Cletus Nicholas takes his life in his hands when he gets on his keke marwa motor tricycle each morning.



For the past five weeks, he has been offering “counselling on wheels” support to survivors of Boko Haram attacks, going into villages around the city of Maiduguri in north-east Nigeria, the birthplace of the Islamist group.

“Even though I am afraid there might be an impending attack whenever I visit, I feel fulfilled and happy to help these survivors get well,” says Nicholas, a counsellor with the Neem Foundation, a group taking mental health services out on to the doorstep.

With a background in psychology and good local knowledge, Nicholas received nine months of training.

“Our lay counsellors are a mix of various people and every single one of them is educated. They understand the conditions of people suffering trauma in their community. These people also understand the area,” says Dr Abiye Mark Ivayenama, a director of the foundation.

Each day, Nicholas weaves his bike through villages, spreading the word about his services.

Hauwa Sule is one of those whom Nicholas met on his rounds. She now comes regularly to the foundation’s temporary office in Wulari for counselling.

Cletus Nicholas, a lay counsellor. Photograph: Festus Iyorah

Sule has been diagnosed with post-traumatic stress disorder (PTSD). Her husband and three sons were killed by Boko Haram three years ago, shot on their farm in the town of Zabarmari.

“This is what I’ve been battling since I lost my family,” says Sule. “I have not been sleeping. I’ve always been crying.”

By 2014, Boko Haram had captured key towns in north-east Nigeria. Many residents were displaced, and the majority sought refuge in Maiduguri. As the military recaptured towns, survivors began to return to rebuild their lives.

Profile Who are Boko Haram? Show Commonly known as Boko Haram, the Islamic State in West Africa is a terrorist organisation based in Northeast Nigeria. Formed in 2002 as Jamā'atu Ahli is-Sunnah lid-Da'wati wal-Jihād meaning “Group of the people of Sunnah for Dawa and Jihad”, the term Boko Haram is loosely translated as ‘Western education is forbidden’ or ‘Western influence is a sin’. Boko Haram started an armed rebellion against the Nigerian government in 2009. Their activities have included suicide bombings and the kidnapping of female students from a college in Chibok in 2014. A mass prison break-out in 2010 swelled their ranks. Their insurgency has also spread into neighbouring Cameroon, Chad and Niger.

In 2015 a coalition of troops from those three countries, alongside Nigerian forces, mounted a concerted effort to push back against Boko Haram. For their part, since 2015, Boko Haram has aligned itself with Islamic State. The UN estimates that at least 20,000 people have been killed in the conflict to date, but that is widely held to be far below the true number. At the peak of its strength it held territory equal to the size of Belgium Nigeria’s President Muhammadu Buhari and his generals have repeatedly declared that they have “beaten”, “defeated”, “technically defeated”, “routed” and “broken the heart and soul” of Boko Haram. Studies suggest casualties have dropped drastically in recent years. But the suicide bombings, child abductions and displacement of the local population continues. Estimates of the group’s strength vary between 4,000 and 20,000 fighters, and the number of people who have fled Boko Haram’s territory in the Lake Chad Basin is thought to be in the order of 2.4 million.

But with thousands killed by the insurgents, nearly 2 million people displaced and more than 5 million in need of food aid across the region, humanitarian groups recognise that many are likely to be experiencing trauma as they return home.

“A greater number of people who need psychosocial interventions are in these isolated communities, and people don’t reach out to them,” says Bem Tivkaa, a clinical psychologist.

Community leaders play a key role in breaking down taboos and encouraging people to attend mental health services. Close to 20,000 people have sought help in the past two years.



“We explain to them our mission to offer mental health and psychosocial support to people who are suffering as a result of the Boko Haram crisis. We also have a sensitisation visit to be sure that they understand what we are coming to the community to do, and that is key so that they have the right expectations,” says Tivkaa.

Counsellors ride motorised bikes to travel to people affected by Boko Haram violence. Photograph: Festus Iyorah

Fatsuma Abdullahi, 35, has been receiving counselling for the past month. In 2014 she lost a brother and her son is still missing.

“I was able to gain from others about how they’re coping with trauma. Before, I didn’t mingle with people, but this group therapy and the sessions with counsellors have been helpful,” she says.

It is unclear how much of Nigeria’s health budget is spent on mental illness. The latest publicly available figures are from 2006 and show just 3%. Health funding in general has been falling in recent years, from 5.97% of the federal budget in 2012 to 4% in 2018.



Fewer than 200 psychiatrists cater for a population of 180 million, according to a 2016 study.

Neem is overwhelmed with work. Tivkaa says there are only 10 clinical psychologists in all of north-east Nigeria. The foundation works with the federal neuropsychiatric hospital to diagnose severe illness such as psychosis.

Sule meets with other survivors for group therapy each Sunday. “When I listened to other survivors’ stories I discovered that I am not alone and some people have similar problems – even far worse than mine,” she says. “Since I started visiting here I’ve learned to accept my loss as a reality and move on with my life.”