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Humanitarian and Development Response, Mental Health

Psychosocial support in crises and protracted displacement – leave no one behind

Toluwalola

By Toluwalola Kasali

Conflict, violence, and human rights violations have forced 50.8 million people to flee their homes and livelihoods to camps and host communities within their countries.  To put the magnitude of internal displacement in perspective, 50.8 million people are equivalent to the population size of Chile, Sri Lanka, Norway, Botswana, and Namibia.

Displaced persons experience flashbacks, nightmares, anxiety, and depression due to the trauma. In this state of mind, they struggle to stay involved in school, skills acquisition, and employment. Sometimes, they display traits like anger and disruptive behaviour, which are reactions to the severe stressors of living in displacement. A combination of these factors affect their mental health and psychosocial well-being.

Stories like that of Zainab, who lives in the Area 1 IDP Camp, Abuja, Nigeria are commonplace – “I have no job and lost all my property. When I think about my loved ones, I cannot sleep, and I feel dizzy.”

Living in displacement often becomes prolonged due to on-going conflicts and the absence of durable solutions – this deepens their vulnerabilities and gradually weakens their resilience. Women and children are especially vulnerable targets of abuse and exploitation, including sexual and gender-based violence. The stigma and discrimination create a barrier to sharing their experiences and seeking support, leading to isolation.

Therefore, it is essential to prioritise mental health and psychosocial support, integrating them in all phases of social programmes for displaced persons. This would require coordination between national governments, non-government organisations, humanitarian, and development partners at national and international levels.

Building community-based interventions

The breakdown in communal structures creates a need for community-based interventions that are complementary and can be integrated into health and social centres as well as learning systems. Using a combination of culturally appropriate counselling, focus groups, games, safe spaces, and emotional support, displaced persons can improve their self-esteem and state of mind.

For example, during a hairdressing training class, Fatima, a 20-years old female who has been living in an IDP camp in Area 1, Abuja for five years, said, “The training has helped me to stop thinking. I am happy because I have people that care about me. The social worker has helped to reduce my burden.”

In the right state of mind, displaced persons can build on resources made available to them in order to leave the camp and start a new life within a supportive community. Rashida also lives in the same camp as Fatima. She received psychosocial support alongside vocational training. She received a business start-up grant, leveraged her social ties (network), and built on her hairdressing skills. She has now been able to leave the camp, open a small home-based salon, and integrate into a neighbouring community.

To build a truly inclusive society where no one is left behind, it is critical to prioritise the psychosocial needs of this vulnerable group and provide them the opportunity to rebuild their lives with dignity. Psychosocial interventions should be provided alongside traditional humanitarian assistance and development programmes that are community-based.

Making a case for social investment

To make a case for investment in psychosocial and mental health support for displaced persons,   it is necessary to realise that psychosocial support creates both intrinsic benefits (improved self-confidence, state of mind, and well-being) and instrumental benefits (improved ability to attend school, work, and participate in skills training). The resulting improvements in quality of life, learning, and productivity, will support better future earnings, which will reduce government spending on unemployment benefits and social safety net programmes. They also become economic contributors to their households, community, and the economy as a whole. This makes a good case for social investment.

This social investment will require predictable and sustainable funding, which will need to be prioritised in national socioeconomic plans and backed by strong political will and commitment. It is also critical that mental health programmes are included in national policies and laws specific to internally displaced persons in order to ensure sustainability.

Funding through external grants, donors, and international organisations help in the short-term. However, in the medium-long term, national governments must take the lead by eliminating spending inefficiencies, increasing domestic revenues, and improving governance to free up funds to incorporate the needs of Internally Displaced Persons into national programmes.

Where innovative taxes are considered for psychosocial and mental health programmes, there should be an assessment of the capacity to effectively impose and collect those taxes. Discussions should also be clear to determine whether all of the revenues will be earmarked specifically for these programmes.

An investment in mental health today is an investment in this generation’s psychosocial well-being and that of future generations. Therefore, the cost of not funding mental health now is high and detrimental to individuals, households, productive capacity, development, and inclusive economic growth.

