I didn't expect to find children, let alone toddlers, in a state-run institution for adults in Kano, northern Nigeria. One of the them was Aisha, a girl between 3 and 4 years old, who lived there with her mother, Hauwa, 25, who was deaf and had a psychosocial disability.
We found Hauwa lying on the floor, barely alive, her belly abnormally distended, her feet swollen, and bearing open wounds. She was in a clearly distressed emotional state. Hauwa and Aisha lived in that room, with only a thin, dirty mattress covering the floor and without any blankets to cover themselves. Aisha stood by her mother, patient, curious about who my Human Rights Watch colleague and I were and why we were there. Her mother, on the other hand, didn't even have the strength to sit up.
We learned from the institution's staff that Hauwa, who had been placed there due to a lack of support services in the community, had been diagnosed with liver disease six months earlier but was never provided with treatment. Staff already faced challenges in even properly feeding people in the institution, let alone affording the prohibitively expensive medication Hauwa required.
Because of this and her increasingly dire situation, the staff pleaded with us to intervene. I desperately texted and called a government official I'd met. In a hopeful turn, she promised that the authorities would ensure Hauwa received care. But it was too late. Hauwa died the day after our visit.
Hauwa's story is tragically emblematic. Over the years, I've met hundreds of other people with disabilities and mental health conditions in Nigeria who, without access to any affordable services in the community, ended up in traditional healing centers, Christian and Islamic faith-based facilities, or state-run rehabilitation centers where they were often neglected.
In the institution where we met Hauwa, others also suffered from untreated health conditions. The same day we met Hauwa, a 75-year-old man died there. Staff members said he had been sick for a month. I saw his body on the floor in one of the rooms, covered with a blanket. That was the only blanket we saw in the institution. We also met a man, 65, who didn't have access to treatment for a debilitating urinary tract infection that prevented him from even being able to stand up.
Lack of access to health care is not the only abuse suffered by people inside facilities across Nigeria. In 2019, Human Rights Watch reported that hundreds of thousands of people with psychosocial disabilities—mental health conditions—were held in chains in various facilities.
While Nigeria banned chaining in 2021, it persists in practice. Chaining is among the most horrific examples of systemic inequality and discrimination against people with disabilities. On my most recent trip, in the same institution as Hauwa, I met Abdullahi, 36, who said he'd just been released from chains on the morning of our visit. Before then, his right leg was chained to the floor for two months.
In Ibadan, in southwest Nigeria, in one of the Christian healing centers we visited, I met Smalli, who was a news correspondent before she experienced a mental health crisis five years ago. Now in her 40s, Smalli described being chained, flogged, and exploited through forced labor during the five years she has spent in the prayer camp. In the same place, we also met a young man chained to a tree.
I can't stop thinking about these people, especially young Aisha. Aisha's loss of her mother robbed her of the only relative she has ever known and forced her to face one of the harshest parts of life for a child: losing a parent at an early age. Aisha's situation is all the more tragic because Hauwa's death was most likely preventable. According to the government official, Aisha will be moved to an orphanage, where I fear she may be at risk of further neglect and abuse associated with institutionalization of children.
The Nigerian federal and states' authorities urgently need to do more to improve this situation. The system that cruelly failed Hauwa and Aisha continues to fail the hundreds of thousands of other children, women, and men with disabilities who are languishing in Nigerian institutions. The government should prioritize the development of quality community-based mental health services that are accessible to everyone, regardless of wealth, such that people with disabilities aren't forced into institutions.
And it's not enough for Nigeria to ban chaining on paper. The government should monitor and meaningfully ensure that no one is being chained or otherwise abused in the country's institutions.
The authorities should assess the conditions of people with disabilities in state- and privately-run rehabilitation centers and ensure that they are able to fulfill all of their human rights, first and foremost their rights to life and to health.
This requires adequate funding and other resources necessary to ensure that they have access to food, essential medicines, and mental health care. No one else in Hauwa's situation should be left to die, no one else should be chained and flogged like Smalli, and no more children should have to grow up, like Aisha, without a parent who could have recovered and cared for her.
Emina Ćerimović is an associate disability rights director at Human Rights Watch.
