How Poverty and Bad Roads Are Killing Nigerians Before They Reach Help

Musa Ibrahim drives his Keke NAPEP from Tudun Wada to the central market in Jos every morning by 5 a.m. and returns home by 8 p.m. On a good day, he earns around 4,000 naira. On a bad day, he earns less. On the day a motorcycle cut across him at the Zaria Road junction and he skidded into a concrete kerb at full speed, fracturing his left leg and his right wrist, he earned nothing. He lay in the accident and emergency department of a state general hospital for eleven hours before his younger brother could scrape together enough to pay for the first round of X-rays. His wife went three days without food to pay for the first set of drugs.

That is what Nigeria’s health crisis looks like from inside an emergency ward. Not abstractions. Not policy papers. A man on a gurney whose family is going hungry while he waits for someone to find the money to save him.

James Jemimah is an emergency nurse who has spent years watching this. “A lot of people find it difficult to be able to fund their medical bills,” she told The Gazette News. “To be able to pay for drugs, investigations, bed fees, and the rest. Some cannot even feed themselves while they are in bed in the hospital. You can imagine somebody that can’t even have a good three square meals. How can he be able to pay for drugs and settle the rest of the bills?”

The answer, in too many cases, is that he cannot. And so he leaves.

The Ward Nobody Wants to Afford

Nigeria is one of only three countries in the world where households pay more than 70 per cent of total healthcare costs directly from their own pockets. That figure, documented by the World Health Organisation and confirmed by multiple Nigerian government reports, did improve marginally to 66 per cent of total health expenditure in 2024, down from 70.3 per cent in 2023, according to the Federal Ministry of Health and Social Welfare. But the direction of improvement does not change the ground reality: households remain the single largest source of health financing in a country where 33 per cent of the population, approximately 73.7 million people, are classified as multidimensionally poor, according to the 2024 Multidimensional Poverty Index.

Only an estimated 9.5 per cent of Nigeria’s population holds any form of health insurance, according to the Federal Ministry of Health’s own 2024 State of Health of Nigerians Report. The rest pay, or they don’t get treated. For the woman with a heart condition cited in a BusinessDay investigation in late 2024, a hospital bill of N112,000 against a monthly salary of N80,000 meant she left against medical advice after two days, rather than the five the doctor recommended. Malaria treatment at a standard facility can cost over N100,000. Pneumonia, ulcer, hypertension and diabetes treatments regularly run higher.

“The hospital is not just meant for those that are sick,” Jemimah said, trying to shift the framing. “Even a healthy person can come for a regular medical checkup. If you can have a regular medical checkup and also be able to eat well, those two can help in physical health.” The advice is sound. But it runs into the wall of daily economic reality almost immediately. For the millions of Nigerians living on daily wages of 3,000 to 5,000 naira, preventive care is a concept that belongs to a different income bracket.

Nigeria’s 2025 health budget was set at N2.48 trillion, representing just 5.18 per cent of the total national budget of N49.74 trillion. The African Union’s Abuja Declaration, which Nigeria signed in 2001, commits member states to allocate at least 15 per cent of their annual national budget to health. After 24 years, Nigeria has never reached that threshold. Not once.

The Roads That Finish What Poverty Started

If underfunded healthcare is the slow death, the roads are the sudden one.

Jemimah speaks about road traffic accidents with the particular exhaustion of someone who has seen too many of them arrive at the same door. “It’s one of the causes of 70 to 80 per cent of the patients we see in accident and emergency,” she said. “Mostly they come in as a result of road traffic accidents.”

The data confirms what she sees every shift. Nigeria recorded 10,446 road crashes in 2025, a 9.2 per cent increase from 9,570 in 2024, according to the Federal Road Safety Corps’ 2025 Annual Road Traffic Crash Report. 5,289 people died on Nigerian roads in 2025. In 2024 alone, 70,530 people were involved in road crashes, with 5,421 deaths, a seven per cent rise from 2023. Road accidents are the second highest source of violent deaths in Nigeria after insurgency, according to Blueprint Newspapers’ analysis of FRSC data. The WHO’s 2018 Global Status Report on Road Safety estimated Nigeria’s actual annual road fatality figure at approximately 39,802, more than seven times the FRSC’s official count, with analysts noting that minor accidents, particularly in Lagos, are significantly under-reported.