Humanitarian and Development Response

Vulnerable children in protracted displacement need education

Toluwalola

By Toluwalola Kasali

Children are major victims of conflict. Forty percent of the world’s 79.5 million forcibly displaced persons are children under the age of 18 who face unexpected disruptions to their lives and education. During crises and displacement, children are at risk of exploitation and abuse, especially when they are orphaned or separated from their parents. 

Providing safe spaces for children to express themselves, participate in learning activities, and grow, gives them emotional support and stability. Education empowers them and reduces vulnerabilities to exploitation, violence, child marriage, child labour, and recruitment by armed groups. 

Despite the difficulties faced by children living in displacement, they have not given up on their dreams. They hope to become lawyers, doctors, presidents, general mechanics, carpenters, electricians, and fashion designers, amongst others. Like many other children around the world, their dreams are valid. Education gives children the tools to realise their dreams and access to opportunities. It increases their hope for a better future. However, that hope is gradually eroded when they cannot envision a future outside the four walls of their camp or host community. 

Based on the universal declaration of human rights, everyone has the right to education – this includes forcibly displaced persons. Therefore, a combination of formal, non-formal, and vocational learning programmes such as classroom learning, community-based programmes for children, focus group discussions, mentorship, and vocational skills training should be prioritised in providing humanitarian and development support. 

To achieve improved outcomes, interventions should not ignore the interdependencies between providing nutrition, healthcare (physical and psychosocial support), and education – improving a child’s nutrition, feeding, health, and overall well-being, has a positive impact on development and learning.

While education has clear benefits, there is often an opportunity cost to parents or guardians living in displacement because children often have to help out with errands or go out to earn money. Decisions to allow children to learn are also affected by personal beliefs, language barriers, social and cultural factors. Overcoming such constraints requires a combination of advocacy through trusted camp leaders, information sessions, conditional cash transfer programmes to incentivise enrolment and maintain attendance and other flexible forms of support. These measures should be supported by marketable skills and job programmes to assist households in transitioning into livelihood activities that promote productivity and self-reliance. 

 As crises become increasingly protracted, short-term educational provisions become insufficient. The needs of displaced children should be integrated into National Policy Frameworks, National Education Plans, and Social Safety Net Programmes. Successful implementation would require budgetary support, improved governance structures, increased funding commitment from international partners, basic social infrastructure, trained and highly committed teachers, and strong political will. 

The perspective of displaced persons should not be overlooked in gathering evidence for decision making. Policymakers can use relevant evidence to base interventions on what has been proven to work in displacement situations. Interventions should be tailored to the context of a particular country and local settings to achieve impact. 

In the long-term, access to education for displaced children will create positive externalities, support long-term productivity, and inclusive economic growth. 

Humanitarian Response

Who takes care of vulnerable displaced persons during the COVID-19 pandemic?

Toluwalola

The COVID-19 pandemic intensifies an existing humanitarian crisis for the 41.3 million people living in internal displacement across the world. Many people living in displacement have fled armed conflict, violence, or human rights violations and have had to deal with poor access to healthcare, poor nutrition, and low income. Their living spaces are over-crowded with poor infrastructure and a lack of essential sanitary and hygiene items such as soap and clean water. These factors limit their ability to effectively follow preventive measures such as frequent hand washing, engaging in social distancing, and self-isolation. For displaced persons, the COVID-19 pandemic creates an additional layer of vulnerability, leading to greater fragility. 

Speaking to the camp leader in one of the IDP Camps, she said, “We don’t even have soap or hand sanitisers. Our people have to go out to find work and eat.”

