ASSESSMENT OF HEALTH NEED FOR INTERNALLY DISPLACED PERSONS

CHAPTER TWO

REVIEW OF RELEVANT LITERATURE

Introduction

Many internally displaced persons, mainly from rural areas, are forced to resettle elsewhere, especially in urban areas: it is felt that the government and various organizations would provide. This chapter will bring about the review of relevant literature on the study area.

Key humanitarian needs

The conflict has had a devastating impact on the civilian population in north-east Nigeria. To date, 1.6 million people remain displaced in the three most affected states.

Basic survival

At household level, displacement, lack of access to land, the closure of habitual trade routes and bans on traditional livelihood activities or inputs used (e.g., the ban on the fish trade and the purchase of fertilisers) have critically disrupted the region’s markets, and directly resulted in a loss of income opportunities for the region’s people, accompanied by significant food insecurity. More than 80 per cent of IDPs identify agriculture or livestock as the main sources of livelihoods before the crisis, making a high dependence on external assistance inevitable in the short term. Households continue to face a strong erosion of their livelihoods, and high food prices, with staple food prices approximately 60 per cent higher than at the same time last year and up to 120 per cent above the five-year average. Among households receiving humanitarian food and livelihoods assistance, there have been improvements in food security indicators, such as Coping Strategies and Food Consumption Scores. However, these improvements would disappear if food assistance was discontinued and if restoring and strengthening livelihoods – especially crop and livestock production and income generating activities – are not adequately supported. Recent food and nutrition assessments12 estimate that 2.6 million people are food insecure and require assistance as of October 2017, and this figure could increase to 3.7 million by the 2018 lean season (June through September), should adequate food and livelihoods assistance not be provided. While livelihoods in northern and eastern parts of Borno State remain particularly affected by the conflict, improvements in security and access in other parts of Borno – particularly Maiduguri, Jere and Konduga LGAs, as well as most LGAs in Adamawa and Yobe states – have strengthened market function over recent months, with many geographical areas seeing improved market conditions.

Essential services

At the community level, the destruction of cities, towns and villages has led to a collapse of public services, most notably the health, nutrition, education and telecommunications infrastructure. The Recovery and Peacebuilding Assessment estimated that it would cost more than $9 billion to rebuild all damaged homes and infrastructure.

Approximately 40 per cent of health facilities, and nearly half of Borno State’s schools were destroyed during the conflict, causing civilian populations – including health workers, teachers and other civil servants – to flee. Where services are still functioning, they are overburdened with increased needs from both host communities as well as internally displaced families. Sheltering in overcrowded and often unhygienic conditions, the affected people are facing food insecurity and loss of livelihoods, poor access to water, poor health and nutrition conditions, and acute and repeated protection risks. WASH assessments identify a vicious cycle, in which unsafe water, inadequate hygiene and poor sanitation have resulted in vulnerable individuals (particularly children under five and pregnant or breastfeeding women) becoming acutely malnourished after suffering repeatedly from diarrheal diseases.While the provision of humanitarian assistance over the last year has stabilised the nutritional situation, an estimated 943,000 children under five across Borno, Yobe and Adamawa states are still acutely malnourished (440,000 with severe acute malnutrition or SAM, and 503,000 with moderate acute malnutrition or MAM). One in every five of these children with SAM and 1 in every 15 of these children with MAM are at risk of death if their malnutrition remains untreated. About 230,000 pregnant or breastfeeding women are also acutely malnourished. Health assessments warn of the particular risks faced by severely acutely malnourished children with medical complications, who are at high risk of dying due to the near absence of secondary health care facilities that can handle such cases. Congestion, poor infrastructure and poor water and sanitation conditions are the main causes of the cholera outbreak which affected more than 5,000 people, and resulted in more than 60 deaths in 2017, but was successfully contained thanks to a coordinated multi-sectoral humanitarian response supported by the WASH, Health, Displacement Management Systems (CCCM) and Shelter and Non-food Items sectors. With more than one third of children out of school, the resumption of education services is crucial not just for the future of the region, but also from a psycho-social perspective. With the majority of the conflict-affected people having experienced significant psycho-social distress, protection remains an urgent need at all levels. At least 30 per cent of IDPs are currently separated from their families, and 57 per cent of these have no contact with family members. In addition to the distress this has caused, family separation has a negative impact on livelihoods, as separated family members (especially men and children) were also providers to the households before the crisis. On average, 30 per cent of households are now headed by women, though it should be noted that in some locations this number is much higher (e.g., 54 per cent in Bama, 44 per cent in Kaga and 43 per cent in Gwoza13). There are an estimated 6,000 unaccompanied minors, 5,500 separated children and 15,000 orphans, among other groups of children at risk or affected by protection concerns. Conflict and displacement have undermined gender norms, affected child rights and have created a power shift between generations and gender roles14. Sexual violence, including rape, is a defining characteristic of the ongoing conflict, with 6 out of 10 women in the north-east having experienced one or more forms of gender-based violence (GBV) 15. Women, boys and girls are at particular risk within the current environment, with many reports of survival sex in exchange for food, money and freedom of movement (into and out of IDP sites). This exposes the population to increasing incidence of sexually transmitted infections including HIV, unwanted pregnancies, and obstetric fistula caused by sexual violence, leading to overall poor sexual and reproductive health outcomes.

