Mental health issues among internally displaced persons

The term ‘Internally Displaced Persons’ refers to groups of people who have been forced to leave their homes or places of habitual residence; in particular, as a result of armed conflict, violence, violation of their fundamental human rights or natural/man-made disasters. Such people may not have crossed an international border before.

According to a report released by the Internal Displaced Monitoring Centre and the Norwegian Refugee Council, titled ‘Global Overview 2014: people internally displaced by conflict and violence’, Nigeria has about 3.3 million persons displaced by conflict, which is one of the highest in Africa. In spite of this, the number of IDPs in the country is still alarming.

The report explains the unprecedented rise in IDPs through accelerated terrorist attacks, heavy-handed counter insurgency operations and sporadic inter-communal violence.

By May 2013, insurgents focused their attacks on towns and villages that were close to Nigeria’s borders with its neighbours, such as Cameroon, Niger and Chad.

Many inhabitants of the border communities were forced to flee to nearby towns and villages due to an increase in deadly attacks and the attendant destruction of properties, businesses and farmlands.

Communal clashes are another factor contributing to the high number of displaced persons in Nigeria. Clashes between farmers and herdsmen over grazing lands in states, such as Benue, Taraba, Zamfara and parts of Kaduna, have left many people dead and injured.

Many of the victims of the flood incidents that occurred across the country in 2012 have yet to be rehabilitated. According to the National Emergency Management Agency, more than 2 million people were displaced by natural disasters in that year alone.

The rise in the number of IDPs in Nigeria during the first quarter of 2015 was due to the violence in the north-eastern part of the country.

The highest number of IDPs was registered in Borno State, one of the three north-eastern states most affected by the Boko Haram insurgency, followed by Adamawa and Yobe states.

At the IDP camps, malnutrition in both adults and children is growing at an alarming rate and the most affected are children. A particular report states that children in the camps showed an 18 per cent threshold of malnutrition, which is above the globally recognised emergency threshold of 15.

Other health problems are malaria fever, typhoid fever, cholera and high blood pressure. Polio and measles are still major public health concerns for children.

However, the most neglected of all health issues is the psychological impact this trauma has had on individuals.

According to some reports, undiagnosed and undocumented depression and post-traumatic stress disorder are obvious in a number of IDPs.

The prevalence of depression and suicide, reports from Sudan claim, is a considerable mental health burden and a challenge to humanitarian agencies.

The depression rate is comparable with other groups affected by complex emergencies.

Also, the rate of suicide attempts among women is quite high, in comparison with general rates worldwide and given the elevated post-traumatic stress disorder rates and disability in displaced populations.

The combined impact of gender disparities and sustained stressors, such as poor housing, poor feeding, sexual violence, displacement and livelihood disruption may contribute significantly to the mental health burden in the IDP population. Provisions for mental health services even before displacement have always been poor and worse still in emergency settings.

It is, however, noteworthy that 98 per cent of folks, mostly women, are meeting the criteria for major depressive disorder.

The World Health Organisation recommends the integration of mental health services and local staff training into a community-based format for the ongoing assessment of mental health needs and the monitoring of displaced persons to determine appropriate support.

IDPs are among the most vulnerable set of people who the government needs to cater for while ensuring that they are secure and of sound health. Cases of sexual abuse are common with implications for physical and mental health in this cohort. While the government confronts this challenge, philanthropic Nigerians and non governmental organisationss need to articulate help that is not just focused on feeding, housing and physical health interventions alone but also a strong incorporation of mental health intervention crucial for the overall quality of life of displaced persons invariably.

WHO recommends that a robust mental health programme should be uploaded right from the emergency situations in the IDP camps to follow through to resettlement.

PUNCH.