By Akin Moses

Decades before now, words like terrorism, abduction, and kidnapping were alien to the average Nigerian’s vocabulary. Unfortunately, today’s harsh reality is that acts like these have become commonplace and many lives are destroyed and lost due to these nefarious acts.

According to the United Nations General Assembly, Terrorism refers to “Criminal acts intended or calculated to provoke a state of terror in the general public, a group of persons or particular persons, for political purposes are in any circumstance unjustifiable, whatever the considerations of a political, philosophical, ideological, racial, ethnic, religious or any other nature that may be invoked to justify them.”

The terms ‘abduction’ and ‘kidnapping’ have been used interchangeably. Kidnapping is the taking away of a person by force, threat, or deceit, with intent to cause him or her to be detained against his or her will.  Kidnapping may be done for ransom or for political or other purposes.

Abduction is the criminal taking away of a person by persuasion, by fraud, or by open force or violence.

The abduction of 276 female students from the Government Secondary School in Chibok town, Borno State, Nigeria on the night of 14^th April, 2014, by the Boko Haram Group is perhaps one of the most devastating examples of terrorist acts in Nigeria and this has generated sustained media attention, both locally and globally, as well as numerous campaign actions.

It was previously reported that only 57 of the Chibok girls escaped shortly after their capture, but as days painfully rolled into months and years, the hope of the return of the remaining girls became bleaker.

However, the release of 21 of the Chibok girls following negotiations between the BH group and the Nigerian Government brokered by International Committee of the Red Cross and the Swiss Government has brought great joy to all and rekindled the hope of many.

Beyond the fact that insurgency is a major threat to local and global peace and security, it constitutes the highest contributor to humanitarian crises in the form of rise in human casualties, internally displaced persons, refugee debacles, food insecurity and the spread of various diseases.

According to a survey conducted by the National Emergency Management Agency, NEMA, in collaboration with International Organisation for Migration, IOM, identified 1,822,541 internally displaced persons, IDPs, in Adamawa, Bauchi, Borno, Gombe, Taraba, Yobe, Nasarawa states and Abuja through Displacement Tracking Matrix, DTM, as of October 2016.

About 97% fled on account of Boko Haram violence since 2014 and 53% are mostly female while others have sought shelter in neighbouring Cameroon, Chad and Niger.

They reported that although Nigerian military operations earlier in 2016 in the country’s North-East had pushed Boko Haram out of some major towns in Borno, such as Monguno, freeing tens of thousands of people from insurgents’ rule, living conditions have remained difficult for them amidst lack of basic amenities/supplies.    

Boko Haram terrorism originated from the north-eastern part of Nigeria. It was started as a Muslim youth organisation by Mallam Lawal in 1995 but later metamorphosed into a violent terrorist group under the leadership of Yusuf and Sheakau.

In the context of Boko Haram insurgency, Osita-Njoku A et al defined terrorism as “the unlawful use of force or violence by a person (at the behest of a group) or organised group (with misguided religions and political ideologies) against the government and its citizens to achieve its desired objectives“.

Identified causes of Boko Haram terrorism in Nigeria are: poverty, unemployment, absence of good governance and increasing radicalisation of jihadist group in the world.

Boko Haram activities have led to harrowing consequences like abduction of women and girls; arbitrary arrest of women by government security agents e.g alleged suspects, sometimes wrongful arrests; use of women as pawns in their activities; inflicting collective terror on women; use of women as wartime labour force, etc.

Women and girls in captivity are used for cooking, cleaning and other duties that may be assigned to them by their captors. Many may also be forced to bear children that will grow to further the course of the insurgency.

Regardless of the motive(s) behind kidnapping / abduction and other terrorist activities, these crimes have devastating, far-reaching effects on the victims, their families and the society at large.

Therefore, beyond the euphoria of the return of the Chibok girls, lies the glaring challenge of their rehabilitation, not just on the short-term, but particularly on the long-term.

