Volume 23/1, June 2021, pp. 71-73
Adewale Olusola Adeboye
In Nigeria, the Boko Haram insurgency has opened up wide-ranging discussions regarding human security and human rights. The crisis has exposed the sheer neglect and near exclusion of people under mental distress from health facilities, despite the urgent need for adequate mental health support and care for those who have experienced extreme violence. If people are unable to receive mental health care, the crisis will likely lead to further violence and other human rights abuses. As well as ensuring that there are mental health care services available, government leaders must address the social determinants of mental health. This includes providing legal support to ensure justice for victims; promoting community enterprises to help build communal resilience; undertaking awareness and information campaigns on the value of mental health support interventions; and encouraging people to recognize that mental health is a human right. To achieve all of these things, new legislation and dedicated funding is needed.
I have worked for the past decade with multi-level local, national, transnational, and international stakeholders, including serving as the secretary and Anglophone West Africa focal Representative in the Africa Working Group of the Global Action Against Mass Atrocities (GAMAAC) and at a time, Country Coordinator for the Terrorism Research Initiative, TRI-Nigeria. Thus, I have long been concerned about the impact of these attacks on the population’s mental health and, accordingly, recognize the need to protect mental health as a fundamental human right. By applying mass atrocity prevention (MAP) and human rights lenses to the unique public and mental health challenges of Nigeria, this viewpoint beams a searchlight on ways to address mental distress after encounters with Boko Haram.
Boko Haram and its impact in Nigeria
Nigeria’s 12-year conflict with Boko Haram has devastated communities in the country’s north eastern states.[1] Boko Haram has targeted its attacks on both civilians and security personnel, damaging and destroying buildings and public infrastructure. Local communities have suffered grave human rights abuses as a result of the incessant raids.[2] These abuses include murder, abduction, sexual violence, forced labor, forced conscription of children, looting, and burning public buildings (such as schools), personal property (such as farmland), and in some cases entire villages.[3] Since the beginning of the conflict, more than 43,000 people have died from Boko Haram violence.[4] Those who survive the Boko Haram violence can be left with enduring physical and mental trauma.[5]
Mental health as a human right
The International Covenant on Economic, Social, and Cultural Rights (ICESCR) asserts that ‘health is a fundamental human right indispensable for the exercise of other human rights where every human being is entitled to the enjoyment of the highest attainable standard of health conducive to living a life in dignity.’[6] The African (Banjul) Charter on Human and People’s Rights draws on language from the ICESCR and also mandates the health security of individuals as a human right.[7] Nigeria ratified the United Nations Convention on the Rights of People with Disabilities in 2007 and its Optional Protocol in 2010, recognizing the importance of mental health.[8] Human rights demands adequate and urgent care for survivors of trauma, especially in high-burden environments such as war zones or mass atrocity environments.
Despite these commitments to human rights, Nigeria lacks a national mental health policy. With a population nearing 200 million, the World Health Organization estimates that over two million Nigerians suffer from depressive and anxiety disorders.[9] However, there are insufficient mental health workers in Nigeria to cater to the dispersed population even without the burden of Boko Harem induced mental distress. For example, in one of the northeastern affected states, Borno, 80% of the Local Government Areas have insufficient numbers of functioning health facilities.[10] During periods of conflict or post-conflict, heavier burdens are placed on every aspect of the public sector, thereby forcing them to compete against each other for reduced budgetary allocations.
Consequently, public health facilities and services in Nigeria, including mental health services, are in a poor state to respond to a crisis such as mass atrocity. Accessibility to mental healthcare services in the northeast essentially is severely restricted, with mental health services and staff unable to meet the needs of individuals requiring attention.[11] In 2020, there were about 250 psychiatrists in the entire country: community mental health task-shifting pilot programs were limited to very few locations.[12] As a result, the impacts from trauma, such as post-traumatic stress disorder, depression, anxiety, and drug dependence go untreated. This exacerbates the harm that Boko Haram has inflicted upon the community at-large, and increases the risk of perpetuating the cycle of violence.
Addressing social determinants and community relationships
To limit the long-term mental health impacts of Boko Haram violence, governments at the local, state, and national levels must protect and fulfill victims’ mental health rights, without discrimination. In a multidimensional, intersectoral response, Nigerian officials must reinforce support for the social determinants of mental health, recognizing that individual needs and community relationships are fundamental in promoting and protecting improved mental health and wellbeing.[13]
The lack of mental health services compounds survivors’ inability to adjust and cope with the losses and trauma they have experienced. Across most of the country, people who have experience mental distress remained stigmatized and discriminated against. Personal and religious beliefs may cause survivors of these atrocities to reject mental health interventions. Government-led awareness and education campaigns at local or community levels, and in partnership with religious institutions, could help promote the acceptance of mental health interventions.
Reparation, another important mitigating factor in healing, has not yet been addressed. The legal system needs to provide official recognition of victims’ needs for justice, and develop strategies to help people who have been kidnapped or injured by Boko Haram. Although testifying must be handled sensitively to limit retraumatizing victims, the courts can provide justice and closure for those who have been harmed.
The suffering caused by Boko Haram is a collective loss to the community, as well as an individual one. An injury to one community member injures all. While the community has experienced harm, it can also be a source of healing. Cultural and community affiliations promote resilience in the forms of family, cultural, religious, and traditional associations. Training in skills acquisition and enterprises, such as soap making and sewing, has offered communities collective coping solutions to mitigate suffering.[14] More such opportunities are needed.
