Nigeria: incessant killings a Public Health Issue

Ethnic-based violence within the same country without the context of declared war is a problem for Africa, and nowhere more so than in Nigeria. Typically, the Nigerian over-centralized government is unable to prevent such violence, and usually arrives after the acute episode has exhausted itself; it has (or shows) no will or inclination to arrest and prosecute the perpetrators. Hence, the government is not just unable to protect the citizens, it can't provide security and it won't prosecute offenders. The peoples are bewildered; helpless, they naturally look for outside help which is usually from the rest of world (read: the US, the UN). The Nigerian government meanwhile reacts to its own impotency in three ways: 1) by avoiding squarely placing the blame where it truly belongs—ethnic intolerance and incompatibility and rather, blaming “the usual suspects” such as the manufactured “drug addicts,” “touts,” “miscreants,” and ambitious, unscrupulous politicians; 2) by deliberately grossly underestimating the casualty count; and 3) by going into psychological denial, burying its head in the sand.

In this situation, the most natural and most familiar UN body to appeal to is the International Human Rights organization. Unfortunately, the local and international Human Rights organizations are more likely to focus on whether the legal rights of the detained persons-perpetrators are being violated than on the plight and disposition of the victims of the violence proper. For example, in July 2009, there was another one of innumerable violence outbreaks in Northern Nigeria. Muhammed Yusuf, leader of the Islamic “Boko Haram” group in Northern Nigeria, sponsoring the mayhem, was reported as directly and personally responsible for quite a few of the hundreds of deaths (some by beheading) resulting from the melee. During his detention in Nigerian police custody, he was reported killed. The Human Rights organizations immediately sprang to action to champion his cause, “angered” by the extra-judicial killing. Unfortunately, there was no similar “Human Rights” outrage and indignation concerning the fate of the thousands of victims, dead, missing, dislocated, dispossessed, maimed and terror-stricken-and-scarred for life, the result of this man and his murderous group's bloody acts and wantonly destructive rampage. Thus, it is clear that the Human Rights agencies are not in the best position to be of too much help to otherwise helpless victims and soon-to-be victims of ethnic–based violence in Nigeria.

Such violence takes a huge toll on human life, limb, livelihood and property. For Nigeria, written reports date back to the 1940's with the coordinated lethal attacks by Northern Nigerians against the then Eastern Nigerians living among them; in 1966, this had blossomed into a full-fledged remorseless systematic ethnic cleansing exercise, a prelude to the Genocidal war—the Biafra-Nigeria war of 1967-70. After 1970, the violence continued, but with the Northerners now in complete control of the Nigerian government and all the peoples living in Nigeria through “militarocracy,” and intimidation, the situation become more like the violence between an iron-fisted mean slave-master and his slave: persistent, accepted and unreported.

The return of “non-military” governance in Nigeria in 1999 did nothing to abate the entrenched pattern and culture of ethnic-based violence. In just the time since then, an estimated hundreds of thousands of people have been killed in Northern Nigeria; more than that have been injured and maimed; many more have lost their property and livelihood; a particular ethnic group has been the aggressor, a specific ethnic group the predominant victim.

As such, ethnic-based violence now ranks higher than even some of the most feared “African” diseases in causing death, disability, destruction and misery among peoples living in Nigeria. It is this sobering fact that brings up ethnic-based violence, a “sickness” just as devastating and impacting as natural disease, on the radar-screen of Public Health. And, it is not just on account of indirect but still lethal consequences like the real health risks associated with decomposing corpses littering the streets and usual unsanitary conditions in makeshift camps where surviving displaced and injured persons seek food, water, treatment, safety and shelter during and after episodes of violence.

What is Public Health? Public Health concerns itself with the protection and improvement of the health of a community, employing treatment and proactive preventive mechanisms to fight disease, tackle poverty, address terrorism, prevent injury and violence and intervene in times of crisis, thus to enhance the quality of life and improve the environmental, physical and mental well-being of the society. Thus, injuries, violence and terrorism are properly covered by Public Health, all the more so because these conditions assume the same characteristics of menacing chronicity, recurrence and endemicity, just as familiar diseases traditionally under Public Heath surveillance and scope.

Public Health is an indispensable agency in all countries. It complements the Health Care System of nations. Advanced, progressive and or enlightened nations which understand this fact pay serious attention and make adequate fiscal provisions and allocations to it. They build, support, improve, sustain and maintain enduring Public Health infrastructures and rigorously apply its programs to the population. They integrate its functions into the overall Health Care regimen of the country. In less developed countries, Public Health is ignored, and or relegated to the “burden basket,” receiving less funds than a single corrupt official can embezzle in just one act alone; the results reflected by the state of Health in the societies of such countries are obvious. Nigeria belongs here.

