‘We think much, sleep very little’: X-raying rising cases of trauma in Zamfara

With Nigeria recording 1,664 new infections on Wednesday, the highest since the pandemic hit the country

• Hbp, insomnia, depression, anxiety, mood swings on the rise

• ‘In 2018, we treated victims of gunshot wounds every day’ – Doctor

• ‘Victims of violence end up perpetuating trauma’ – Psychiatrist

• ‘The world focuses on North East, Zamfara is bleeding’ – Momale

It is March 2020 and we are in Dogondaji, Kaura Namoda Local Government of Zamfara State, investigating the impact of violence on livelihoods and social wellbeing of families.

Ramatu Lawal, Project officer and Jibrin Gani, Monitoring and Evaluation Officer, of The Pastoral Resolve (PARE) an NGO which has done a lot of work with rural communities and other stakeholders, in the context of conflict management.

They are present to assist with interpretations and lead me to the various communities.

The camp of the nomads is a sandy isolated place, and there is no electricity supply and no pipe borne water.

We sit on mats spread out in a corner and the interview begins.

High blood pressure, sleeplessness, headaches and depression are common among the communities in Zamfara State.

Yan Sakai and Yan Bindiga, vigilante groups emerging from the Hausa and pastoral communities respectively, were the principal elements at the heart of the conflict, spreading a circle of mayhem all around.

Also, there were the ‘conflict enterpreneurs’ who took advantage of the violence to feather their nests. Several layers of violence were occuring at the same time.

This may explain the high level of violence and brutality that occurred in numerous locations, finally leading to trauma among the locals.

Today, many of these victims have mental health challenges and are in need of help.

Meanwhile 1 out of every 5 Nigerians is said to have a mental health challenge, amounting to 40 million citizens.

There is only one psychiatric hospital in Zamfara State, and just a small number of psychiatrists available.

The number of persons living with trauma keeps rising, but the number of psychiatrists remains the same.

The psychiatrist at the Federal Medical Centre Gusau declined being interviewed, and referred this reporter to the Zamfara State Hospital Services Management Board (HSMB).

The HSMB declined a request for a telephone interview.

 

Safiya Mohammed, 25, complains of having endured a beating from Yan Sakai.

In the first attack her husband was kidnapped and one million naira was paid as ransom.

As if this was not enough trauma, a second attack by Yan Sakai occurred in which her husband was killed in her presence.

She has not recovered from the event.

Tukur Bala, 50, lost 50 cows during an attack by the bandits. He has two wives and 12 children.

Loss of cows in a pastoral community is synonymous with a drop in prestige.

In Danfami, Birnin Magaji Local Government, we meet Nafisa Sabongari, 30, a housewife.

Danfami is a Hausa farming community.

Several members of her family were kidnapped over a period of time.

These include her mother, step daughter, her husband’s sister, and another relative.

In consequence of all these, she lost a pregnancy and has not been sleeping well since the attack.

Every day Rabi Usman, 50, a housewife, wakes up thinking that something dreadful is about to happen.

Unknown to her this state of mind has become something like a deep personal wish.

She sleeps for between thirty minutes to one hour each day.

Her words “One night Yan Bindiga came and kidnapped my son.

We had to sell all my property to raise the ransom of three hundred and fifty thousand naira.”

“If I sleep by 8:00pm I will wake by 3.00am. Then I won’t be able to fall asleep again,” says Safiyatu Abdu, 50, a milkmaid.

Earlier she had to pay a two million Naira ransom for the release of her elder brother who had been kidnapped.

Irregular sleep and endless headaches are regular features of life among the milk maids.

Adama Magaji discusses another level of trauma common among women.

“My granddaughter wants to get married, but there is no money to support her.

“Again, there are the women who have lost their husbands, but there is no man to marry them since all the men have been killed.

“Meanwhile, the women left behind in the community with children, are on their own, with nobody to support them,” she said.

The reduction in the male demographic raises so many issues and questions, both in the short and in long term.

