Mental Health – Internally Displaced Persons

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.

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

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