Speed limit violations alone accounted for 41 per cent of all identified crash causes in December 2025, according to the FRSC Corps Marshal, Shehu Mohammed. Mechanically defective vehicles, tyre bursts, driver fatigue, and overloading account for most of the remaining causes. Nigeria’s total highway network of 194,394 kilometres is rated among the worst-maintained in the world.

Jemimah identifies a human behaviour dimension that statistics alone do not capture. “Some of them actually take drugs,” she said of motorcycle and tricycle operators arriving in her ward. “Some of them don’t know the real rules of driving on the road. Since we are living in a lawless society these days, we don’t have more of all these road safety people. Everybody is just doing what he wants to do on the road.”

The victim profile she describes is precise and consistent: daily wage workers, breadwinners of households that live hand-to-mouth, who are injured or killed and take their family’s income with them to the ward or the mortuary. The economic shock of a breadwinner’s road accident, she explains, does not stop at the hospital bill. It extends to every meal the family does not eat and every school fee that does not get paid while recovery stretches over weeks or months.

How the Body Keeps the Score

Beyond emergency ward throughput, Jemimah offers a medical education on what Nigeria’s economic pressure is doing to people’s bodies over time, not in spectacular crashes but in slow, interior erosion.

“Stress actually has an indirect effect, not really direct,” she explained. “The stress alone doesn’t have the ability to cause the harm in the human body. But the stress can cause one or two abnormalities in the function of the body, leading to the manifestation of the effects.”

The mechanism she describes is cellular. When the body is denied rest over extended work periods, the cells that compensate for the deficiency eventually exhaust their capacity. What follows ranges from joint weakness and chronic back pain to, in severe cases, acute mental health breaks. “Instead of you relaxing the brain, you’ll just be talking. Before you know it, you’re running on the streets,” she said.

Her practical prescriptions are shaped by what she knows Nigerians can actually afford. On nutrition, she steers away from the language of expensive superfoods toward what grows in a backyard: “Mothers should have the knowledge of food combinations, more vegetables, because you can easily make them at home.” If you just have water, you can grow your own veggies and cook, and it’s not that costly.” She recommends beans, groundnut paste, and palm oil as accessible protein and healthy fat sources that, combined thoughtfully, produce a balanced diet.

On inactivity, she is equally direct. When calories are consumed without corresponding physical expenditure, “those fats that are supposed to be burnt out are now building up inside,” she explained. “It will start altering the blood flow in the cells. ” Hypertension, coronary artery disease, and obesity are the downstream consequences of the sedentary lifestyles increasingly common in urban Nigeria. None of them are cheap to treat.

Her most unexpected advice targets the psychological burden of cultural expectation. “Limit social pressure,” she said. “There is a way of life that society has already set that is totally not helpful when it comes to the health of an individual.” She names the pressure to marry by a certain age, to have children before a certain year, and to acquire visible material markers of success on a timeline that does not account for economic reality. These expectations, she argues, produce a chronic low-level stress that compounds into clinical conditions over years. “Everything has its own time,” she said. “Don’t try to rush things.”

What the Numbers Cannot Carry

Musa Ibrahim is still recovering in Jos. His Keke is parked. His family has not eaten well in weeks. His wife is trying to find casual work at the market to cover what is left of the hospital bill.

He did not cause his own accident. He was doing what millions of Nigerians do: working every hour available, on roads that are inadequate, beside other drivers who were also doing what they had to do to survive, with no insurance to absorb the blow when something went wrong.

James Jemimah will be in the emergency department tomorrow morning when the next one arrives. She will do what frontline nurses in a cash-strapped system do: find a way to help within a structure that was not built to hold this much weight.

“Every individual should do the work they can,” she said. “Every human being knows his limit. So once you work and you reach your limit, find time and rest.”

It is the kind of wisdom that only people who have watched the system fail up close can offer with that particular calm. The question is whether Nigeria’s government is listening or whether, like so many patients who cannot afford the bill, it too has been discharged against medical advice.