Victims are exposed to a myriad of conditions and hazards that necessitate rehabilitation.

Effects on Victims

Psychological Effects: This was succinctly documented in a paper by Alexander et al.⁸

1. Emotional: sudden nature of the traumatic event leads to shock and numbness; fear and anxiety disorders (but panic is not common);⁹helplessness and hopelessness; dissociation (feeling numb and ‘switched off’ emotionally); anger (at any/everybody – perpetrators, themselves and the authorities); anhedonia (loss of pleasure in doing that which was previously pleasurable); depression (a reaction to loss); suicidal ideations or attempt; guilt (e.g. at having survived if others died, and for being taken hostage).

Their emotional bond with family and friends is severed and in the face of terror, some develop Stockholm Syndrome.

The term Stockholm Syndrome refers to the particular psychological response, sometimes seen in abduction cases, in which the victim forms an attachment to their perpetrators.  Children could be particularly susceptible to the development of Stockholm Syndrome.

Dr Shirley Jülich explains in her paper published in the ‘Journal of Child Sexual Abuse‘ that if unable to escape and isolated from others, victims turn to offenders for nurturance and protection.

The need to be nurtured and protected combined with the will to survive compel victims to actively search for expressions of kindness, empathy or affection from the offender.

The victim suppresses any feelings of danger, terror or rage, and through this denial, is able to bond to the ‘positive’ side of the offender.

Additionally, to facilitate survival, the victim similarly suppresses his or her own needs and becomes both hyper-vigilant and hypersensitive to the offender’s needs, feelings, and perspectives.

2. Cognitive: impaired memory and concentration; confusion and disorientation; intrusive thoughts (‘flashbacks’) and memories; denial (i.e. that the event has happened); hyper-vigilance and hyper-arousal (a state of feeling too aroused, with a profound fear of another incident);
3. Social: withdrawal; irritability; avoidance (of reminders of the event).
4. Denial (i.e. a complete or partial failure to acknowledge what has really happened) has often been maligned as a response to extreme stress, but it has survival value (at least in the short term) by allowing the individual a delayed period during which he/she has time to adjust to a painful reality.
5. ‘Frozen fright’ and ‘psychological infantilism’ are two extreme reactions that have also been noted.

The former refers to a paralysis of the normal emotional reactivity of the individual, and the latter reaction is characterized by regressed behaviour such as clinging and excessive dependence on the captors.

Extended periods of captivity may also lead to ‘learned helplessness’ in which individuals come to believe that no matter what they do to improve their circumstances, nothing is effective.

6. Another common consequence is indoctrination, where victims are ‘brain-washed’ to accept wrong / distorted norms, beliefs, and values. This distortion of their fundamental beliefs may be temporary, or occasionally permanent.
7. Genuine psychopathology has also been noted e.g post-traumatic stress disorder (PTSD).

The International Classification of Mental and Behavioural Disorders (ICD 10) also recognises the ‘Enduring personality change after a catastrophic experience’ as a possible chronic outcome after a hostage incident. This condition is characterised by:

1. a hostile or mistrustful attitude; social withdrawal and estrangement;
2. feelings of emptiness or hopelessness;
3. a chronic feeling of being ‘on edge’ as if constantly threatened.

For the diagnosis to be made, the symptoms must have endured for at least two years.

Denial, ‘frozen fright’, ‘psychological infantilism’ and ‘learned helplessness’ are not age-specific. Children may also display ‘school refusal, loss of interest in studies, dependent and regressed behaviour, pre-occupation with the event, playing at being the ‘rescuer’, stubborn and oppositional behaviour, and risk-taking.

The impact can be particularly serious if the children have been detained over an extended period and if the incident entailed a breach of trust.

Physical Effects on Victims

For the victim, the experience is tormenting. Often cramped in appalling conditions, the captive may be open to the elements of health hazards, or subject to threats or beatings that can lead to injury and even death.

