“To not have your suffering recognized is an almost unbearable form of violence.” - Andrei Lankov
Short-lived moderate, tolerable activation of the body’s stress response system is not harmful to health in general. For children, it is an important part of the normal developmental process, as it helps prepare the child cope with adversity.
On the other hand, excessive and prolonged activation of the body’s stress response system could lead to what is referred to as toxic stress. This type of stress can hinder healthy development in children by affecting the child’s cognition and behavior, and can also alter the expression of stress regulatory genes, thereby increasing the risk of stress-related physical and mental ailments later in life.
The ongoing insurgency in Nigeria is a very unfortunate one. Since 2009, the terrorist group popularly known as Boko Haram has waged a raging campaign against Nigeria and some countries along its porous northeast border. Widespread poverty, Illiteracy, poor governance, corruption and a lot of other factors have created breeding grounds in the country for the armed group.
The attacks have increasingly targeted civilians, making children most vulnerable. The group is involved with raiding towns and villages. Many homes, schools and religious institutions have been destroyed. Some primary health care facilities in the areas exposed to the insurgency have been shut. As a result, hundreds of individuals have been abducted, thousands have been killed, and more than a million people have been displaced, leaving many children orphaned and homeless.
The attack on Baga, a town in the volatile northeast region, has been one of the most devastating attacks perpetuated by the group. Witnesses described stepping over many dead bodies as they ran for safety. A 12-year-old boy was reported to have witnessed the horrible death of his father, whereas the whereabouts of his mother was unknown to him. Frequent shootings and bomb explosions are common happenings in the country, especially in the northern region.
The horror faced by many is inconceivable; people have been paralyzed by fear. Chronic fear has detrimental effects on health, especially in children. When an individual is exposed to intense fear, the activation of the stress response systems leads to an elevation of several stress chemicals in the body.
The release of such stress chemicals or hormones like adrenaline (as well as noradrenaline) and cortisol is essential for survival. Prolonged release of one of those hormones, cortisol, can have long-term effects on the body by suppressing immune response, altering the function of some neural systems and causing damage to certain brain structures such as the prefrontal cortex, hippocampus and the amygdala.
These structures are involved with thought, emotion, memory, learning, fear and behavior. It should be noted that children who have been exposed to intense fearful events tend to lose the ability to differentiate threat from safety. This affects their ability to interact socially with others and often leads to the development of some anxiety disorders. Going back in April 2014, the group was involved with the abduction of over 200 schoolgirls. Some of the girls have since escaped while others are still unaccounted for.
The kidnap of schoolgirls has affected the country’s effort in promoting girls education and closing the gender gap in schooling. It should be noted that Nigeria has the highest number of children not attending school. UNICEF did warn that the attacks on schools and school children could attenuate education access, especially in the region exposed to the insurgency, which is home to 60 percent of the 10.5 million out of school children.
Without any doubt, education is the single most valuable investment you can make on children. Being in school alone can protect children from situations that could affect their mental health negatively. Some of the abducted girls that escaped reported that they were subjected to many forms of psychological and physical sufferings including sexual abuse. Most of the children as well as their families have showed signs of stress, anxiety and depression.
Health care professionals in the region noted a rise in the number of people requesting for counseling. In the case where parents are also undergoing stress, it tends to make matters even worse for the child. Healthy and positive relationships with family or caregivers are very important in regulating stress hormone production in children, hence promoting healthy development.
A startling increase in Post Traumatic Stress Disorder (PTSD) among individuals living in the area exposed to the insurgency was reported by the Federal Neuropsychiatric hospital in Maiduguri. Exposure to violence has been linked with psychological difficulties in children ranging from insomnia and anxiety to PTSD.
Children that have also been separated from their families or witnessed the death of loved ones are at increased risk of developing the disorder. PTSD is an anxiety disorder that usually occurs after someone experiences one or more traumatic events.
