With the persistent increase in armed conflict in Nigeria, mental health has gone a long way, but access to effective, high-quality, and inexpensive mental care has yet to be achieved. As the conflict keeps escalating in length and breadth of the country millions of people are in long-term displacement, impoverishment, sexual violations, physical disabilities and mental health problems. These call for the passage of a mental health law especially, for those in humanitarian situations, ensuring that access to effective, compassionate, and high-quality mental health care is available for them. The need for political power, diversity, corruption, poverty and unemployment can be attributed to the persistent increase in humanitarian crises in Nigeria. The humanitarian needs in Nigeria are immense, the continuing conflict in the country ranging from the North-East to the recent crisis in North-Central, particularly Niger and Plateau states and North-West, especially Zamfara, Sokoto and Katsina states has severely affected millions of people subjecting them to displacement, impoverishment and threat of violence. In February 2021, a humanitarian response plan by the United Nations Office for the Coordination of Humanitarian Affairs shows that in the North-East 1.92 million people are displaced internally, and 257,000 have sought refuge in neighbouring countries; Cameroon, Chad and Niger. As violence keeps escalating in some parts of the North-West, especially Zamfara, Sokoto and Katsina states, reports by International Organization for Migration in February 2021 show that more than 124,000 displaced people were living in Zamfara state. With less than ₦5000, Sokoto residents buy locally-made guns to protect their lives, properties and communities against these armed groups. Kidnappings, killings, armed robbery and sexual violence have been the order of the day in the country thereby resulting in a humanitarian crisis.
Effects of Humanitarian Crisis on Mental Health
The effects of armed conflicts on health and human lives have resulted in long-term displacement, impoverishment, sexual violations, physical disabilities and mental health problems. Reports by CARE show that between 2009 to 2021 more than 27,000 people have been killed, about 1.8 million Nigerians are internally displaced; 80 cents are women and children suffering from gender-based violence and mental illness as a result of the conflict. So, about 7.1 million people need urgent assistance this year. The said armed conflict, insecurity and insurgency in the Northeast region, resulted in women and girls being under threat of violence, abduction, rape, as well as forced child marriages, while boys and adolescent males continue to risk forcible recruitment by armed groups. The mental health of individuals or communities is usually affected during or after conflicts. Children, women, the poor, victims of sexual violence, families who lost their loved ones and internally displaced people are the main victims of mental illness. These people may experience a variety of mental health issues, including post-traumatic stress disorders, anxiety, depression, substance abuse, psychosis, anti-social behaviour, and somatic symptoms, among others, whereby lead to suicide. Nigeria is one of the epicentres of suicide in the world, the country accounts for approximately 80% of the global suicides with a suicide estimate of 17.3 per 100 000, which is higher than the global 10.5 per 100 000 and Africa’s 12.0 per 100 000 estimates. Moreover, Nigeria, currently, has been reporting the highest number of depression, financial constraints, marital conflict and mental illness cases in Africa commonly assumed precipitating factors for suicide.
Over the years mental health advocacy has been clamouring for the establishment of a regulatory framework to improve mental health services in Nigeria. In 2002, such a Bill was presented before the National Assembly, unfortunately, the Bill didn’t see the light of the day, due to differences among our lawmakers. The Lunacy Law of 1958, seen as the only mental health law in Nigeria, has limited the scope of mental health illness to madness, which is not so, as the concept goes beyond that. The said law has been described as outdated and inconsistent with current realities by medical experts. One major challenge to mental health services in Nigeria is the inability of the current legal framework to adequately provide for mental health services in the country. Research shows that one in four Nigerians are suffering from some sort of mental illness. It is so painful that the ground norms of the country – the constitution, pay no attention to the rights of these vulnerable groups. The law that fails to protect these susceptibles, how will it care for those suffering from mental illness in humanitarian situations? As it is believed that these categories need urgent attention. Recently, the Discrimination Against Persons with Disabilities (Prohibition) Act, 2018 and Violence Against Persons (Prohibition) Act, 2015 were enacted to protect the rights of persons with disabilities and vulnerable ones. It should, however, be noted that the duo Acts only relate to the rights of a person with disability and violence against persons respectively, while it pays slight attention to the rights of persons with mental illness, talkless of those in conflict situations.