Under harsh living conditions, victims become malnourished and impaired immunity renders them susceptible to various diseases like malaria, typhoid fever, diarrhoea, insect/rodent-borne diseases.

Sexual abuse puts them at risk of sexually transmitted infections like HIV/AIDS, Hepatitis B & C, Syphilis, Gonorrhoea, etc.

Effects on the Victims’ Families and Friends

Kidnappings have similar effects on the victim and his or her family and friends. Psychological distress, family crises / destabilisation, anxiety disorders, depression and even guilt feelings are some of the effects on family members.

Medical Rehabilitation

This requires a multi-disciplinary approach. Services and support must be collaborative, person-directed and individualised.

Recommended Screening and Diagnostic Tests include:

1. Screening for drugs and mental health disorders such as post-traumatic stress disorder, depression, substance use etc.
2. Screening for sexually transmitted diseases such as Hepatitis  B (if negative , give 3doses ; stat, one  and six months after the first dose ), if positive, further evaluation should be done at a recommended health care facility), syphilis, gonorrhoea, chlamydial infection, trichomoniasis, HIV infection(should be done six weeks, three months and six months after the first screening).
3. Screening for communicable diseases such as tuberculosis.
4. Other routine tests such as full blood count; urine/stool tests and pregnancy test( done at the time of arrival and two weeks after)

Psychosocial rehabilitation is essential for the restoration of personal recovery, community functioning / integration, and satisfactory quality of life for the victims.

The goal of psychosocial rehabilitation is to help disabled individuals to develop the emotional, social and intellectual skills needed to live, learn and work in the community with the least amount of professional support.

The overall philosophy of psychiatric rehabilitation comprises two intervention strategies. The first strategy is individual-centred and aims at developing the patient’s skills in interacting with a stressful environment. The second strategy is ecological and directed towards developing environmental resources to reduce potential stressors. Most disabled persons need a combination of both approaches.

When hostages are released, it is essential for them to:

1. Receive medical attention,
2. Be in a safe and secure environment,
3. Connect with loved ones,
4. Have an opportunity to talk or journal their experience if and when they choose,
5. Receive resources and information about how to seek counseling, particularly if their distress from the incident is interfering with their daily lives,
6. Protect their privacy (e.g. avoid media over-exposure including watching and listening to news and participating in media interviews),
7. Take time to adjust back into family and work,
8. Family and friends can support survivors by listening, being patient and focusing on their freedom instead of engaging in negative talk about the captors.

It is important to realise that families and friends of abducted children are confronted with numerous issues in coping with fears and uncertainties as well and may also need support in dealing with their own emotional reactions.

Effective psychiatric evaluation involves providing hope and respect for the client, empowering the client, teaching them wellness planning and emphasising the importance for the client to develop social support networks. Services delivered may include:

1. Psychiatric (symptom management; relaxation, meditation; support groups and in-home assistance)
2. Health and Medical (maintaining consistency of care; family physician and mental health counselling)
3. Housing (safe environments)
4. Basic Living Skills (personal hygiene or personal care, preparing and sharing meals, home and travel safety and skills, goal and life planning)
5. Social (relationships, recreational and hobby, family and friends, communications & community integration)
6. Vocational and/or Educational programmes
7. Financial support
8. Community and Legal (resources; health insurance, community recreation, houses of worship, ethnic activities and clubs)

It is very clear therefore, that a proper understanding and detailed evaluation of the hazardous conditions during captivity and the psychological states of the victims and their families, are necessary for the planning and implementation of an efficient and effective rehabilitative, restorative and integrative programme. It is very important for the agencies saddled with these responsibilities to continue to engage the services and support of relevant professional bodies and organizations to guarantee rewarding outcomes.

Dr. Akin Moses is the National President, Society of Family Physicians of Nigeria. He can be reached at Lawakmoses@yahoo.com