In a situation where basic needs are unmet, proactive, and urgent measures have to be put in place to prevent an outbreak of COVID-19 in camps. The modes of relief distribution and support would also need to be modified to protect this vulnerable group. Humanitarian responses should prioritise the availability of Water, Sanitation, and Hygiene (WASH) facilities. Measures should also be put in place to manage the delivery of relief items such as food by reducing the concentration of people at distribution points per time, promoting safe distances, and calm during the distribution process. Visitation to the camps at this time should be strictly limited to relief distributions, and access for health workers with adequate monitoring of all instances to minimise the possibility of importing cases of COVID-19 into the camps. Ensuring access to food and other essential items limits the need for the displaced to leave the camps. Health workers and humanitarian support teams should also be provided with personal protection equipment. Information and awareness campaigns should be run in the camps to teach them how to minimise the risk of infection. Effective and trusted camp leaders should be enlisted to disseminate information and ensure compliance. This will improve the acceptability of the messages. 

While the practical implementation of these measures may be challenging in many camps, these are necessary measures for the prevention of COVID-19. It will be harder to contain the disease in over-crowded camps as the spread is likely to be rapid and devastating. Prevention, at this time, is a more effective option. 

To respond effectively, governments should work with local, regional, and multilateral institutions to formulate a coordinated response to ensure that humanitarian services continue to be provided in camps. Governments should take the lead, recognising that these are people displaced within their own country and should, therefore, be provided with the same health, social, and financial protection measures available to the general population. Internally Displaced Persons should be included in the National Preparedness and Response Plan for COVID-19. 

As travel restrictions and supply bottlenecks persist with countries trying to stop the spread of the virus, humanitarian responses across and within borders will be significantly hampered, and this should be reflected in the response plan. 

When the dust settles, lessons must be learned as we move forward, recognising that camps and informal settlements are intended to be temporary measures and not permanent solutions. The issue of protracted displacement must be addressed by supporting displaced persons to achieve self-reliance aimed at rebuilding their lives. Given the right resources and support, displaced persons can leave the camps, contribute to their communities, and be reintegrated into the wider society with dignity.

Uncategorized

MY NAME IS AISHA: DISPLACEMENT IS NOT A CHOICE.

Toluwalola

“I liked life at home, it was very peaceful before the attacks.”

Life was peaceful at home before BokoHaram invaded our town and I look forward to going back home someday. We had to leave everything behind, enduring a long and dangerous journey to escape our attackers. The first few years living in the camp were very tough; we were exhausted, frequently experiencing flashbacks, feelings of isolation, depression, and hopelessness. It was hard to understand why this happened to us – we did not choose to be here. We were faced with our new reality which was hard to accept; everyone had lost someone or something they loved dearly in the violence, and many of us had lost the zeal to go on with life. Here we were, several miles away from home and expected to start all over again.

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Uncategorized

MY NAME IS AISHA: A COLLECTION OF STORIES FROM INTERNALLY DISPLACED PERSONS

Toluwalola

How it all started…

It started off as a typical day in Gwoza, located in a Local Government Area of Borno State, in North-East Nigeria. The rocky and hilly terrain, providing beautiful scenery. My parents were at home, and my siblings were playing outside as usual. I was washing my clothes inside the house when I started hearing gunshots. I called out to everyone, and we tried to see what was going on. That was when we noticed men moving into our village in large groups. At first, we thought they were soldiers who had come to protect us because they came in trucks, but later, we realised that the gunfire was coming from BokoHaram militants who were engaging soldiers in battle. Everyone was running, and we knew it was no longer safe to stay in the house. So, I left with my siblings and parents; we ran to the hills and stayed there hoping that the militants will retreat, but they did not – they had taken over our town. They killed our men, destroyed our property, farmlands and went away with valuable items. Living in the mountains, we ran out of food and water and survived by eating dry Guinea corn and Millet. It was not long before we realised that we would not survive much longer if we continued to stay, so we decided to leave the village. We had heard of people being killed as they tried to flee town, but we were left with no other choice.

We left in the rain carrying only some of our belongings and followed a path that had some people on it. We dressed my brothers in female clothing and covered their heads because if they were identified as men, they would have been killed. We helped to disguise many other men, but some of them were discovered and killed – my brothers were able to escape. We were stopped twice along the way by militants; they collected our identity cards, phones and the little money we had and were allowed to continue our journey. At some point, they started chasing us, and we ran for our lives.