Section 21(2) of the Discrimination Against Persons with Disabilities (Prohibition) Act, 2018, which relate to mental health, provided free medical and health services in all public institutions for persons with mental disability. The section reads: “A person with mental disability shall be entitled to free medical and health services in all public institutions.” The Act equally established the National Commission for the full integration of people with disabilities into society – being responsible for their educational, health care and civic rights. But the question is, how effective is the commission in keeping up to this task? The Lagos special people’s law can be said to be a partial milestone in promoting mental health services. The law establishes the Office of Disability Affairs to cater for these vulnerable peoples, in line with section 1. However, section 32(1&2) of the law, reads: “Government shall guarantee that persons living with disability have unfettered access to adequate health care without discrimination based on disability.” “Persons living with a mental disability shall be entitled to free medical and health services in all public institutions.” Going by the wordings of the above provisions, it is crystal clear that the law pays no attention to mental health services, and talks less of those in conflict situations. Even the implementation of the law has been questioned recently, where the chairman of people living with disabilities urged the Lagos state governor to ensure full implementation of the law to give these vulnerable groups access and inclusion in the decision-making process as provided for therein.
The effect of no legal protections for these vulnerable peoples in Nigeria can be seen in terms of denied access to indispensable human needs, like health, education, employment among others and thereby attributing such kinds of illnesses to spiritual problems. Several mental health professionals revealed that quality mental health services are available only to wealthier citizens who can afford them. The lack of quality mental health care and its prohibitive cost often drives people to consult traditionalists. In recognition of the importance of mental health services the Ekiti state Governor, Kayode Fayemi recently signed the State’s Mental Health Service bill into Law to cater for the welfare of all members of the society regardless of their physical, mental or social status. According to the Governor, the new law will establish purpose-built mental health facilities that will guarantee and ensure that every person living with mental disorders has access to mental health care facilities in the state. The role played by International instruments on mental health services can never be exempted, for instance, the third Geneva Conventions of 1949, also lay more emphasis on the importance of mental health care in humanitarian crises. Article 30 of the treaty which deals with medical attention, required all states in armed conflict to provide adequate infirmary, appropriate diet, as well as isolation wards set aside if necessary, for cases or people with mental diseases. The significance of health care in humanitarian crises can also be appreciated through the International Humanitarian Law provisions for wounded and sick people. The I, II, III and IV Geneva Conventions of 1949 and the two additional protocols of 1977 all contained provisions for the medical treatment of wounded and sick in humanitarian crises. Having said that, it has been proven that medical attention to people with mental illness in conflict situations is very essential and therefore, every government should take it seriously.
The agitation for Federal legislation prompted a lawmaker from Kwara State to sponsor a Bill titled: “Mental Health And Substance Bill” which seeks to enhance and regulate mental health services. The Bill, when passed into law, would establish the National Commission for Mental Health And Substance Abuse Service for the effective management of mental health. However, as the bill is currently debated before the National Assembly it is our humble recommendation that the lawmakers should include provisions that will protect the right of people with mental health illnesses in humanitarian or conflict situations for adequate budgetary allocations to cater for their needs especially health care facilities and services. As we hope that the new Bill sees the light of the day and does not die like the earlier ones, we equally call on all states of the federation to enact a mental health law in their respective states, to protect the rights of these vulnerable people by emulating Ekiti state. In Nigeria, mental health has gone a long way, but universal access to effective, high-quality, and inexpensive mental care has yet to be achieved. The passage of a mental health bill is a significant investment in Nigeria’s mental health, ensuring that access to effective, compassionate, and high-quality mental health care should be the desire of our leaders. Moreover, to protect these vulnerable peoples, especially those in conflict situations, working legislation must be in place that would make adequate provisions and protection for people with mental health challenges. Therefore, the writer calls on our lawmakers to do needful at the right time.
Author(s) Name: Yusuf Balogun
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