The crisis has significantly affected the dignity of women and children. This is further entrenching pre-existing gender disparities. In the Global Gender Gap Index, Nigeria ranks 118th out of 144 countries16.

Humanitarian access

In addition to the assessed needs presented above, a significant portion of affected people are hard to reach, which means that humanitarian actors are not able to assess their situation, or provide them with aid or basic services. These people are likely to face very high security risks and are believed to have limited or no access to markets, goods and services.

Health Need

Conflict-affected people remain at significant risk of epidemic- prone diseases like cholera, measles, meningitis, and viral haemorrhagic fevers (VHF) such as Lassa and yellow fever. Women and children are often disproportionally affected given their responsibilities within the family: collecting water, preparing food, and providing care to those who are sick. Malaria is endemic in the north-east and accounts for half of all consultations in EWARS (Early Warning and Alert Disease Response and Surveillance system) sites, with a 50 per cent surge in cases during the rainy season (June through September). Malaria, acute respiratory infections and watery diarrhoea are the top three leading causes of illness among IDPs, along with high levels of severe acute malnutrition (SAM). More than 40,000 children are at risk of dying from SAM with medical complications. The 2013 Nigeria Demographic Health Survey reported that the north-east region has a high unmet need for modern contraceptives, and an extremely low contraceptive prevalence rate of 3 per cent. This translates to a high fertility rate and very high mortality ratio of 1,538, compared to the national value of 576. Only 20 per cent of pregnant women deliver with a skilled birth attendant. The lifetime prevalence of mental illness among Nigerians is estimated to be 12.1 per cent. This means that, out of the 7.9 million people in need in north-east Nigeria, over 930,000 people will suffer from a form of mental illness in their lifetime. Despite the magnitude of the problem, the region has a weak and poorly funded mental health system with very few mental health professionals compared to the rest of the country. This is particularly alarming given the high incidence rate of gender-based violence cases. Only 18 per cent of fully or partially functioning health centres in Borno State can reportedly provide violence survivors with integrated clinical management services20. However, more in-depth assessments of those facilities revealed that medical staff are unfamiliar with standard treatment protocols, breach patient confidentiality and often blame survivors seeking care21. The current repetition of the Health Resources Availability Monitoring System (HeRAMS) assessment showed that, out of 755 health facilities in Borno State, 292 (39 per cent) are fully damaged, 205 (27 per cent) are partially damaged and 253 (34 per cent) are not damaged. In terms of functionality, 376 (50 per cent) are non-functional.

