the roadside because no ambulance ever came.

This is the harsh reality for millions of Nigerians. In too many parts of the country, a medical emergency is not just a health scare; it is often a death sentence.

Having worked in busy emergency rooms in both Nigeria and the UK, I’ve seen firsthand how timely care saves lives. Unfortunately, in many parts of Nigeria, the difference between life and death isn’t about advanced equipment—it’s about time and access to care.

 

Where Are the Systems?

Nigeria does not have a fully functional nationwide emergency medical service (EMS). That’s not a controversial statement; it’s a lived experience. For most Nigerians, there is no working 3-digit emergency number they can call in their hour of need. There is no certainty that an ambulance will come, and if it does, it may arrive without trained personnel or essential equipment. If you’re lucky, a good Samaritan or an untrained passerby might get you to the nearest hospital in a car, a bus, or even a keke NAPEP. 

This isn’t just a rural problem. Even in cities like Lagos, Port Harcourt, Benin, and Kano, trauma victims often lose critical minutes stuck in traffic, bleeding without care, while families scramble to find a hospital that will accept them without an upfront payment.

Many public health facilities lack the minimum tools for basic resuscitation. Primary health centers, our first line of defense, often close after hours. Where they remain open, there’s rarely oxygen, emergency medications, or anyone trained in handling acute cases. And in places where resources exist, delays in care are worsened by poor triage systems and bureaucratic hurdles.

This is a healthcare emergency. But because it unfolds in silence, one community at a time, it doesn’t get the urgent attention it deserves.

The Cost of Inaction

Let’s be clear: the consequences are enormous. The World Health Organization estimates that more than half of deaths in low- and middle-income countries could be averted with timely emergency care. In Nigeria, where we already struggle with high maternal mortality, infant deaths, road traffic injuries, infectious disease outbreaks, and escalating violence in some regions, the failure of our emergency system is costing us thousands of lives every single week. It is not just a health problem, it’s an economic one. When families lose breadwinners to preventable emergencies, entire households spiral into poverty. When road crash victims are permanently disabled due to delayed care, the economy loses productivity. When trust in the health system erodes, people turn to unregulated, unsafe alternatives.

We cannot afford this.

What Can Be Done And Done Now?

We don’t need to reinvent the wheel. Countries with fewer resources than Nigeria have built more effective emergency care systems. Rwanda’s community paramedic model, Ghana’s national ambulance service, and Uganda’s motorcycle response teams are all examples of creative, scalable solutions tailored to local needs. Rwanda, for example, started from scratch and built a national ambulance service that actually works, integrating mobile technology, location-tracking apps, a toll-free emergency number (912), and trained community responders to reach people quickly, even in remote areas. This is proof that with the right strategy, building a functional emergency system is both possible and achievable. 

Here’s what we must prioritize:

1. A National Emergency Medical Services (EMS) Framework

Nigeria must move beyond fragmented, state-based efforts and adopt a centralized, coordinated EMS model. We need:

• A nationwide toll-free emergency number that works.
• Real-time dispatch centers with trained call handlers.
• Regionally coordinated ambulance services linked to hospitals.
• Clear response protocols for trauma, obstetric, pediatric, and medical emergencies.
• This is not rocket science. It is infrastructure and political will.

A unified EMS framework will not only save lives but also bring coherence, accountability, and efficiency to how emergencies are managed across the country. 

2. Empowering Communities as First Responders

In many emergencies, the first few minutes determine survival. Yet, most Nigerians don’t know basic first aid, CPR, or how to respond during a seizure or bleeding episode. We must:

• Train community health volunteers, transport workers, and local leaders in basic life-saving skills.
• Equip key areas with first aid kits, defibrillators, and trauma packs.
• Create public awareness campaigns that demystify emergencies and educate people on how and when to seek help.

Empowering ordinary citizens with the knowledge and tools to act before professional help arrives can drastically improve survival rates and build a culture of shared responsibility in emergency care. 

 

3. Integrating Emergency Care into Primary Health

Every PHC in Nigeria should be able to stabilize a patient in distress, whether it’s an asthmatic child or a woman in obstructed labor. That means:

• Training healthcare workers in emergency protocols.
• Ensuring the availability of essential drugs, oxygen, and power supply.
• Establishing referral linkages to higher centers with guaranteed transport.

By embedding emergency readiness into the foundation of our primary healthcare system, we can save lives at the community level and reduce preventable deaths before patients ever reach a hospital. 

4. Reimagining Ambulance Services

We must shift from the idea that ambulances are hospital property or political showpieces. A proper ambulance service:

• Responds to the scene, not just transfers patients from one hospital to another.
• Has trained EMS personnel, not just a driver and a ward assistant.
• Is integrated into the national emergency framework and not siloed by state or hospital boundaries.
• Motorbike ambulances, tricycles with medical compartments, and community transport partnerships can all serve rural and hard-to-reach areas effectively.

Rethinking ambulance services means building a system that prioritizes rapid, skilled response regardless of location. By expanding the definition of what an ambulance can be, we can extend emergency care to even the most remote communities. 

 

5. Harnessing Technology

In today’s Nigeria, millions use mobile phones, yet we often fail to leverage this widespread access to technology for emergency care. By utilizing mobile technology, we can create systems that bridge the gap in access to life-saving services. Here are a few ways we can make this happen: 

• Mobile-based emergency reporting apps with geolocation.
• Tele-triage systems linking community responders to doctors.
• Public dashboards showing ambulance availability, hospital capacities, and traffic updates.

Technology can leapfrog many of our infrastructural challenges, if we’re bold enough to invest in it.

6. Financing and Public-Private Collaboration

Emergency care should be seen as a public good, not a profit-driven luxury. Government funding, insurance coverage, and donor support must prioritize pre-hospital and emergency services. At the same time, we must:

• Engage private hospitals and NGOs in system-wide emergency planning.
• Set standards and accountability measures for service quality.
• Develop local manufacturing of medical supplies to reduce dependency and cost.

These strategies, backed up by sustainable financing and meaningful collaboration, are essential to building a resilient emergency care system that works for all Nigerians. 

A Final Word

We must stop normalizing death in emergencies.

No Nigerian child should die of dehydration when a drip and some electrolytes could have saved them. No accident victim should bleed out on the roadside because help didn’t come. No woman should perish in childbirth because the midwife had no oxygen or vehicle to reach a referral center.

This is a collective failure. But it is not inevitable.

We need bold leadership; at the federal, state, and local levels. We need professionals willing to challenge the status quo. And we need everyday Nigerians to raise their voices and demand better.

Emergency care is the great equalizer in health systems. It responds not to wealth, tribe, or title, but to urgency. Every Nigerian, regardless of where they live, deserves that kind of fairness.

Let’s stop managing the crisis. Let’s fix it.

Author Bio: Courage O. Idahor is a physician with experience in emergency medicine, having worked in emergency departments in both Nigeria and the UK. He is committed to enhancing access to emergency care in Africa through collaboration with healthcare professionals. As the founder of a research network, he focuses on investigating the factors contributing to disparities in preventative and emergency care, with a particular emphasis on developing more effective healthcare systems for underserved populations.