Individuals who develop this condition display certain symptoms like frequent flashbacks of the traumatic event, avoidance of any trauma reminder, and hyper-arousal in the absence of any impending risk. The intensity varies, depending on the individual and the type of event. So also is the duration, which could last from several weeks to years.
Although in some parts of the country, camps and healthcare facilities are put in place for the individuals affected by the insurgency, thousands of youths orphaned or separated from their parents are reported to be facing ongoing trauma. Children and adolescents inflicted with trauma are more likely to show suicidal tendencies and some of them eventually end up committing the act.
Some co-morbid conditions like substance abuse, anxiety disorders, and major depression tend to develop in individuals with PTSD. Children and adolescents in such camps or facilities also face neglect. Neglect not in a form of the failure in meeting a child’s physical needs, like shelter and food, but more of deprivation and lack of stimulation. This form of neglect often occurs when a child’s cognitive, emotional and social needs are not fully met as a result of disruption or absence of parent or caregiver responsiveness, attention and protection.
Chronic neglect affects the stress response system in the body and can pose a greater threat to development than even abuse, resulting in cognitive impairments and health problems later in life. Significant attention must be given especially to the mental health state of the affected children.
Health services for assessment and identification of cognitive and behavioral problems should be routinely available and therapeutic intervention should be started as early as possible. This would not only be beneficial to the affected individuals and their families, but also to the society collectively.
Furthermore, concerns are being raised that the group uses children to perform some of their operations, like suicide attacks. There have also been reports of adolescents fighting along with members of Boko Haram.
Many factors like poverty, neglect, exposure to violence and abuse are all connected with children being linked with armed groups. Not only do such factors contribute risks for the recruitment of children as child soldiers, they also result to problems in the rehabilitation and reintegration of former child soldiers back into normal (civilian) life.
Take for instance, in a situation where a child is exposed to persistent fear due to frequent attacks and becomes orphaned in the process, with little or no support from his environment, the child wouldn’t feel safe and he’s more likely to get angry and depressed. Such individual may develop little or no empathy.
Terrorist groups take advantage of such vulnerability in recruiting new and loyal members. Conflicts in many ways do affect child soldiers. Some face critical transitions as they try to reintegrate into normal life.
After all the violence and abuse they must have experienced, their mental health state is important in the reintegration process. Studies on child soldiers in other countries have shown symptoms of PTSD, anxiety and depression.
Discrimination and social stigmatization are major post-conflict issues child soldiers face when they try to reintegrate within the society. Females for example will find it hard to get married later in life as some people might consider them im for marriage. Family as well as community acceptance and support could play a huge role in social and psychological readjustment along with successful reintegration.
With the issue of a very low number of mental health and neurological professionals in the country, improving the health state of the affected individuals in both the present and post conflict situations requires a multifaceted approach. There’s need for healthcare professionals to engage with other key stakeholders in the society to tackle the multidimensional effects of the insurgency.
Collaborations with certain individuals, government officials, the civil society, and most importantly with religious leaders could prove to be very effective. In a country like Nigeria, religion plays a prominent role in people’s life. The moral authority religious leaders possess places them in a unique position in the society. They are able to exert their influence even on the way people think.
As children grow and the relationships with their families and the environment develop, religion further leads them to derive meaning with the natural environment and the world around them. Unquestioned about the impact religion has on children, in the face of adversity it can promote resilience and instill a sense of hope by providing spiritual, emotional and physical support.
Healthcare professionals along with religious leaders and other stakeholders should continue to raise awareness on current practices and be actively engaged in advocacy and public policy efforts as well as reform campaigns on the general well-being and health of the children. It is evident that today’s children are tomorrow’s leaders. A productive nation with a prosperous future depends heavily on the healthy development and well being of its children.
Aliyu Ndajiwo is a medical student focused on making a significant impact on the lives of certain individuals in his home country Nigeria, and improving healthcare through practice, research, advocacy and entrepreneurship. He has strong interests in Medicine and Neuroscience. and is currently in his 4th year of Medical school in the West Indies.