INSURGENCY AND INTERNAL DISPLACEMENT IN NORTH EASTERN NIGERIA

The North Eastern part of Nigeria has become the hotbed of serious conflicts and insurgency. It comprises Borno, Yobe, Taraba, Gombe, Bauchi and Adamawa states. Given the spate of Boko Haram insurgency in this region, the sovereignty of the Nigerian state has been under serious threat. Indeed, for example, it is the case that the insurgent Boko Haram control 20 out of the 27 local governments in Bornu state where their activities have been on the rise. By implication, a pocket of 7 local governments which include Maiduguri Metropolitan, Jere, Konduga. Kaga, Bayo Kwayakusar and Biu local governments are under the control of the government (The Nation, 2016). Since the Boko Haram conflicts in the region, about 17, 000 people are estimated to have been killed in the series of intermittent attacks on the host communities and government facilities (Amnesty International, 2010). Apart from the Boko Haram insurgents, there are also pockets of communal clashes in parts of Taraba Plateau which have uprooted millions of people from their natural homes to leave in IDP camps. At the same time, the government led counter-insurgency operations against the people and other natural induced disasters have also forced people to migrate from their homes to take up temporary accommodation in IDP camps. The large number of IDPs was confirmed with the Internal Displacement Monitoring Centre (IDMC), a branch of the Norwegian Refugee Council, in April 2015 that about 1538982 people living in IDPs across Nigeria are the product of insurgency of communal clashes and natural hazards (IDMC, 2015). This is in addition to the other 47,276 IDPs in the plateau, Nassarawa, Abuja, Kano and Kaduna (NEMA, 2015). In terms of acute poverty, North Eastern Nigeria has the highest level of poverty in the country. Explaining the incidence of insurgency and conflicts in the region, such conflicts have been the bye product of the increasing displacement in Nigeria. This scenario was poignantly captured thus. Recently, the North-East is reported to be the home of state with highest unemployment rate in the federation, that is, Yobe State at 60.6%, as at the end of 2011. It is the zone with highest number of Internally Displaced Persons (IDPs) totalling 11, 360 in the 1st quarter of 2012and in 2010-2011 with highest number of forced displaced persons of Internally Displaced Persons (IDPs) (about 22% or 82%, North-West with 31% or 116, 207 and North- Central with highest of 42% or 162, 281 out of 377,701) due to Identity-Based Conflicts such as ethno- religious and political conflicts and violent clashes between the religious militia/armed group (Boko Haram) and government forces. Hence, within this period of coverage, the North account for 95% of IDPs in paradox of Boko Haram, an armed group that promotes sectarian violence of a different dimension that has engulfed the entire zone in the history of Nigeria, that is neither inter or intra-religious but essentially against the western educated Muslim elite and government (Muhammad, 2012: 4). Following the increasing number of internally displaced people in the country, the National Emergency Management Agency (NEMA) in 2016, reported that there are several IDP camps in Nigeria. Many of these camps were created to cater for displaced people. It was reported that many of these camps were located in the volatile North Eastern part of Nigeria where the activities of the dreaded Boko Haram insurgency have been on the increase. It should be stated that 16 of these camps were concentrated in Maiduguri, the capital of Bornu state and the number of IDPs in these camps ranges from 120,000 to 130, 000 persons (NEMA, 2016). They are also satellite camps spread across some local governments in the region. While the Regional Country Director of NEMA noted that the satellite camps housed about 400,000, it also stated that not less than another 1.2 million IDPs are putting up with their relatives (NEMA, 2016). From an official report, a total number of 1,934,765 displaced persons are currently domiciled in formal camps, host communities and satellite camps as a consequence of insurgency in the North Eastern states of Borno, Yobe, Taraba, Gombe, Bauchi and Adamawa states.

INSURGENCY, IDP AND BARRIERS TO GLOBAL HEALTH QUALITY SERVICES IN NIGERIA

As stated above, it is no longer news that Nigeria is currently experiencing insurgency that has undermined the global health quality service. It is the case that the intensity of armed attacks and abuse against the civilian population and destruction of vital health infrastructure has increased over the years. Since the emergence of Boko Haram insurgents in 2009, key health services and architecture for displaced persons have been adversely affected. At the same time, the access of IDP to quality health service has been of great concern. Frequent blockades, fears of maiming and killing, and threats to public service providers by insurgents have been found to affect safe delivery of quality health services to war ravage IDPs. Due largely to lack of movement, unavailability of service providers, lack of drugs and monitoring of IDP camps by central health officials, global health quality service has been adversely affected in Nigeria (Borno State Health Sector Bulletin, 2016). In the context of poor-quality health services, progress at improving global quality health service is impaired (World Bank, 2018). On the basis of this, our findings are predicated on the following thematic issues which include impact of conflicts on migration of health workers, inadequate funding, service provisioning, health infrastructures, and movement restrictions.

