Healing the mental scars of IDPs

During and after conflicts, people are more likely to suffer from a range of mental health problems. Mental health is crucial to the overall wellbeing, functioning, and resilience of individuals, societies recovering from emergencies. AJUMA EDWINA OGIRI, writes with agency report on the need to prioritise mental healthcare for people living in camps for Internally Displaced Persons (IDP).

It began as a hot autumn day like any other for Aisha (pseudonym). The girl with big eyes was looking out of the window of her house, watching a group of men approach her brothers who were harvesting crops. Aisha thought they were family friends because they came up close to her siblings.

Her mother Gaji was doing her household chores when she heard her 13-year-old daughter let out a piercing scream.

“Mother, they are killing my brothers!” cried out Aisha.

After that, Gaji doesn’t remember much except that somehow she fled with her daughter to the surrounding countryside. They returned later to bury the young men who, like so many others, were murdered by insurgents.

The killings which Aisha witnessed aggravated her already fragile mental state.

“She became violent, kicking and fighting everyone. I couldn’t control her,” Gaiji said.

Initially the mother and daughter returned to their home in northeastern Nigeria, but the armed rebels made forays into that community as well. So Gaji moved with Aisha to Bakass, a camp for internally displaced people on the outskirts of Maiduguri, Borno state.

Gaji worried about her daughter, who had trouble communicating and would often disappear.
“I couldn’t leave her alone, because I wasn’t sure what she would do,” Gaji said.

Since the start of the conflict between Boko Haram and Nigerian security forces in the north-east, more than 30,000 people have been killed.

More than 2,000 women and girls have been abducted and subjected to physical and psychological abuse, forced marriage and sexual violence, forced labour, forced to participate in armed operations and repeatedly raped.

This complex context of protracted violence, abuse, killings, disappearances, enslavement and imprisonment has had a profound impact on the mental health and psychosocial wellbeing of people in the north-east. Millions of people have been affected, either first-hand or through indirect exposure to violence. Entire families and communities live in fear, fleeing their villages to seek refuge in safer areas, bigger cities or neighbouring countries.

According to the Displacement Tracking Matrix produced by the International Organization for Migration (IOM), by March 2017 more than 1.8 million people had been displaced across the six most affected regions: Adamawa, Bauchi, Borno, Gombe, Taraba and Yobe. A third are in official IDP camps and camp-like settings, with the rest living in host communities, with friends and relatives or in rented or free accommodation temporarily provided by private citizens, churches and other local groups. In addition, everyone experiences some kind of loss in displacement: loss of property, including the loss of a home, loss of relatives and friends through death or separation, and loss of identity and status.

The World Health Organization (WHO), estimates that as many as 1 in 5 people in IDP camps may need mental health care. The organisation also added that the rate of common mental disorders can double, because in emergency settings, Gender based violence, abductions, and gross atrocities can trigger psychological problems which take years to heal.

WHO further revealed that despite this huge and urgent demand for care, there is only one specialised mental health facility in the whole region; the Federal Neuro-Psychiatric hospital, Maiduguri, which has seen the number of its patients increase significantly.

“In a humanitarian crisis, mental health is often neglected because the focus is on saving lives due to preventable infectious diseases such as diarrhea, respiratory tract infections and malaria. But WHO has made mental healthcare one of its top priorities in north-eastern Nigeria,” Dr Wondimagegnehu Alemu, WHO Representative to Nigeria said.

Also, in September 2017, WHO, Borno state authorities and the Federal Neuro-Psychiatric hospital teamed up to launch the mental health Gap Action Programme (mhGAP). The partners trained 64 primary healthcare workers in IDP camps and other humanitarian facilities to recognise and treat mental disorders which are common in emergency settings.

Aisha was one of the first beneficiaries of the programme. She began her treatment in October 2017 in the Bakass camp, through Falmata Muhammed, a primary healthcare worker who provides psychosocial support to Aisha once a week.

If Falmata has questions over how to handle difficult cases she turns to her supervisor, Umar Musami, a Psychiatrist at the Federal Neuro Psychiatric Hospital. Umar visits Bakass camp every two weeks to also treat patients and observe Falmata.

“I either supervise her in person or she calls me on the phone and tells me the patient’s symptoms and I will advise her on what to do.
“Aisha has improved remarkably. When she came she was having severe psychological issues, but she is now doing better,” Umar said.
In the first five months of the programme, 5,000 people accessed mental healthcare in 36 primary healthcare facilities. In 2018, WHO is scaling up the pilot intervention and training 70 additional health workers across north-eastern Nigeria.

The mhGAP Humanitarian Intervention Guide contains first-line management recommendations for mental, neurological and substance use conditions for non-specialist health-care providers in humanitarian emergencies, where access to specialists and treatment options are limited. It is a simple, practical tool that aims to support general health facilities in areas affected by humanitarian emergencies in assessing and managing acute stress, grief, depression, post-traumatic stress disorder, psychosis, epilepsy, intellectual disability, harmful substance use and risk of suicide.

WHO recommends at least 1 supervised health care staff member in every general health facility during humanitarian emergencies to assess and manage mental health problems, as psychological and psychiatric help need to be made available immediately for specific, urgent mental health problems as part of the health response.

Communities affected by emergencies need long-term access to mental health care as adversity is a potent risk factor for a wide range of mental health problems.

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