Boko Haram's Soaring Toll in Trauma

WSJ

MAIDUGURI, Nigeria—The last psychiatrists remaining in the heartland of Boko Haram squeezed in a few hundred patients one recent morning. The waiting room was packed and the power was out.

The war between the Islamist insurgency and a frazzled army has left 7,000 people dead since 2011, but it has also created a backlog of anguished survivors at the Federal Neuropsychiatric Hospital here. Inside, the nine psychiatrists usually have just minutes for each patient, and little to offer beyond a prescription for antidepressants—before the mentally ill walk back out to rejoin what has become an ever-expanding and twisted conflict.

Some 52,000 patients have active files here, the hospital says—a case load that has doubled since Boko Haram launched its campaign of killing and kidnapping.

They include a 6-year-old girl who saw Boko Haram murder her parents, her file says, and now interrupts her class by shouting: "They're here!"

Boko Haram has burned down villages, shot rockets into homes, and beheaded drivers on highways in its campaign to impose Islamic law. It has forced both boys and girls into its ranks—and the recent abduction of nearly 300 schoolgirls brought the group global attention.

Nigeria's army, meanwhile, has routinely rounded up young men on slight provocation, shooting them in the streets, said human-rights groups and Western diplomats. The army denies the charges.

For all involved, the psychological toll is clear.

One of the doctors, Babagana Machina, says soldiers and suspected Boko Haram members alike have marched into his office, each of them exhibiting symptoms of post-traumatic stress disorder. After five minutes of therapy and a prescription for cheap antidepressants, they leave through the crowded waiting room.

"Some of them will tell you that they killed even their parents," said Dr. Machina, who qualified to practice psychiatry just last year. The sixth edition of the "Shorter Oxford Textbook of Psychiatry" lay open on his desk as he added: "I'm learning on the job."

He works with eight fellow psychiatrists at the clinic, and 20 are in training. Seven psychiatrists have resigned, one after narrowly evading a kidnapping attempt.

The doctors declined to disclose the identities of their patients—and many of the emotionally damaged here weren't able to speak for themselves.

But the doctors allowed a reporter to see the medical histories of patients, which are jotted into aquamarine folders that spill across the floor, putting words to the emotional cost of the conflict. "She witnessed a bomb blast," reads the opening sentence for a 45-year-old mother.

A hospital survey conducted last year estimated that between 10% and 20% of the population in the state needs mental-health services. Every day, 20 or 30 people show up for the first time here.

That the Maiduguri psychiatric hospital functions at all represents one of the oddities of northern Nigeria.

In many other ways, the state in this corner of the country has collapsed. Boko Haram has bombed police stations, torched government schools, ripped open the gates of jails, incapacitated an airport, carjacked army tanks and occupied many roads.

And yet the doctors at the psychiatric hospital have carried on—sometimes in the dark during power outages. They often treat security forces who have seen comrades beheaded, burned alive and maimed, both in video and in person.

Among those who show up at the psychiatric hospital, many can't afford medication. The doctors dip into their salaries to help out patients.

"We tax ourselves," said Dr. Machina.

The prospect of reinforcements for the doctors remains remote. It is nearly impossible to recruit people to the area.

But it is also hard to leave. Dr. Machina has twice deferred an acceptance letter to King's College London, he says, in order to treat the patients who clearly need him here.

Said Isa Rabebbe, the hospital's medical director: "This is what we do."