Many men were killed, and some died of hunger while hiding from the militants.  Young girls and women were taken away.

Finally, we got out of the village trekking by foot from Gwoza to Madagali, a local government area about 15 miles away in Adamawa State; we were tired, thirsty, hungry and dirty. Our feet were swollen and pierced by thorns. We stayed there for two days and did not have money to continue our journey. Later, a bus was sent, and we were brought to the Internally Displaced Persons (IDPs) Camp in Area 1, Abuja. The story is not very different for many of us. My family and I have been displaced since 2014.

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Dignity

Creating a Multisectoral and Coordinated Camp Management System for Internally Displaced Persons

Toluwalola

IDP Camp Management_Diagram_JPEG

The on-going insurgency and displacement situation indicate that we need to evolve from providing spontaneous solutions to deliberate and well-structured plans. The increasing number of displaced persons puts pressure on existing facilities, negatively affecting living conditions and causing avoidable ill health amongst the people.

Ideally, camps should be temporary settlements until people are resettled in their areas of origin (“return home”), within local communities (“local integration”), or in other states within the country (“outside integration”). However, many people have been living in camps/camp sites for over two years because they are not resourced, skilled or adequately equipped to move on even when the security situation has improved in their areas.

Currently, a solution gap exists between the early phase of displacement and long-term rehabilitation. I believe that Internally Displaced Persons (IDPs), need to be prepared while in camps on how to create and sustain life outside the camp. They need to be equipped through counselling, psychosocial programs, education, skill acquisition and training – they need to develop sustainable means of livelihood, as well as regain their dignity. This can be achieved with a structured camp management system which involves:

  • Creating a coordinated working system within the camps. Humanitarian, governmental, non-governmental, and social organisations, have complimentary roles and will need to adopt a harmonised approach to executing operations that will help achieve early-phase settlement and long-term rehabilitation. This will reduce inefficiencies, resource mismanagement, duplication and wastage.
  • Governments defining a framework, providing durable structures, and infrastructure within which other organisations can effectively work together to achieve stated objectives.
  • Creating a process that links early phase settlement to long-term reintegration needs.
  • Carrying out a comprehensive, collaborative, and multi-sectoral needs assessment to identify the full range of requirements and gaps. This will support the implementation of a “needs-driven” response.
  • Defining core priorities and identifying the lead actors based on their expertise and mandate – social and humanitarian workers, health workers, counsellors, security agencies governments, psychologists, etc.
  • Assigning clearly defined responsibilities to agencies/organisations to improve accountability.
  • Regular meetings/feedback process involving all organisations.
  • Monitoring, evaluation and impact assessment.

Camps should be run by groups of dedicated agencies and professionals who understand the nature of the crisis, pulling on their collective strength and experiences to help create an effective system within which IDPs can effectively and more efficiently, go through the phases of displacement and reintegration.

 

 

 

Purpose

Who am I?

Toluwalola

I remember being approached by Leading Ladies Africa about three years ago to be part of the “30 Days of Gratitude” series. I recently stumbled upon my write-up and every word still rings true today.

So, who am I?

Certainty and security of purpose have been my safety guards for as long as I have known myself.

I had cherished so often, the protection that planning my future brought and I pleasured in the success of those plans becoming a reality and celebrated the achievements.

Suddenly and without warning, real life and purpose began to fight for relevance and the more I tried to hold-on to my own idea of a perfect career, life and plan, the further it slipped through my fingers.

While I find myself pushing forward towards accomplishing what I call “my purpose”, the constant need to jump off high walls, walk through unknown paths, and veer off the tarred road to the dusty road can really be unnerving.