Hauwau Umar, 30, a milk maid, became depressed on account of the loss of her properties to Yan Sakai.

Her words “I am also scared of every slight sound and movement. I barely feed.

“I had to flee from bandits even though I was pregnant.”

“We fled to Birnin Magaji when the bandits came. The pregnancy stopped growing and I was admitted into the Birnin Magaji hospital.

“I had to do a scan and then I was given drugs. Finally, the baby started growing again. When the child was born, we named her Yusra,” says Azima Bello, 23, who was four months pregnant when she and her family were chased by bandits.

Musa Sarkin Zango, 62, a pastoralist, lives in Birnin Magaji Local Government. His recent life is a long detailed history of kidnappings and ransom payments.

He was kidnapped for 12 days in 2019 and then had to pay a ransom of 4.5 million Naira to Yan Sakai before he was released.

His brother Ibrahim Isa was kidnapped, as well as five other relatives amounting to millions of naira as ransom payments.

Today, Zango has been diagnosed with high blood pressure.

He is surprisingly cheerful, but somewhat stoic when we meet him.

Aminu Shehu, Executive Director, Safe Motherhood and Children’s Initiative comments on the plight of women and girls “Bandits trigger early marriage.

Girls are married as soon as possible before the insurgents notice them.

When bandits come into town, they normally take the girls away.”

Aisha Rabiu, Gender and Child Welfare Officer of the Safe Motherhood Initiative, also sheds light on women and girls.

According to her, “The parents send their children to the city in order to protect them.

“It’s not only rape, sometimes the bandits take the adolescents away to wherever they are residing, and only few come back.

“Some girls are completely unaccounted for. The parents cannot say where exactly their children are.

“This is similar to what is happening in Borno. It’s not only the girls that the bandits take, even the women, wives and the children are included.

“When the bandits enter a house any women they see they will go with her, and the husband cannot oppose their decision as they may kill him.

“When some girls enter the city, they prefer to join commercial sex workers, because they don’t have anywhere to go.

“There is no one to feed them, and no place to reside. There are no safety nets to look after women and girls.”

A 2019 report produced by PARE, Search For Common Ground and Terres Des Hommes  titled Zamfara Conflict-Analysis and Multisectoral Need Assessment (MSNA) indicates “As a result of this violence, men and women are affected differently. Men are mostly killed or kidnapped.

“They also lose their means of livelihood and are placed under huge financial strain due to extortion, demands for ransom money and seizure or destruction of properties like houses, field crops, livestock, grain silos/stores, shops/merchandise, and vehicles (trucks/motorcycles).

“Women suffer physical and psychological trauma from rape, or miscarriages in the course of fleeing from their communities/homes.”(X)

Musa Umar, Executive Director, Voluntary Aid Initiative (VAI), Zamfara State, speaks on the state of infrastructure relating to health in the state “Mental health is not a priority here. If you look at the budget, you will hardly see any fund allocated to the hospitals.

“The hospitals get their funds from the hospital services management board, and even the entire board cash allocation is not more than five hundred thousand naira per month as outlined in the 2020 budget, when we have twenty two general hospitals in the state. The hospitals all have to share this amount.”

He adds that one of the areas where the state is facing challenges has to do with “the shortage of manpower cutting across doctors, midwives, nurses and other health related professionals.

“We have a shortage in this regard. Most of our health personnel prefer staying in the state capital rather than residing in other local governments.

“We have  a facility where we have over thirty doctors. That is the Yariman Bakura Specialist Hospital, Gusau.

“Whereas there are general hospitals in the other local government areas, where you find only one or two doctors in each hospital.”

“The understanding of who is mentally ill is not there.

“A lot of people think that a lunatic is a mentally ill person. This definition is limited.

“There is also the issue of commitment from the government, involvement of civil society organisations and other private individuals.

“In developed countries it’s not only government, but also private individuals that are engaged in matters related to the treatment of the mentally ill,” says Mohammed Mustapha, Team Lead, Voluntary Aid Initiative, while commenting on the attitude towards the mentally ill in Zamfara State and Nigeria generally.

