Nigeria: What Nigeria's Health Sector Can Learn From the #EndSARS Protests

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For two weeks, young Nigerians coordinated peaceful protests across the country to demand an end to police brutality, illegal profilings, extortion and in some cases, extrajudicial executions by the Special Anti-Robbery Squad (SARS) of the Nigeria Police Force (NPF). Protest participants cut across different backgrounds and social classes but were united by a common goal, to #EndSARS.

What began as a peaceful protest turned violent as thugs infiltrated the protest. This led some state governors to declare curfews to stop the escalation of violence. On October 20, 2020, Lagos State Governor Babajide Sanwo-Olu announced a state-wide curfew from 4 p.m. This was later extended to 9 p.m. That evening, protesters at the Lekki toll gate began sharing reports on social media that they were being shot at by military personnel. The governor first said that no one was killed during the incident, which he said was perpetrated by forces beyond his control. Later on, he announced that one person died at a hospital.

The incident and the response to it by the state government resulted in the deterioration of an already fragile situation. Violent protests and destruction of private and government property shook Lagos and other cities leading to more deaths.

President Muhammadu Buhari addressed the nation on October 22, 2020, after a meeting with the security chiefs. He said he had acknowledged the concerns of the public regarding SARS and wanted to "warn those who have hijacked and misdirected the initial, genuine and well-intended protest of some of our youths in parts of the country, against the excesses of some members of the now-disbanded Special Anti-Robbery Squad (SARS)." He however did not mention the Lekki toll gate shootings in his address. On October 25, 2020, a release by his Senior Special Assistant on Media and Publicity, Garba Shehu, announced that President Buhari expressed his optimism that the judicial panel of inquiry set up by the Lagos State Government would "give justice to the peaceful protesters who lost their lives, security men who were murdered, and property owners whose assets were vandalised and looted."

The violence has died down. Comments made on social media allude to the despair that many young Nigerians feel that the vision for a major systemic change which energised the protests had been shattered. Yet there is also the sense that the stage has been set for a much longer process to ensure that the changes the EndSARS protesters are requesting are made.

The largely organic protests were hailed for their coordination, transparency, fundraising ability, delivery of services such as medical care and legal support, and even provision of food and water. Across several cities, protesters cleaned up after each protest. By far, this set the protests apart from any others in Nigeria's recent past. But central to their success was their ability to garner global attention to their cause and catalyse a national conversation that has pushed both state and federal governments to begin to take action within the same month that the protests began.

For anyone who advocates for development issues in Nigeria, especially for health issues, there are key lessons that can be surmised from the #EndSARS protests. Three lessons are highlighted below:

Successful advocacies are people-centered

There are many things that we advocate for in Nigeria's health sector. From family planning, appropriate nutrition, maternal and child health, and health security to universal health coverage and access to quality care. The list is unending.

Over the years, there has been progress in some of these areas. For more profound and sustained impact to be made, these communities have to take the lead in advocating for the issues that affect them. There is only so much that advocacy organisations can achieve if they are the only ones pushing for change. They must stop operating with the assumption that the communities they are advocating for don't know what they want or are totally helpless. For us at Nigeria Health Watch, this is all about building an active citizenship for health.

This played out in the first two weeks of the #EndSARS peaceful protests. Previously, there has been advocacy for a reform in Nigeria's policing methods but with little response from the government. The #EndSARS protest, which saw young people who identified closely with the issue and felt they were the targets of SARS, passed a strong message to the government that was heard "loud and clear" across the country, and even led to major actions being taken, such as disbanding the unit and pledges to begin mental health evaluations of SARS officers.

So what was different this time? Their messaging is aspirational - they envisioned a future without police brutality and built a coalition to demand for it. In a popular TED talk, Melinda Gates from the Bill & Melinda Gates Foundation shared what nonprofits can learn from Coca Cola. She highlighted the ubiquitous nature of Coca Cola and identified three strategies that help the company achieve this. The last point focused on aspirational marketing. She said a fundamental mistake the development community makes is thinking that people needing something doesn't mean they can't be made to want it.

Mechai Viravaidya, popularly called Mr. Condom, also shows how impactful advocacy can be when everyone joins in addressing the problem. In his TED talk, he shared how Thailand lifted millions out of poverty by checking population growth and making family planning a household name. One thing was clear after his 13 minute-presentation - it would have been impossible if everyone hadn't caught the vision and pitched in their support. He said they worked with everyone from monks, teachers, ordinary citizens to realise the dream. In his words, "you need everybody to be involved in trying to provide whatever it is that makes humanity a better place".

In Benue State, Nigeria Health Watch's advocacy (supported by Christian Aid UK in Nigeria) to ensure residents have access to quality healthcare through health insurance has evolved to empowering community members to take action. They are trained on the meaning of universal health coverage and how health insurance can help them achieve that. Imagine residents of the state educating each other, demanding effective health insurance schemes that cover everyone including the informal sector. The impact will be tremendous.