IMPACT OF CONFLICT ON MIGRATION OF HEALTH WORKERS

As a consequence of fratricidal conflicts, findings show that health workers often migrate for fear or threat of maiming and killings. It is not uncommon to find both local and humanitarian health workers permanently abandoning their work place. Even though the local ones leave and sometimes return when the situation is calm, evidence suggests that many of them don‟t return to their duty post2. The most common cadre among these caregivers, according to the Yobe state Human Resources Information system (HRIS), are the doctors and nurses. This statement was further buttressed by an informant participant of the research when he noted as follows: In relation to other health and community workers, doctors and midwives who are better at giving quality health service provision due to their professionalism are afraid to travel to some IDPs camps in conflict affected areas because of reprisal attack which is partly based on insurgent‟s suspicion about health workers. In the course of our duty, many of us are harassed, intimidated and interrogated by insurgents as well as security personnel to establish our motives3 Beyond the abscondment of health workers from IDP camps, findings also revealed that conflicts have also affected the IDP accommodating host communities. Many doctors and nurses also abscond from general health providing centres such as general hospital and maternity centres. The following information is provided about Doctor and nurses migration in conflicts ravaged areas (Table 2). Table 2 indicated a sharp drop in the number of doctors and professional nurses/midwives in some general hospitals. Apart from the fact that these professional health workers were largely inadequate, many of them were leaving their duty post as a result of conflicts. For example, the General Hospital in Bundi- Yadi which has 3 medical doctors, lost three of them by 2014. In a similar vein, the total number of midwives in that same hospital dropped from 33 to 25.

IMPACT OF CONFLICTS ON HEALTH INFRASTRUCTURE

Findings also revealed that insurgents‟ deliberate target of government institutions, especially health facilities such as sub-health post, maternity centres, and hospitals have also undermined global quality health service. Some health infrastructure and facilities have been attacked, with insurgents carting away valuable drugs, hospital equipment, ambulances and vehicles. This has undermine quality health services as some of these facilities meant to be used for in-house facilities for keeping materials and addressing emergency cases becomes unavailable (Ager et al., 2015). In Borno for example in was observed in a survey that about 593 health facilities, including 2 tertiary hospitals, 16 secondary hospitals, 113 primary health care centres, 239 primary health care clinics, 219 health posts and 4 IDP camp clinics exists in Borno. Out these facilities, 246 of were either destroyed or functional (Borno Health Sector Bulletin, 2018). This translates to 42% of the functional healthcare facilities in the state. Out of the 593 health facilities highlighted above, 99 (17%) were partially functional, and 81 (14%) were non-functional (Borno Health Sector Bulletin, 2018). In the case of Adamawa, of the 1120 facilities surveyed, which include 1 tertiary hospitals 28, secondary hospitals 363, primary health care centres 336, primary health care clinics 389 and 3 IDP camps. Only, 516 of the total amounting to 46% were destroyed (Borno Health Sector Bulletin, 2018). Of the 379 health facilities that were not fully destroyed, 240 (63%) were partially functional, and 61 (16%) were non-functional (Borno Health Sector Bulletin, 2018). This destruction and non-functionality of health facilities are consequence of conflicts and long term abandonment due largely to the impact of conflicts. Indeed, many health workers often vacate their duty post or abscond outright, because of the fear of been victim of attack. As stated by one of the research participants who is a health worker with one of the IDPs in the North “every night we vacate the IDP camp and take refugees somewhere, we were advised by the security officers to do so, because of the fear that the insurgents might make us ready-made targets”5. Indeed, some health infrastructure such as hospitals and local clinic has had to be closed down until normalcy is restored. Movement for health workers and patients to access health infrastructures and facilities has been a principal problem due to delays and limitations imposed by the security services (the Joint Task Force, JTF). (Ager et al., 2015).