On a global level, the World Health Organization (WHO) is the recognized international agency dedicated to coordinating and pursuing world Public Health issues on that scale. When the hapless and helpless victims of ethnic-based violence in Nigeria look up for outside help, it is to this body, the WHO, that they should then be directed to, and the WHO in turn may tickle what there is of Nigeria's Public Health to some form of action. Since Nigeria's Public Health agency has not spoken up and has offered nothing to address ongoing and worsening ethnic violence in Nigeria (nor has the WHO been heard from directly on this matter), it has to be assumed that no one has raised awareness of the issue to that level.

The latest outbreak of ethnic-based violence in Northern Nigeria occurred after April 16 2011 defeat of the Northern Nigerian Muslim candidate by a Christian Southerner in Nigeria's recent Presidential elections. It was started by Muslims in Northern Nigerian Sharia States. This time around, the casualty figures were (under)estimated at 500 to 3000 persons killed, not counting missing or injured and psychically traumatized people, not counting destroyed property and livelihood and their own peculiar toll on the people. Shortly following the bloody orgy, hapless and helpless Nigerians typically soon afterwards went about their “usual business” in usual zombie-like acquiescence to the usual urgings of leadership which cannot assure their safety or security. For their part, the by now bored media left to beam their searchlight elsewhere; and the rest of the Press went home. Even the military protection rushed in after the fact to “secure the area” was now gone, too, redeployed elsewhere. Then, the Boko Haram chose this time, barely two or three weeks later, to strike again, in the same area, with the same deadly efficiency, attacking and razing a Christian village and killing 9 villagers, according to unofficial reports. But, this fresh event and suchlike will never make news anywhere—not in Nigeria or the world media; no one wants to hear any more of this same type of bloody act with more “follow-through” delayed attacks. This is the pattern of violence, tactic and response that has been repeated time and again in Northern Nigeria. This type of violence is certainly a Public Health issue.

Violence of this type in Nigeria is always ethnic-based, where both religion and geographic region or zones are mere proxies for ethnicity. Such violence can be compared to a super-active seismic region where major earthquakes occur very frequently, with numerous large aftershocks in-between, and non-stop rumbling of the ground, coupled with incessant tremors, indicating a destabilized permanent fault-line. A Public Health disease model for comparison is endemic Malaria, for example, where mosquitoes cannot be controlled but people are forced to live with them, unprotected. Like the tremblors, like the assured disease-laden mosquito bites in these analogies, this violence cannot be stopped and it is not going to go away—unless there is an effective form of physical separation.

It is time that the peoples living in Nigeria, the Nigerian government, the countries of the world and relevant world institutions like WHO came to the realization that this type of gratuitous but preventable ethnic-based violence in Nigeria is a Public Health matter. Then, Public Health tools and pressure can be applied to tackle the problem; but do not expect mere “education,” a strong instrument of Public Health, to work here. Drastic maneuvers in the mien of familiar “quarantine” (physical sequestration) are necessary: permanent physical separation of the incorrigible perpetrator and its perpetual victim needs to occur—has to occur.

Public Health demands that the ethnic-based violence in Nigeria be prevented forthwith. The best way to prevent it is by the separation of the ethnic groups into their own respective sovereign independent entities, from where they may, if they so desire, find common ground for consenting and mutually beneficial, obviously non-violence-prone, inter-relationships. This is a solution that Nigeria already knows is inevitable, anyway, but is too afraid to adopt, especially without sensing the “blessing” of the world, and feeling that it has “world permission” and support to proceed. Little does Nigeria understand that the world cares only for its own problems, and expects every group to take care of its own problems, making whatever adjustments, however painful, to get it done. It's Nigeria's own problem.

All Health professionals in Nigeria and their colleagues all over the world with Public Health interest have a specific role to play: start voicing support for a non-violent separation of the ethnic nations in Nigeria where forced co-existence has consistently and convincingly proven impossible and has only generated sustained, lethal and indefensible violence while creating a permanent horrific bloody mess. Give your blessing, permission and support to Nigeria to resolve this issue thus. This recommended solution, of course, ought to be seen as the Public Health equivalent of effective quarantine in primary disease prevention and prevention of disease transmission now applied to the scourge of ethnic-violence.

Ethnic-based violence in Nigeria is a Public Health concern; a Public Health response is needed.

Oguchi Nkwocha, MD
Nwa Biafra
A Biafran Citizen
oguchi@comcast.net

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