When Sirens Fall Silent: Inside Lagos’ Failing Ambulance System

The Crisis of Emergency Care in Nigeria

Emergency care systems play a vital role in preventing death and disability from acute illnesses and injuries. In May 2019, the World Health Assembly passed a resolution that highlighted the critical importance of these systems. However, despite this global recognition, many low- and middle-income countries, including Nigeria, continue to face significant challenges in developing effective emergency care systems.

Historically, limited resources have been directed towards combating infectious diseases and addressing maternal and child health, often leaving emergency services underdeveloped. Universal health coverage, which ensures access to quality healthcare services without financial hardship, remains a key objective for countries looking to strengthen their emergency care systems. Yet, Nigeria’s health system has long struggled to meet the needs of its growing population, even as economic indicators have improved.

Between 2000 and 2019, Nigeria’s gross domestic product per capita rose from $568 to $2,230. However, its healthcare delivery still lags behind. Globally, Nigeria ranks 142nd out of 195 countries in terms of healthcare access and quality. One of the critical challenges facing the country is the mass exodus of trained healthcare professionals. Nigeria continues to experience one of the highest rates of medical brain drain in the world. The nation’s healthcare infrastructure remains inadequate.

Estimates suggest that over half of all deaths in low- and middle-income countries could be prevented through effective emergency care. In Nigeria, this could mean saving up to one million lives each year, about 3,000 lives daily. Despite this staggering potential, emergency departments in the country are often run by providers without any formal training in emergency medicine, as there are currently no nationally recognized postgraduate programs in the specialty.

Roughly 10 to 15 percent of Nigeria’s 1.6 million annual deaths are believed to occur within emergency departments. Lagos is one of the few states that has a public ambulance transport system, but many stakeholders have said some of the vehicles are not functional. Even when ambulances are operational, navigating the city’s traffic-choked roads poses a major obstacle to timely emergency response.

A Lifesaving Experience

The story of Ifeoma, a media expert who reported on health for years, highlights the importance of a functioning emergency care system. On the day she lost her newborn, she found something extraordinary in the blare of sirens and the sudden rush of breath that arrived just in time. LASAMBUS, the Lagos State Ambulance Services, saved her life. They came with everything—oxygen, monitors, and trained personnel. They stabilized her and drove her to Isolo General Hospital, ensuring she was alright.

Her baby didn’t make it, but LASAMBUS did. In its heyday, LASAMBUS was a model of public health responsiveness. First introduced during the tenure of then-Governor Babatunde Fashola and strengthened under his successor Akinwunmi Ambode, LASAMBUS was more than just a fleet of emergency vehicles; it was a lifeline. Strategically stationed across the state and seamlessly integrated with LASEMA, the service represented a rare feat: a state healthcare infrastructure that worked.

The Decline of LASAMBUS

Today, that legacy is in tatters. Reports of long delays, missing ambulances, and near-absent emergency care have become common. During one recent major emergency, an ambulance reportedly took over 45 minutes to arrive at the scene. In a state as dense, chaotic, and incident-prone as Lagos, those minutes often mean the difference between life and death.

What happened? “Maintenance died. Priorities shifted. Square pegs found their way into round holes,” says Ifeoma bitterly. She points to a larger pattern across the state’s healthcare infrastructure: grand policy announcements followed by poor execution, procurement-driven governance that prioritizes new assets over sustaining the old, and a lack of accountability for failures.

In several parts of Lagos that once had stationed ambulances, including Ojota, Surulere, Epe, and densely populated areas like Mushin and Alimosho, many LASAMBUS outposts have reportedly become inactive or abandoned. The sight of a siren-sounding, oxygen-fitted rescue vehicle has become rare. And with its disappearance, Lagosians have reverted to private alternatives or, worse, improvised solutions.

Calls for Reform

Health experts are calling for an independent audit into the current state of LASAMBUS. How many ambulances are functional? How many are parked and abandoned? Who is responsible for oversight? What happened to the collaboration with LASEMA?

A 2020 study revealed an average response time of 17 minutes, ranging from seven to 60 minutes, which experts have said was too lengthy relative to global standards. Factors contributing to delays include traffic congestion (60 percent), poor incident descriptions (18 percent), and distance (seven percent). In 2019, for instance, LASAMBUS only responded to 37.1 percent of road traffic accident calls, hindered by poor infrastructure, unfitted vehicles, and dispatch coordination issues.

Private Alternatives and Progress

While progress has been made, these figures underscore the urgent need for expanded, equitable, and better-coordinated emergency care systems across Nigeria. Private and non-governmental emergency medical systems in Nigeria demonstrate better performance. Eight Medical, a private first responder service, boasts an average response time of 10 minutes, having responded to over 15,000 calls and reportedly saved 8,000 lives.

Flying Doctors Nigeria offers air ambulance services with a fleet of 20 aircraft and 47 staff. The service caters primarily to clients who can afford its premium offerings. Additionally, organizations like Trauma Care International Foundation and LFR International have stepped in to bridge the response gap through training. These groups have trained over 350 paramedics in Lagos and more than 1,000 Federal Road Safety Corps personnel nationwide, aiming to improve first response across critical locations.

The Latest Efforts

In what appears to be an official acknowledgment of the state’s declining emergency response capacity, the Lagos State Government unveiled 10 new pre-fabricated ambulance points under the LASAMBUS scheme. The move, according to the government, is seen as a corrective step to boost the state’s struggling pre-hospital care system, which has faced mounting criticism over delayed response times and deteriorating infrastructure. These new ambulance points represent not just infrastructure, but renewed hope and access to lifesaving care.