The Health of Internally Displaced Persons

The world is in flux and people are moving constantly However, a segment of the movement is forced. The forced movement results in relocation of people and people groups either within their own country as internally displaced persons (IDPs) or to other countries as refugees. The forced movement can be due to natural causes such as floods, earthquakes, hurricanes, droughts and other disasters but often is human-made. The human causes of forced movements include wars, genocide, terrorism, insurgency, persecution and political instability. Globally, in 2015, 27.8 million people were internally displaced translating to 66,000 people/day.[1] IDPs are found in Syria, Yemen, Iraq, Columbia, Nigeria, Sudan, South Sudan, the Democratic Republic of Congo and Kenya. In the same year, up to 4.8 million people were internally displaced in Syria alone. The Internal Displacement Monitoring Centre estimates that there were almost 2,152,000 IDPs in Nigeria as of 31st December 2015 found in 13 states and covering 27 local government areas.[2] This estimate of IDPs in Nigeria does not include the increasing cases due to communal clashes and the incessant clashes between herdsmen and farmers.[3] When people are displaced, they move with their culture and health vulnerabilities, are frequently not welcomed by unwilling hosts (largely in part due to the limitation of resources) and are exposed to other health problems. The health of refugees tends to receive more attention than IDPs because many conventions, treaties and obligations of nations to treat the former well and the many international and multilateral agencies concerned with the care of refugees. IDPs can often transmit diseases to hitherto areas that were free of such or had potent vectors to transmit such. They are also vulnerable to all kinds of challenges both health and non-health. Health problems may be communicable including epidemics of measles, malaria and cerebrospinal meningitis; malnutrition; mental health such as anxiety, depression and post-traumatic disorders; reproductive health, for example, sexual harassment, rape, unwanted pregnancies and abortions. Access to healthcare and organising health services for them are challenging. Non-health problems include housing needs, security, access to safe, clean water and basic sanitation and schooling for the children of IDPs. These many problems of IDPs create a situation whereby they can be easily recruited as agents of terrorism and insurgency. It is to be noted that IDPs do not emerge overnight but slowly, and the problems are often ignored or unnoticed by national governments. They tend to be forgotten or overlooked as they do not encroach on the ‘space’ of the privileged and rich.[4] The health of IDPs is the focus of the commissioned article by Owoaje et al. in the current issue of our journal.[5] They have done an extensive review of the subject matter including assessment of the quality of the literature cited. Health problems identified among IDPs in Africa included post-traumatic stress disorders, malnutrition, fever, malaria, acute respiratory infections and lower quality of life. The evidence on the health problems of IDPs is limited, and their article fills the gap. The solutions to the health problems of IDPs lie first in tackling the root causes of wars and insurgency through a combination of diplomacy, good governance, infrastructural development, employment and other political measures. Second, there must be an emergency preparedness plan including active surveillance which should be activated in dealing with IDPs or when natural disasters occur. Proper coordination of such a plan is critical for its success. Health services should be sensitive to identify new users of health services that are outside their catchment areas and promptly report if the number of such clients is increasing in an unexpected manner. Third, resources within the country, especially money and personnel need to be deployed to meet the needs of IDPs. IDPs are citizens of their country and should not be treated otherwise. The Nigerian Government needs to dedicate more resources to the problems of IDPs and not wait for the international community first. In summary, the approach must be one of the providing sustainable durable solutions built on the first three components. This approach will encompass sustainable reintegration (in the place of origin of IDPs) where feasible, sustainable local integration (in the place of refuge) and sustainable integration (in other parts of the country).[6] In the Nigerian context, tackling the health problems of IDPs requires a high level of political commitment at local, state and federal government levels. The National Emergency Management Authority should take the lead role in coordinating the care of IDPs. All IDP camps should be identified, and persons in substandard environments should be relocated to proper camps. The National Population Commission should conduct a quick enumeration of persons in the camps as a first step. This is required for proper planning of care. Furthermore, the care must be holistic encompassing both health and non-health dimensions. Areas of concern outside the health sector include security using both formal and informal security agents to ensure protection within and outside the camp; decent accommodation is another focal area to prevent overcrowding and reduce the risk of transmission of infectious diseases; provision of adequate water and sanitation are very important to promoting the health of persons in IDP camps. In addition, adequate feeding is extremely important as malnutrition has been one of the problems amongst IDPs in Borno State;[7] training of IDPs in skills that can provide employment and establishment of schools for the children in the camps is crucial. The health challenges can be met through the establishment of primary healthcare centres that will provide preventive, promotive and curative services. Preventive services will include immunisation, family planning, counselling, antenatal care and primary mental healthcare. Curative services for the family with a well-linked two-way referral to a general or tertiary hospital will help. Provision of an ambulance will be a useful tool to deal with medical emergencies. Prompt integration and resettlement of IDPs as quickly as possible should be done. It is our hope that the health of IDPs can be improved through these measures.