Some advocacy organisations also adopt this strategy in their work. As advocates, we must learn to work with the people we are advocating for because they are the most important stakeholders.

Mental Health as a priority

When the protests got hijacked and became violent, a lot of graphic multimedia surfaced online. People also took to social media to share their frustrations as emotions were high from all that was happening.

Organisations jumped into action to provide mental health support for anyone who needed it. The She Writes Woman Mental Health Initiative and Remedium launched toll-free lines, Stand to End Rape Initiative (STER) provided mobile numbers people could text "HELP" to and be contacted by a counsellor while Mentally Aware Nigeria (MANI) worked with STER to coordinate long term mental health support for victims of police brutality and their families as well as victims of violence related to the #EndSARS protests nationwide. Also, the Sunshine Series shared tips on prioritising self-care and building resilience and provided phone numbers for people to reach them through WhatsApp and phone calls.

In a recent media briefing, Dr Tedros, the Director-General of the World Health Organisation (WHO) said, "Close to one billion people are living with a mental disorder, and one person dies every 40 seconds by suicide. Yet relatively few people globally have access to quality mental health services".

Kachi Ekwerike, founder of Postpartum Support Network Africa says this is an opportunity to expand mental health care in Nigeria. He reacted to comments on how the public health community can contribute to ending police brutality in Nigeria by providing voluntary mental health services. While he believes police officers can benefit from mental health support services, providing it for free is not sustainable because mental health practitioners are already overwhelmed. "Government should be investing heavily in the mental health care of the police," he said.

This provides an opportunity for young medical practitioners to specialise and provide mental health services. It also an opportunity to share the task with other cadres of health professionals who can be trained to provide basic mental health screenings and care.

Knowledgeable first responders are lifesavers

Some of the deaths that occurred in the aftermath of the peaceful protests could have been prevented if the people around knew the right steps to take. Anthony Onome Unuode was one of the sad and unfortunate deaths. He was stabbed when thugs attacked peaceful protesters in Kubwa, a suburb of the Federal Capital Territory (FCT). There was a video of him walking on his own moments after the attack. His body was bloodied from what looked like a head injury and he appeared disoriented. He probably would have survived if the people around got him to stop walking, stopped his bleeding and took him to the nearest hospital immediately. According to Dr Osariemen Iyare, a public health physician and resident at the Federal Teaching Hospital Ebonyi, head injuries can be difficult to manage. He said the patient can appear stable for up to 24 hours then suddenly deteriorate. He said that the basic rules of emergency care require that all blood loss be stopped.

A first responder that is knowledgeable about basic first aid and knows what to do in an emergency can mean the difference between life and death. A classic example of this is the life-threatening accident of Canadian professional ice hockey player, Clint Malarchuk, in 1989. His co-player's skate blade hit the right front side of his neck, severing his carotid artery and partially cutting his jugular vein.

With blood oozing from his neck, Malarchuk's life was saved by the swift action of his trainer, Jim Pizzutelli. He gripped Malarchuk's neck and sealed off the blood vessel, not letting go until doctors arrived to start treatment.

It may not always be what is needed in every emergency situation but when more people are knowledgeable about basic emergency care, lives can be saved.

When Shell Nigeria Exploration and Production Company (SNEPCO) handed over emergency medical equipment to Lagos in January 2020, they first trained emergency medical personnel. This started impacting lives even before the official handover happened. A staff member of the beneficiary clinic, General Hospital, Odan, Lagos Island, shared how he was able to use the skills he learnt during the training to respond to an emergency on his way to work.

It is important for Nigerians to know what to do in certain situations before professional help arrives. There is an opportunity here for individuals, organisations, and even health centres to train those who are willing to learn. It might also be beneficial for those who often ply our highways and interstates, such as road transport workers, to receive basic first responder training that could prove useful if accidents happen.

Advocating for the good of Nigeria

The #EndSARS protests went beyond calling for an end to police brutality to a call for systemic change. Even though what the protesters envisioned may yet to be achieved, the steps taken towards fostering a national conversation that drives actionable change must be applauded. Sustaining the momentum through continued consistency and coordination is the work that now lies ahead for the #EndSARS protesters, as advocates for Nigeria's health sector are well aware.

The #EndSARS protests have provided insights that advocates for health should understand. Health development organisations, civil society and other advocacy organisations may want to reassess their strategies, to ensure that the people they are advocating for are carried along organically. They must take a closer look at how they frame the messaging around the issue they advocate for. There are times when using an aspirational rather than a deterrent messaging can lead to the desired behaviour change more quickly.

When people see the inherent possibilities that lie in doing the right thing, they are more likely to see a future that is possible, aspire to it, and most importantly, take the lead in advocating for it, just as the young people at the front of the #EndSARS protests did.

What lessons are you taking away from the EndSARS protests as a health advocate? Share with us on Twitter @nighealthwatch, and on Facebook and Instagram @nigeriahealthwatch

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