Destruction of homes and killings of friends and relatives have traumatised countless adults and children across northeast Nigeria
By Kieran Guilbert
MAIDUGURI, Nigeria, Feb 1 (Thomson Reuters Foundation)- Puffing on the cannabis joints dangling from their mouths, a group of teenage boys hurl insults at a stream of pupils as they rush past them on their way to school.
But the joints are empty, and the words are hollow. These young Nigerians are using role play to highlight the problem of drug abuse among youths in a camp for the displaced, who are turning to marijuana to numb the pain inflicted by Boko Haram.
The destruction of their homes and the killings of their friends and relatives have traumatised countless adults and children across northeast Nigeria, where the militant group has waged a bloody seven-year campaign to create an Islamic state.
"Sometimes we talk about our feelings, and what happened," 15-year-old Modou Mamman told the Thomson Reuters Foundation at the Dalori II camp in Maiduguri, the capital of Borno state.
"But not too much, because it gives us a bad feeling in our hearts," he said, glancing at his peers, who all recalled how they had been separated from their parents or watched them die.
Most of the 1.8 million people uprooted by Boko Haram are children and women, who, having lost their fathers and husbands, are struggling to cope in crowded camps and local communities.
With food, shelter and security the main concerns, health experts fear that psychological wounds are being left to deepen in a region with only a few psychiatrists, where people with mental health issues are often beaten, abused and locked away.
While the most severe cases - from schizophrenia to post-traumatic stress disorder (PTSD) - are referred to the one mental health facility in the northeast, millions of people suffering from trauma are going untreated, aid agencies say.
By counselling women while teaching them valuable skills, ranging from pasta-making to tailoring, and using drama and play therapy to encourage children to express themselves, mental health workers are striving to ease the suffering.
"People have no peace in their hearts at first, only bitterness," said Martha Philip, mental health team leader for the International Organization for Migration (IOM).
"But the wounds heal, gradually, and people develop resilience. Slowly, slowly, we are seeing some improvement."
PLAYTIME AND PASTA-MAKING
While Mamman and his friends practise their role play again in a support centre in Dalori II, dozens of younger children nearby squabble gently over toy building blocks and board games.
Being uprooted, losing relatives and witnessing violence has left more than two million children in northeast Nigeria with psychosocial distress, said the U.N. children's agency (UNICEF).
Yet as children tend to lack the ability, and vocabulary, to fully express their emotions, mental health workers analyse them while they play, draw and act - looking out for signs of trauma.
"When we first ask kids to draw what is in their mind, they draw bombs, corpses and burning houses," said IOM mental health worker Emmanuel Maina. "A young boy, who watched his parents die, told me: 'When I see Boko Haram, I am going to kill them'."
Many of the children complain of flashbacks, nightmares and headaches - signs of depression and stress.
Some are prone to aggression, while many are withdrawn or silent, said the health workers, recalling a five-year-old boy who has not spoken since Boko Haram destroyed his family home.
"If we leave kids idle, they may one day practice what they have seen," said Maina.
Among the clutter of toys, several women huddle around sewing machines and pasta makers, gossiping while they work.
These women - mostly widows and now heads of their families - have little time for themselves. But learning profitable skills allows to them make money while forging bonds with other women and receiving counselling, mental health workers say.
Having seen her father, home and life ripped away by Boko Haram, mother-of-five Fatima Abbakaka thought the worst was behind her. Then her husband left her to live with another wife.
But by making pasta to sell in the camp, Abbakaka said she is able to cope without him - a sentiment echoed by the two widows helping her to knead the dough and stretch it into shape.
"I had lost all hope in life," said Abbakaka, explaining how the friendship with these women, and counselling she received, had helped. "Now, I realise it is important that I am alive."
While the IOM and U.N. aid agencies say they have provided psychosocial support to hundreds of thousands of children, mental health services are lacking in a region where millions of people have untreated trauma, according to health experts.
"The government's response (to the insurgency) is mainly focused on food aid, nutrition, security and reconstruction," said psychologist Fatima Akilu, head of the Neem Foundation, which works to improve psychosocial care and tackle extremism.
"As there is so little understanding or investment in mental health, the trauma that is now manifesting in the northeast has left us overwhelmed," said Akilu, whose foundation next month plans to open a psychology training centre in the northeast.
The state health ministry is training hundreds of health workers to provide psychosocial first aid, and deploying 25 psychiatric nurses to provide mental health care in areas of the northeast previously cut off by Boko Haram.
The government is planning to integrate mental health services into primary health care facilities, but a lack of funds is an obstacle, according to Muhammad Ghuluze, director of emergency medical response in the state health ministry.
Only 3.3 percent of Nigeria's health budget goes towards mental health, according to a study published last month in the International Journal of Mental Health Systems (IJMHS).
"The attitude towards mental health care in Nigeria has been inept, but because of the dire needs, we are starting to see more attention from the government," Ghuluze said.
In the meantime, children like Mamman are just happy to have a safe place to play, and friends to confide in.
"We first became friends because we all had Boko Haram in common," Mamman said." "Now, we are like family."
(Reporting By Kieran Guilbert, Editing by Ros Russell; Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters, that covers humanitarian news, women's rights, trafficking, property rights, climate change and resilience. Visit http://news.trust.org)