Insurgency, Internally Displaced Persons, and Humanitarian Response

Insurgency and internal displacement present a composite-intrinsically linked relating to understanding and appreciating the dynamics arising from conflicting relations in different societies requiring a certain humanitarian response. The definitive insights about insurgency and internally displaced persons stem from the cause and effect relations. Although the concept ‘insurgency’ is difficult to define, Scholars and International Organizations have attempted different definitions to situate the concept realistically. Insurgency manifest differently in terms of nature, character, dynamics and effects it has on the people in different societies. It is largely construed by the conditions warranting its manifestation. However, different definitions point to the basic objectives of an insurgency, which denominate the need to wrestle power from, subvert or displace a legitimate government for the purpose of gaining control of a population or a particular territory, including its resources (O’Neil, 2002). Guide to the Analysisof Insurgency (2012:6) defined insurgency “… a protracted political-military struggle directed toward subverting or displacing the legitimacy of a constituted government or occupying power and completely or partially controlling the resources of a territory through the use of irregular military forces and illegal political organizations.” Put differently, insurgency involves rebelling or insurrection against a constituted government or an existing authority using civil resistance, and often, it takes the form of a protracted violent conflict in which group sharing the same ideology seek to “... overthrow or fundamentally change the political or social order in a state or region through the use of sustained violence, subversion, social disruption, and political action” (Moore, 2007). Insurgent movements are internal to the societies where they occur. They are usually led by the people indigenous to the society, who use most often indirect aggression, which makes it difficult for the government to use the legal monopoly of the force to clamp down on the insurrection. Accordingly, the structural explanation for insurgency deemed it that it occurs in poorly developed or inequitable political, social or economic conditions exacerbated by oppressive or corrupt regimes, ethnic factionalism, and lack of natural resources or disparities in their distribution, social stratification, or military occupation (Moore, 2007). The implication of the insurgency is the covering of a wider scope of low-intensity conflicts that manifest in the form of terrorism, leading to the internal displacement of persons. The internally displaced persons, according to the United Nations Guiding Principles (1998), are:

• Persons or groups of persons who have been forced or obliged to flee or to leave their homes or places of habitual residence, in particular as a result of or in order to avoid the effects of armed conflict, situations of generalized violence, violations of human rights or natural or human-made disasters, and who have not crossed an internationally recognized State border.

The internally displaced persons are a category displaced within a geographical location. Because of the displacement, they suffer several consequences as the means of their livelihood, such as agriculture and trade are dashed out as a result of violent conflicts or disaster, which could be as a result of a consequence of human or natural factor (Ladan, 2006). Therefore, IDPs experiences worsening situation of food insecurity and malnutrition; the effect is more on women and children. These situations among others create the need for a humanitarian response. Humanitarian response presents an inclusive procedure toward assisting displaced people and displacement of whatever kind that requires humanitarian assistance. Humanitarian assistance comes in different forms, some in kind, cash, logistical and psychological in nature. All of these manifest in the provisions of health facilities, water supply, food and nutrition, education, shelter and protection for the IDPs. The support rendered to IDPs is principally the concern of the State, however, individuals, groups, non-governmental organizations (both national and international) and foreign governments and institutions also support IDPs in various camps through the country’s government suffering the consequences of internal displacement.

Boko Haram: Context and Complex of IDPs and Humanitarian Challenges

Nigeria with over 180 million populations is a complex country given its diversity in terms of ethnic and religious identities. The complexities of Nigeria stem from the north-south divides, with Islam and Christianity play out the dominance in the northern and southern parts of the country. The social context of the identity politics along ethnic and religious groupings intra and inter regional brought much doubt on the unity of Nigeria. This started early during and after independence, which degenerated into civil war (1966- 1970). Decades after the civil war, Nigeria has continued to remain divided along that line. In the social relations among people, social forces play out eminently, and sometimes, violently when group claims are across purposes. Therefore, there is no gainsaying that Nigeria’s IDPs status in the international comparative scale is in doubt. The number of IDPs in Nigeria has increased considerably since Boko Haram Islamist started violent operation in the Northeast Nigeria in 2009. The records are there that there were 12.5 million IDPs in the 21 sub-Saharan countries and Nigeria have the largest population of IDPs in Africa with over four million population of IDPs, who have been forced out of their homes as a result of violent conflicts. However, the data provided are nonetheless exhaustive.See the detail in figure 1 for the presentation of the variations in the IDPs across countries in Africa.

Accordingly, the position of Nigeria as the worst case scenario in Africa also makes it the third worst country in the world ranking of IDP numbers after Syria and Colombia. It is of interest to note that more than two-third of the IDPs in Nigeria is consequent actions of the insurgency, which represent 91.98 percent with communal clashes representing 7.95 per cent and natural disaster representing 0.06 per cent. Therefore, there are more man-made disasters than natural disasters in Nigeria, which prominently stems from insurgency and communal clashes. The enormity of insurgency in Nigeria has caused serious human challenges. There is none that has led to the death, refugees and indeed, internal displacement like the one caused by the Boko Haram operating in the Northeast in Nigeria.