I turned 30 this year and had imagined a totally different me at this age but today, I find myself more involved in causes that drive positive social developmental impact, change and making a sustainable difference:

I find myself awake at night writing a report on the long-term rehabilitation plans for Internally Displaced Persons (IDPs) in North-East Nigeria;

I find myself worrying and writing a report and letters to the UK Government on how to eliminate knife crime amongst teenagers;

I find myself being emotionally disturbed by videos of a teenager being beaten up on the street and decide to write a letter half way across the world to ensure he gets justice;

I find myself bothered about young boys growing up on the streets of Lagos, violation of young women and the widening gap between the rich and the poor in Nigeria;

I find myself stopping while driving in Lagos to ensure that a traffic official doesn’t take unfair advantage of an unsuspecting driver who is unsure of the rules and cannot fight for himself;

I find myself at job interviews being asked, “What is most important to you; money, fame or power? I find myself responding, “None of the above, I just want to make a difference”. The potential employer jokes and tells me that I should be applying to charity organisations instead;

I find myself pushing for social impact investments in Nigeria that will create jobs, boost development and change the lives of people;

I find myself wanting to make a difference because that is what brings me real happiness and joy.

As I fight the battle between what I imagined I will be and the journey my purpose is taking me on, I am gradually finding myself and following a path; one that will hopefully lead me to who I really am.

So I say:

I am grateful to God for leading me through the unknown;

I am grateful for the strength and resilience God has given me to take on so many diverse projects;

I am thankful for the journey; the bumpy roads and the smooth drives on the highways;

I am thankful for my great family, friends and mentors;

I am super grateful for a relationship with God that makes everything else pale in comparison;

I am grateful for lessons learned, thankful for the disappointments that turned out to be real blessings and strength of character that I have built in the process;

I am thankful every day for another chance at life and determined not to be a waste of space on earth.

I look forward to 2016 with both excitement and nervousness. The path is completely unwritten, and I look forward to writing the story as the days roll by.

My name is Toluwalola Kasali and I am determined to make a difference in the world. I want to be me and still change lives while being at it. I want someone to go to bed everyday thankful that the Lord has kept me here for another day.

I am thankful for the opportunity to lend myself to causes that matter to me otherwise, life will have little or no meaning. I am therefore and in essence, thankful for life and living.

 

Dignity

The Dignity Kit Project

Toluwalola

On the 28th of July, we set out to support 1000 displaced women by providing dignity kits to meet their basic hygiene needs. We had beautiful and clear skies despite the rainy season and the great opportunity to visit 4 IDP camps in Abuja; Area 1, Kuchingoro, Wassa and Waru.

To get the dignity kits packed, I had the support of amazing volunteers who gave up three consecutive Saturdays to be part of the team. The process of getting to the final stage of distribution was just as amazing as experiencing the smiles on the faces of the women as they opened their kits to reveal its content.

I sincerely hope that the pictures and videos  below, speak a thousand words to your heart as they did to mine.

PICTURES

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VIDEOS

The videos are about 30 seconds each and show women across different camps:

1.Surprised and Thankful

 

2. A Woman Discovers Her Towel Fits Perfectly 

 

3. Take a Look at What I Got

 

4. Thanks for Coming

 

5. Young Ladies Compare Dignity Kit Content

 

6. What is in my Kit?

 

7. They Can’t Stop Smiling 

 

8. The Women are Happy

 

9. The Female Heads of Families

 

10. The Dancing Woman of Kuchingoro

Mental Health

Mental Health and Displaced Persons: The unseen scars of conflict

Toluwalola

 

In preparation for a recent event on Internally Displaced Persons (IDPs), it became clear to me that psychological effects of displacement arising from situations of conflict and violence, create challenges in rebuilding the lives of IDPs. While mental and emotional scars are easily dismissed because they cannot be seen, the effect on their daily lives is evident.

IDPs refer to persons who have been forced to leave their homes as a result of armed conflict, situations of violence, violations of human rights or natural disasters who have not crossed an internationally recognised state border[1].

There are currently at least 1.8 million IDPs in Nigeria with Ninety-Four percent (94%) of these displacements due to the ongoing conflict in North-East Nigeria. Displaced persons have suffered a great deal; witnessing the death of loved ones, destruction of lives and property and abuse. They endure long perilous journeys to escape their assailants and find themselves exposed and vulnerable. In many cases, children lose both parents in the process, becoming heads of families, providing for themselves and their siblings.

