Commentary: Mental Health Needs of Liberian Refugees in NigeriaSkip other details (including permanent urls, DOI, citation information)
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Conflict, violence, wars and their consequent refugee and displaced population are prominent features in many parts of Africa. In a recent issue of The Journal of the International Institute (vol. 7, no. 3; 2-3, 16), U-M Anthropology Professor Maxwell Owusu presented a good account of how well Liberian refugees in camps in Ghana adjusted to their refugee status. He attributed their positive adjustment to their determination to rebuild their lives as well as to improved infra-structural facilities, such as water, electricity, a health clinic and schools. A second group of factors that were said to have promoted refugee adjustment were the efforts of NGOs and some Christian churches.
Two important aspects of the problem were lacking in Professor Owusu's discussion, however. The first is the harm that the totality of the experience of war does to the mental health of refugees. A second is the apparent lack of concern with which the United Nations High Commissioner for Refugees (UNHCR) treats refugee mental health in Africa.
The story of "refugeeism" in Africa, I contend, cannot be said to be complete without considering the impact of war and violence and the consequent refugee status on the mental well-being of African refugees. People adopt different coping mechanisms to wrestle with earthquakes, war, death of loved ones, violence, assault, rape and life-threatening illnesses. Some people succeed in containing their problems; others do not. Without empirical and expert investigation, the observed facade of "wellness" among African refugees must be taken for what it is-a coping mechanism. The UNHCR and its experts know that, but quite often, African refugees are denied full psychological rehabilitation and restoration.
In order to encourage empirical investigation in the area of refugee problems, the African Society for the Psychological Study of Social Issues, of which I am president, made "The Psychological and Health Effects of War and Violence on Women and Children in Africa" the theme of its 1994 Annual Convention at Ibadan. My paper was one of several based on empirical research conducted at Oru, Ijebu Ode, a site of a Liberian refugee camp in Nigeria. The comments that follow are drawn from that work and others noted in the bibliography.
The Nigerian government was a major player in efforts to restore peace and civility to Liberia during the civil war there. The first batch of Liberian refugees to Nigeria arrived by sea via Lagos in 1990. The government settled them at Oru village in Ijebu Ode, Ogun State on the campus of a former teacher training college. The camp compound was surrounded by barbed wire, and non-threatening armed personnel surveyed the gate. The refugees, numbering at first over 6,000, were housed in dormitories, classrooms and other available building spaces on the campground.
"Home" for the refugees at Oru was a small space with two or three twin-size mattresses on a bare floor. Many of the rooms were partitioned into household areas, separated from each other by nothing more than a curtain, making maintenance of private personal space impossible. The average dwelling space for most households was about three square meters per person. The campsite had a building where refugee children attended primary school and a clinic for the sick. Scattered about the compound were trading shades, where some of the refugees sold wares, and others, such as tailors, cobblers and artists, practiced their profession.
The camp was under the sole control of a commandant, a Nigerian military personnel who reported to the presidency. A counselor and a few other administrative staff assisted him, and a nurse was in charge of the clinic. In a period of four years, three different camp commandants served at the camp. Staff members attributed the high rate of turnover to the stress of administering "a group of restless, aggressive and conflict-prone refugees," and my own observations corroborated their opinion.
One might expect common fate to bind Liberian refugees at Oru into a cohesive group. My observations in the camp indicate this was not so. Refugees represent sections and structures of the society or country of their origin. As armed conflict seesaws between geographical areas-as villages, towns and cities change hands between the conflicting groups-people move, get displaced or flee into refugee camps. In the camps, the conflict continues between members of opposing groups in a silent way. Liberian refugees at Oru did not forget the faction they had belonged to and supported in the Liberian conflict nor did the males give up their traditional dominance over women and children. A few observations about interaction between refugees at Oru drive these points home.
In my attempt to survey the refugees, I found that getting them to perform any task, such as filling out questionnaire booklets, required protracted negotiation, bribing of factional leaders and arm-twisting. Factional leaders, or "presidents" as they were called, used their position to engage in extortion, illegalities and oppressive behavior. For example, refugees complained that the rice and beans that were allocated to the camp every two weeks were being sold in the market while some families were denied adequate rations.