Theoretical Framework

Displaced Aggression Theory

This study adopts the social psychology theory of the displaced aggression. Displaced aggression is a neo-Freudian hypothesis of the frustration-aggression, which became attained scientific prominence with the publication of Dollard, Doob, Miller, Mowrer, & Sears in their publication in 1939.The displaced aggression theory postulates that aggression comes to play as a result of triggered frustration by extraneous factors. Displaced aggression is expressed when aggrieved people cannot retaliate directly against the source of provocation and, instead, subsequently aggresses against a seemingly innocent target (Pedersen, Gonzales, & Miller, 2000). Miller (1948) cited in Baron &Richardson (1994) suggested three factors that aggressor’s targets, which include among other: (1) strength of instigation to aggression; (2) strength of inhibition to aggression; and (3) the stimulus similarity of each potential victim to the frustrating agent. The inability to get to provocateur due to “the unavailability of the provoking individual, intangible instigators, and the fear of retaliation from the provocateur” (Vasquez, Lickel, & Hennigan, 2010), the aggression is then transferred to selected people considered to be the most vulnerable targets without the capacity of retaliation. Relating this discourse to the Boko Haram insurgency, Ted Robert Gurr (1970) mirrored the situation through the lenses of his relative deprivation thesis. He argued that the larger, the people perceived discrepancy between expectations and actual satisfaction, creating human insecurity, the greater the potential for the insurgency. The insurgent redirects their grievances to other targets given the impossibility or the lack of capacity to effectively direct their aggression toward the source of the provocation or frustration (Miller& Marcus-Newhall, 1997). In this context, the refugees and the displaced people in the Northeast Nigeria are people who became victims as a result of their vulnerability due to the absence of the requisite capacity of possessing the monopoly of the use of force to defend themselves. The implication of the displaced aggression by the Boko Haram Islamist has been great. It included the destruction of lives of government institutions and force-men and women, the sacking of many people from their homes and their means of livelihood; the massacre of people based on their belief systems, particularly non-Muslims and moderate Muslims, who do not share their ideological principles, and the crumbling of the economy of the Northeast region. The aim of which is to establish an Islamic caliphate in the region and to return the Northern Nigeria, and, if it is possible overthrow the state to the full practice of Islam. The consequences of the displaced aggression gave rise to over three million people displace internally.

Human Needs Theory

This study is also anchored by the Human Needs Theory. According to Coate and Rosati (1988), human needs are a powerful source of explanation of human behaviour and social interaction. All individuals have needs they strive to satisfy, either by using the system ‘acting on the fringes’ or acting as a reformist or a revolutionary. Human needs theory, just a few decades old, was popularized in the works of Abraham Maslow, John Burton, Marshal Rosenberg and Manfred Max-Neef. The theory posits that the basic cause of intractable conflict is the underlying need of people to meet their needs on individual, group and societal bases. According to this theory, human beings need certain essentials if they must live and attain well-being in any ramification of life. Such essentials are known as (basic) human needs. The argument of human needs theorists, therefore, is that the unavailability of alternative means to meet the needs of individuals or groups is what triggers violence – or conflict. Other times, violence also occurs when humans require understanding, respect and consideration for their needs. These needs are not only subsistence ones such as food, water and shelter but also other biological needs such as participation, identity, understanding and recognition (Kok 2007); security, safety, belonging [love], self-esteem and personal fulfilment [life satisfaction] (Maslow 1973).

Burton (1990) who has been applying human needs theory more actively to social and political conflicts looks at how universal human needs often are neglected, causing groups to use violence to claim their rights and satisfy their needs. Marker (2003) believes that unlike interests, needs are untradeable, insuppressible and non- negotiable. Contrary to the belief that all needs are complementarily essential to human life; no need is inferior to another, Maslow (1973) views some needs as more urgent than others, but agrees that all needs are instinctive. Those he terms more urgent he sees as more powerful too. In his opinion, the powerful needs are subsistence needs such as food, water and shelter which he claims precede all other human needs. As Coate & Rosati (1988) recommend, ‘social systems must be responsive to individual needs, or be subject to instability and forced change (possibly through violence or conflict)’.