Thousands of people with mental health conditions are chained and locked up in various facilities across Nigeria where they face terrible rights abuse, the Human Rights Watch said on Monday in its latest monitoring report.
The report said detention, chaining, and violent treatment are pervasive in many settings, including state hospitals, rehabilitation and traditional healing centres as well as both Christian and Islamic faith-based facilities.
A mental health condition refers to a range of experience that affects a person's mood, thinking, and behaviour. These include depression, anxiety, schizophrenia, and bipolar condition. It can affect anyone, regardless of age, gender, race, ethnicity, religion, spirituality, sexual orientation, or any other background.
A senior disability rights researcher at Human Rights Watch, Emina Ćerimović, said: "People with mental health conditions should be supported and provided with effective services in their communities, and not chained and abused."
"People with mental health conditions find themselves in chains in various places in Nigeria, subject to years of unimaginable hardship and abuse," the official added.
It quoted President Muhammadu Buhari saying last month that his administration would not "tolerate the existence of torture chambers and physical abuses of inmates in the name of Islamic rehabilitation centres."
But the report said the Nigerian government is yet to acknowledge similar abuses in government-run facilities too.
The HRW said between August 2018 and September 2019 its representatives visited 28 facilities ostensibly providing mental health care in eight states and the Federal Capital Territory, Abuja.
The places visited included federal psychiatric hospitals, general state hospitals, state-owned rehabilitation centres, Islamic rehabilitation and traditional healing centres, and Christian churches.
During the visits, it said about 124 people were interviewed, including 49 chained victims and their families, staff in various facilities, mental health professionals, and government officials.
"Deep-rooted problems in Nigeria's healthcare and welfare systems leave most Nigerians unable to get adequate mental health care, or support in their communities.
"Stigma and misunderstanding about mental health conditions, including the misperception that they are caused by evil spirits or supernatural forces, often prompt relatives to take their loved ones to religious or traditional healing places," the report said.
HRW said during the visits, it found that people with actual or perceived mental health conditions, including children, were placed in facilities without their consent, usually by relatives.
In some cases, it said the police would arrest people with actual or perceived mental health conditions and send them to government-run rehabilitation centres.
"Once there, many are shackled with iron chains, around one or both ankles, to heavy objects or to other detainees, in some cases for months or years.
"They cannot leave, are often confined in overcrowded, unhygienic conditions, and are sometimes forced to sleep, eat, and defecate within the same confined place. Many are physically and emotionally abused as well as forced to take treatments," the report said.
In one of the state-owned rehabilitation centres in the southeastern part of Nigeria visited, the HRW said a nun in charge said they chain people to their beds "so they do not run away."
The HRW did not give the nun's name. In other cases, it said the names of the victims were deliberately changed to protect their safety.
The HRW said the nun defended the chaining of a woman who had HIV "to stop her from going around the men."
Nigeria has fewer than 300 psychiatrists for an estimated population of over 200 million. In 27 of 28 facilities visited, all residents had been unlawfully detained. They did not enter the facilities voluntarily and could not leave if they wished to do so.
Also, it said it found another woman at the same institution chained naked to her bed.
The staff, except one older guard, the report said, would, at 6:30 p.m. each day, leave residents, including children as young as 13, with no one to help them.
The facility has no electricity. So, people are chained to their beds in total darkness. The nun said that "the patients are given flashlights to use at night."
In a traditional healing centre close to Abuja, the federal capital territory, HRW said it met a woman who was pinned to a tree trunk with an iron ring.
The woman was restrained in that position for more than three weeks with her upper body naked. She was unable to move and so she was forced to eat, urinate, and defecate where she sat.
Impact of chaining
Chaining for a long period, the report said, could cause serious injuries and psychological distress.
The report quoted a 35-year-old woman chained for 10 months in an Islamic rehabilitation centre in Kano, northern Nigeria, as saying: "Everything about this (chaining) is difficult. You feel like you want to commit suicide ... regardless of how you felt before coming here, you will get worse."
Besides, the report said adults and children in some Islamic rehabilitation centres were reportedly whipped, causing deep wounds.
Also, people in Christian healing centres and churches described being denied food for up to three days at a time, which staff characterized as "fasting" for "treatment" purposes.
The HRW said in many of the traditional and religious rehabilitation centres visited, staff forced people with mental health conditions, including children, to eat or drink herbs, in some cases with staff pinning people down to make them swallow.
Victor, a 29-year-old Christian man held in an Islamic rehabilitation centre in Kano since June 2018, said:
"I heard that I would be here only for two weeks at first when I was brought here, then later that changed to one month, then two months. Now I am going on my third month here. Other people here say they were told the same thing and they ended up staying here for years.
In psychiatric hospitals and government-run rehabilitation centres, the report said staff forcibly administered medication, while some staff admitted to administering electroconvulsive therapy (ECT) to patients without their consent.
In some cases, it said families took their children - including young adults - to religious and traditional rehabilitation centres for actual or perceived drug use or "deviant" behavior, including skipping school, smoking tobacco or marijuana, or stealing from their parents.
The report said some children in the facilities - some as young as 10 - have been abandoned by their families.
Akanni, a 22-year-old woman who had a mental health crisis following the death of her mother and who had been detained in a church in Abeokuta for five months at the time of a March 2019 interview, said: "When my father brought me, I didn't know that he would leave me here. I was not happy, but I don't have a choice."
Shums, a 27-year-old man with depression, was shackled by his leg to another man's leg in an Islamic rehabilitation centre in northern Nigeria.
"We are like this all the time. Even when we have to use the toilet or sleep," Shums said. Two other men there were also shackled together. The centre's healer said one man had suicidal thoughts, "So I chained him to another person who is responsible, to prevent him from killing himself."
Nigeria signatory to Conventions on disabilities
Nigeria ratified the Convention on the Rights of Persons with Disabilities (CRPD) in 2007. Under the convention, Nigeria has the obligation to ensure equal rights for people with disabilities, including the right to liberty and freedom from torture, ill-treatment, and forced treatment.
While the Nigerian Constitution prohibits torture and other inhuman or degrading treatment, the government has not outlawed chaining.
In a 2015 report, the United Nations special rapporteur on torture said that chaining "unequivocally amount[s] to torture."
As a result of the findings, the HRW called on the Nigerian government to ban chaining and urgently investigate chaining in state-owned rehabilitation centres, psychiatric hospitals, and faith-based and traditional healing homes in all 36 states and the Federal Capital Territory.
Also, it said the government should also prioritise the development of quality, accessible, and affordable community-based mental health services.
"President Buhari denounced chaining as torture. But it's not enough to raid these centres and shut them down. People rescued from these desperate conditions and other Nigerians experiencing psychological distress should have access to proper psychosocial support and mental health services," Mr Ćerimović said.