With such traumatic experiences, people report flashbacks and nightmares leading to Post Traumatic Stress Disorder (PTSD). The loss of loved ones usually leads to depression, feelings of isolation and hopelessness.

Too often however, food, water & shelter are defined as the sole primary needs, ignoring the devastating effects of conflict and violence on mental health. Displaced persons experience grief, loss of economic opportunities and a sense of self, a breakdown of cultural identity and family structures. These socioeconomic stressors put an immense strain on the mental health of individuals. We can help to meet their basic needs while also preparing them to survive mentally, physically and economically.

In providing the help they need, poor access to mental health care is a major concern in many of the affected countries – high cost of services, limited number of health professionals, remote locations, etc., creates a treatment gap for mental disorders in IDPs.  The associated stigma and fear of isolation means many cases are unreported. These factors raise the need for psychosocial support to be incorporated as part of the immediate humanitarian response.

From my experience, there are also social and behavioural effects of displacement. Their mindsets are shaped by past experiences and current circumstances.  Their actions are a departure from what might be considered the norm. But how do we define “normal” in a situation where normal has ceased to exist for many? Using an example of two camps for displaced persons I visited, in the first camp, which is close to town and receives regular supply of relief materials, the people were conscious about safety and order and waited patiently for distribution to be completed to collect their share. However, at the second camp, with poor road access and irregular supply of relief materials, a fight broke out immediately after the distribution – there was a scuffle for available supplies and their instinct was to fight for their basic needs.  It was the “survival of the fittest” – desperation, hunger and need.

For the human mind, basic needs are for survival and safety, however, safety can only matter when basic needs of food, water and shelter have been met.

Insecurity in IDP camps where they should feel safe, leaves them with little choice but to flee again and as a result, many have been displaced more than once. For those living in host communities, conflicts arising between displaced persons and the host communities can be mentally and socially unsettling – many times, members of the host communities feel their needs are just as valid and want a share of relief materials, further raising tensions. This situation should not be allowed to linger and for that to happen, we must provide economic opportunities that enable displaced persons earn a living sustainably.

When the period of displacement is prolonged as it is in many cases, a protracted phase of anxiety and uncertainty is created. The drivers of insecurity and conflict must be addressed to make the issues of potential return to place of origin or other settlements sustainable.

Women and children particularly, represent a high percentage of this vulnerable group. The women suffer different forms of exploitation when in need of basic items, with very few channels of expressing or reporting these grievances and abuse. Increasingly, we have a duty to ensure that people are not held under a different form of oppression after fleeing violence and captivity. The effects on the mind are unseen, but nevertheless, detrimental to their ability to recover and regain total freedom.

The issues of displacement are multifaceted and as such, a multisectoral, comprehensive and collaborative approach is required; bringing together social and humanitarian workers, health workers, counsellors, security agencies, governments and psychologists.

Mental assessment and counselling sessions which include trauma counselling, professional, religious counselling, etc., must feature prominently in our solutions. Access to mental health services must also be prioritised for funding.

Unresolved mental health issues have dire consequences which if allowed to linger, can cause greater harm in the future. We can help by choosing to first understand their state of mind; where they have been and what they have been through, working with them to offer needs-driven solutions, not a one- size-fits-all offer.

We must help rebuild their lives so they are no longer viewed as burdens to the society.  IDPs display characteristics of resilience, courage, and strength of mind to thrive, and have employed an admirable set of skills to survive. We must recognise and harness their potentials, empowering them to become contributors to social & economic development within their host communities and State. Dignity can and must be regained for our displaced population.

There are huge costs to internal displacement, not only to individuals affected, but also to the economy, stability and security. The underlying causes of displacement must be addressed with a lot more effort put into preventing displacement, protecting people, and finding long-term solutions.

The road to full recovery and resettlement is long but achievable and the process must begin today. There is no harm in falling but there is great harm in staying down. There is great potential in every individual and they must be given the opportunity to realise their dreams.

 

 

 

[1] Internal USAID document on Internally Displaced Persons