Moreover, while over 75 to 80 percent of the population consisted of women and children under 12 years of age, men exercised power and authority over decision making in matters such as the distribution of food and other necessities. Faction leaders struggled for power and attempted to silently gain control over committees set up by the commandant. Men dominated committees on food, access to treatment, permission to leave camp and access to jobs.
Vulnerability of Women
African women are particularly vulnerable to certain gender specific war violence including rape, assault and powerlessness. Before arriving at their respective camps, Liberian women and children were already distressed and traumatized as a result of what had happened to them as individuals or what they had seen happen to others. This distress led to mental breakdown for some of the refugees and displaced Liberians. The case of one patient, a 25-year-old female Liberian refugee who was referred to the hospital by the commandant of the Oru camp, is illustrative of the plight of many others.
The patient had manifested aggressive behavior, restlessness and violent and destructive behavior towards properties; other symptoms were high irritability, poor sleep, irrational talk and heaviness in the head. The intake interview revealed during the war that she had lost her entire extended family as well as her means of supporting herself. She took refuge at the ECOMOG camp where she was sexually molested several times, became pregnant and delivered a baby whose father she could not identify. The baby eventually died due to malnutrition and lack of proper care. The woman later entered into several abusive relationships with men and lived on the streets before a Liberian woman helped her to the refugee camp at Oru village. There she seemed to adjust well and met and married a 37-year old Liberian tinker. The couple had a baby boy before the onset of the present breakdown.
The patient was diagnosed as suffering from a post disaster psychiatric condition of affective disorder and severe depression. She was hospitalized at Aro Psychiatric Hospital where she was undergoing treatment.
Several empirical research studies of the Liberian refugees indicate that refugee populations showed significantly higher rates of metal illness than non-refugees. For example, when compared with international students in Nigeria, the refugee population showed higher rates of neuroticism and depression. Moreover, refugees who scored high on stress measures reported higher symptoms of physical and mental illness. Such high levels of stress are known to lead to neurosis, hypertension, peptic ulcer and other psychological and psychosomatic disorders. Liberian refugees were also more externally oriented, more depressed and showed more symptoms of neuroticism than non-refugees.
The results of these observations and empirical studies point to a gap in the UNHCR's treatment of African refugees. African refugees usually have their material needs met, but receive no psychological restoration or rehabilitation. Refugees elsewhere, however, receive not only material things from the UNHCR but also psychological rehabilitation. Grief and other types of war trauma cannot be resolved by provision of food and blankets. It is essential that UNHCR authorities in charge of the African zone reexamine their attitude toward the unfortunate refugees under their jurisdiction and endeavor to provide them with treatments similar to those accorded in other regions.
Shyngle K. Balogun, "Psychological Well-being of Victims of War Displacement: The Case of Liberian Refugees in Nigeria," African Journal of the Psychological Study of Social Issues, 2 (1995) 186-197.
Benjamin O. Ehigie, "Stress and Related Health Problems Among Female Refugees: A Case of Liberian Refugees," African Journal of the Psychological Study of Social Issues, 2 (1995) 162-175.
B.O. Olley, "Post-disaster Psychiatric Disorder: A Case Study of a Liberian Refugee Woman in Nigeria," African Journal of the Psychological Study of Social Issues, 2 (1995) 151-161.
Denis C. Ugwuegbu & Adeniyi O. Temowo, "Psychosocial Variables as Determinants of Neuroticism Among Refugees in Nigeria," African Journal of the Psychological Study of Social Issues, 2 (1995) 140-150.
Visiting scholar Denis Chima Ugwuegbu is a professor of social organizational psychology and the former chair of the Department of Psychology, which he founded, at the University of Ibadan, Nigeria. An internationally renowned psychologist, Ugwuegbu has served as a consultant to various organizations and government ministries in Africa. His latest work, The Psychology of Management in African Organizations , was published by Greenwood Publishing Group at the end of May.