Mustapha also sheds light on the treatment of the sick: “The capacity of the health workers is another important matter.

“Apart from the NGOs, I don’t think government provides in service training to those people. Most of the training they get is from the NGOs.

“You will be employed but you will not be trained and retrained. So there is a gap there. Most of them do not have the required qualifications.

“The highest qualification is the community health extension worker (CHEW) certificate.”

He reveals “Another thing is that the communities do not patronise local hospitals very well.

“Up till now they prefer herbs and traditional medicine. They go to the hospitals only if they tried the traditional medicine and it did not work.

“All these have implications for the treatment of the mentally ill.”

On the background to mental illness, he adds, “Trauma can express itself as depression, suicidal thoughts, high blood pressure, withdrawal symptoms, pessimism, and flashbacks.

“These people are not captured by our system, and we need to go out there to meet them.”

Asaula is a community a 50-minute motor cycle ride from Tsafe, headquarters of Tsafe Local Government.

At a point the entire community was completely abandoned on account of repeated attacks by bandits.

In 2019, as a result of violent attacks, the villagers could not grow any crop, add the locals.

Yusuf Wambai, 62, has difficulty sleeping.

“I sleep by 10:00pm every day. If I wake by midnight then I cannot sleep again.

“Almost everybody here in Asaula has one sleeping disorder or the other.

“The constant fear of being attacked is responsible for this,” he said.

“I have not slept for twenty four days because I have been thinking. I am scared and depressed,” adds Muhammadu Kabiru Makeri, a 50-year-old famer who has a severe sleeping disorder.

He has two wives and 10 children. Two of his houses were burnt during the recent violence, and he lost 50 sheep.

He repeats “For the past 24 days I have not slept.

“My eyes are always wide open and I see the night coming, the same way I see the arrival of dawn.”

“Even the smallest sound makes me feel like running. The sound of children playing can agitate me,” says Fatima Sule, a 40-year-old housewife who has a severe sleeping disorder.

According to her she has not gone to the hospital to complain about her condition because of a lack of funds.

Many of the women are thinking too much, and sleeping very little, confesses Hadiza Adamu, 55, who became heart broken when her son was killed.

She developed high blood pressure as a result of this.

Barrister Ahamed Shehu is Director, Judicial Reform, Zamfara State ministry of Justice, and the Coordinator of the Sexual Hazards Referral Centre, Gusau.

He comments on a significant number of cases handled by his centre in a one year period: “We received about a hundred cases in a period of one year, and those cases emanated from Gusau, and some of them came from the local governments.

“The cases include defilement, rape and sodomy, and most of them range from the age of four months -20 years. There are more male than female victims with the ratio being 70:30.

“We noticed signs of anxiety, sleeplessness and depression among the victims.

“Withdrawal symptoms were apparent. They don’t want to attach themselves to anybody.

“When you ask questions, they don’t want to talk, and they are not willing to listen.

“They act like dumb people, and they start crying. This occurs among both male and female victims.”

He adds that depression, anxiety and insomnia are widespread among victims of violence in Zamfara.

The centre is coordinated by the ministry of justice, health and women affairs.

“During the peak period of banditry, the average that we see in the hospital was six victims in a day between 2018 and 2019.

“However, there were times we will see two or one. But it’s an everyday event.

“There’s no day we won’t have a victim of banditry presenting. If we say one victim every day in 2018, it won’t be an exaggeration and many were brought in dead.

“When you go for the ward round, you spend six hours seeing patients from the previous day with gunshots wounds that had been resuscitated,” says Dr Ahmadu Anthony, Head Clinical Services of the Yariman Bakura Specialist Hospital, Gusau.

Dr Ada Ikeako is an Abuja based psychiatrist and comments on the available infrastructure for the treatment of the mentally ill “We don’t have enough institutions to treat the mentally ill in Nigeria.

“We need more bed spaces. At least one in every five Nigerians has a mental health challenge of some sort.