Conclusion
The Boko Haram insurgency has exposed serious and substantive flaws in Nigeria’s public health system. Nigeria has human rights obligations to address these failings, and to do so in ways consistent with the Convention on the Rights of Persons with Disabilities. The Human Rights Commission has been advocating for the domestication of the Convention at state levels for some time, to promote the human rights entitlements of people exposed to Boko Haram atrocities. In particular, it is imperative that the National Assembly passes a mental health bill that, among other things, will lead to an increase in the number of mental health workers to provide care to all who need it, and to help reduce discrimination and stigma.[15] Local government and state emergency response teams could also advocate for such legislation. Mental health support in Nigeria, and especially in the northeast, requires multidimensional and multidisciplinary approaches for research and practice that frame health issues within the broader context of the psychosocial well-being and rights of post-conflict societies. It must provide justice, employment, and economic support, all of which contribute to sustained good mental health of individuals and communities.[16]
Adewale Olusola Adeboye MA, PhD, is the secretary and Anglophone West Africa Focal Representative in the Africa Working Group of the Global Action Against Mass Atrocities, and the founder, West Africa Responsibility to Protect Coalition. E-mail: adeboyewale@gmail.com
[1] K. Dietrich, “When we can’t see the enemy, civilians become the enemy”: Living through Nigeria’s six-year insurgency (Washington, DC: Center for Civilians in Conflict, 2015). https://civiliansinconflict.org/wp-content/uploads/2015/10/NigeriaReport_Web.pdf
[2] S. K. Okunade and O. Ogunnubi, “Insurgency in the border communities of North-Eastern Nigeria: Security responses and sustainable solutions,” Round Table 109/6 (2020), pp. 684–700. Available at: http://dx.doi.org/10.1080/00358533.2020.1849496
[3] Amnesty International, Nigeria: Abducted women and girls forced to join Boko Haram attacks (April 14, 2015). Available at https://www.amnesty.org/en/press-releases/2015/04/nigeria-abducted-women-and-girls-forced-to-join-boko-haram-attacks.
[4] International Committee on Nigeria and International Organization for Peacebuilding and Social Justice, Nigeria’s Silent Slaughter: Genocide in Nigerian and the Implications for the International Community, 2020. https://clientwebproof.com/Nigeria-Silent-Slaughter/
[5] Human Rights Watch, “Those terrible weeks in their camp”: Boko Haram violence against women and girls in northeast Nigeria (October 27, 2014). https://www.hrw.org/report/2014/10/27/those-terrible-weeks-their-camp/boko-haram-violence-against-women-and-girls
[6] International Covenant on Economic, Social, and Cultural Rights, G.A. Res. 2200A (XXI) (1966). https://www.who.int/hhr/Economic_social_cultural.pdf?ua=1
[7] Convention on the Rights of Persons with Disabilities, G.A. Res. 61/106 (2006). https://www.achpr.org/legalinstruments/detail?id=49
[8] Convention on the Rights of Persons with Disabilities. G.A. Res. 61/106 (2006). https://www.un.org/disabilities/documents/convention/convoptprot-e.pdf.
[9] O. Gureje, V. O. Lasebikan, L. Kola, and V. A. Makanjuola. “Lifetime and 12-month prevalence of mental disorders in the Nigerian Survey of Public mental health and Well-Being”, The British Journal of Psychiatry. (2018) 188 (5): pp. 465-471.
[10] “Northeast Nigeria Response”, BORNO State Health Sector Bulletin No. 19 February 2017. Available at https://reliefweb.int/sites/reliefweb.int/files/resources/Borno-Health-Sector-Bulletin-Issue-19.pdf.
[11] J. M. Said, A. Jibril, R. Isah, and O. Beida, “Pattern of presentation and utilization of services for mental and neurological disorders in northeastern Nigeria: A ten-year study,” Psychiatry Journal. (2015) pp. 1-5. Available at https://www.hindawi.com/journals/psychiatry/2015/328432/
[12] P. Adepoju, “Short of mental health professionals, Nigeria tries a new approach,” Devex (September 29, 2020). Available at https://www.devex.com/news/short-of-mental-health-professionals-nigeria-tries-a-new-approach-98176
[13] World Health Organization and Calouste Gulbenkian Foundation. Social determinants of mental health. Geneva, World Health Organization, 2014.
[14] N. Ating, “270 Gombe IDPs Head to Financial Freedom, Kick Off Small Businesses,” AUN This Week, (12 September 2017). Available at https://www.aun.edu.ng/index.php/news-events/news/270-gombe-idps-head-to-financial-freedom-kick-off-small-businesses
[15] C. Onyemelukwe, “Stigma and public mental health in Nigeria: Some suggestions for law”, Journal of Law, Policy and Globalization 55 (2016), pp. 63-68. Available at https://www.iiste.org/Journals/index.php/JLPG/article/viewFile/34236/35208
[16] E. Gustafsson-Wright, and O. Schellekens, Achieving universal health coverage in Nigeria one state at a time: A public-private partnership community-based health insurance model (Washington DC: Brookings Institute, 2013). Available at https://www.brookings.edu/wp-content/uploads/2016/06/Achieving-Universal-Health-Coverage-in-Nigeria.pdf.