Over 2.2 million people have fled the violence of Boko Haram in North East Nigeria. Suicide bombings and armed violence are regular occurrences. Psychiatrist Marjolein van Duijl supported us to train international aid workers who are working with Internally Displaced Persons in the area. Currently Clinical Director at the Centre for Transcultural Psychiatry Veldzicht in the Netherlands she reflects on her experiences.
‘The training was intense and impressive. People here work in dangerous circumstances and encounter a lot of suffering,’ says Marjolein. The training which happened in close collaboration with Save the Children and the Nigerian Joint Emergency Response took place in the city Maiduguri in North East Nigeria which was the epicentre of religious violence in 2009. Over 700 people in the city were killed and almost half of the population in the region was displaced due to the violence of Boko Haram.
The displaced stay in camps where they live in dangerous circumstances. The camps are cramped and overpopulated and there are no basic provisions such as healthcare, clean water and toilets. Diseases such as cholera and malaria are never far away. The refugees, often farmers, want to go home but cannot till their land due to landmines and general insecurity.
‘In this chaotic and busy city it is remarkable you don’t see any motors like elsewhere in Nigeria,’ says Marjolein. ‘Motors were prohibited after they were used for terrorist attacks all the time. Now you see a lot of yellow tri-cycles as taxi.’ Still, bombings continue. In the past year 83 attacks were committed by children. Marjolein continues: ‘This doesn’t get any news coverage in the Netherlands, even though the conflict with Boko Haram has already costs the live of over 100.000 people.’
Almost half of the 2.2 million displaced are children and they are a very vulnerable group. ‘Children in North East Nigeria are faced with the risk of kidnappings, poverty, bomb explosions and hunger. They live in continuous uncertainty in unsafe circumstances. Add to this that when people first fled Boko Haram, schools were used as a refugee camp. The children did not get an education anymore and this has had enormous impact on their future and their dreams. Without perspective on a better future the children have become susceptible for abuse.’
(Foreign) aid organisations focus mainly on emergency aid. Water, food, safety and shelter. Marjolein: ‘Mental health care is often forgotten. Many refugees have had potentially traumatising experiences, but most people working in refugee camps has no experience with any form of psychosocial support.’ War Trauma Foundation trains health professionals and community workers in low resource settings in areas hit by war and disaster. Key elements of the trainings are how to signal psychological need, how to provide psychosocial support and refer where necessary to psychiatrists and psychologists.
Providing the training was an eye opener for Marjolein. ‘In the north of Nigeria there is still a lot of prejudice and superstition around psychological illnesses. People quickly think there is witchcraft in play, which is a common believe in western Africa and was a special point for attention in the training.’
Local aid workers of 7 aid organisations took part in the training. ‘The staff is continuously exposed to external stressors and often have difficulty themselves to cope with the suffering of their patients. Care for oneself is important to provide quality care, and people have to look after each other.’ Aside from sharing practical experiences the training includes modules on cultural outings of stress and psychological problems, how to deal with vulnerable people, how to deal with aggression and how to support self-help of the person in need.
During the training specialists from local health networks were present to tell about their work and to stimulate appropriate referral. ‘Aid workers in refugee camps are now much better in tune with the mental health care provisions present.’
(Interview by Mirjam Kwint, senior communications Centrum voor Transculturele Psychiatrie Veldzicht, www.ctpveldzicht.nl)