“That’s 40 million people and it’s quite a number. I think government is trying, but the private sector and the government should partner, so that we can have more centres where people can go when they have psychological issues.”

Turning to Zamfara, she states: “Victims of violence would end up going to perpetuate trauma.

“There is this cycle of trauma where the victim of trauma will become perpetrators of trauma.

“They are more prone to depression and suicides. When you are depressed you are not able to function effectively at work and in relationships.

“More people are now becoming perpetrators of violence on others.This is the long term impact of untreated post-traumatic stress disorder on the community.

“It affects productivity, you can’t work, and you can’t pay taxes.”

Ikeako who is also an addiction specialist, points out: “Having people in Zamfara who are traumatised, going through hyper arousal, not being able to sleep at night, nervous, jittery, having flashbacks when they have painful memories of what happened to them, denial, a sense of shock and disbelief, is not healthy. All these are symptoms and signs of post-traumatic stress disorder. Whether you develop PTSD, depends on the severity of the trauma.

“It also depends on the intensity of the trauma. It depends on how psychologically prepared you were before the trauma. What was your emotional health like even before the trauma?”

Way forward

Dr Shehu reasons: “If the resources were available, we would have certainly gone to other local governments, especially Kaura Namoda from where we have received cases, and these were very devastating.

“If the resources are available it would be good if we could establish the centre in the three senatorial districts of the state, so that we can bring justice closer to the people.”

“People are becoming dangerously desperate, and that is why the issue of kidnapping is coming in.

“Kidnappers no longer wait for you on the road. They come to your house and take you.

“It’s as bad as that. We are sitting on a time bomb, because things are so difficult. There are people who cannot cope.

“A right thinking individual will not degenerate to the extent of committing crimes.

“It is a psychiatric tendency and that is what stress pushes people to do,” warns Dr Anthony.

“So you have these large numbers, hundreds, thousands of people who are victims of trauma who just suffer silently and try to make the best of it, and so it’s unfortunate.

“We definitely need to get them the help as quickly as possible to those areas that are suffering. You are supposed to have crises intervention immediately after the trauma.

“Behavioural therapy is very effective for trauma, that’s counselling that occurs between 10 to 16 weeks.

“There is a medication for poor sleep, hyper arousal, mood swings, and anxiety.

“They need supportive psychotherapy as well.  If its children, they need family intervention, family oriented psychotherapy,” suggests Dr Ikeako.

Sarkin Kudu Tsafe, Abubakar Abdullahi Tsafe draws attention to the plan by government to set up small and medium scale enterprises “Government has promised to give loans of N50,000 for people to set up small industries.

“We have done the training, done a business plan towards getting access to the facility.

“We will eventually get it and expect to set up 50 enterprises within the emirate.

“Each enterprise will gainfully employ a minimum of five people, which will go a long way.”

In December 2020, the Zamfara State government initiated a campaign to raise awareness about gender based violence, child abuse and rape among the citizenry.

Saleh Momale, Ag. Executive Director of PARE, draws attention to the absence of key NGOs and international actors in Zamfara. “Unless the local governments in the state become functional, there is nobody to attend to the locals except we bring all the NGOs from the North East back to Zamfara to start providing these services.

“There is a deficit in terms of civil society and international actors, peace building actors and humanitarian actors in Zamfara.

“This is a paradox. The entire attention of the world is on the North East, whereas Zamfara is bleeding,” he said.

He speaks of a needed framework for development in the area. “What is the long term strategic framework for dealing with the challenges of insecurity, governance and economic development for these areas in the state. Unless there is a strategic framework which will consistently guide the actions of public, private and civil society activities within the forthcoming years, we will only have haphazard interventions or spot interventions, creating very good examples surrounded by a landscape of chaos and insecurity.

“Overtime, these islands cannot survive. It’s not happening yet, it may be happening here and there. But we are yet to see that strategic road map.”

This investigation was sponsored by The Pastoral Resolve (PARE)