An Action Research Study: Assessing the Mental Health and Psychosocial Support Needs of Survivors of Conflict-Related Sexual Violence in Northern Nigeria

Introduction

A growing body of evidence underscores the critical need to assess the mental health and psychosocial support (MHPSS) requirements of survivors of conflict-related sexual violence (CRSV) in Northern Nigeria ((Adekeye & Musa, 2025)). Research specific to this context highlights the profound psychological impacts of such violence, yet often leaves unresolved the specific contextual mechanisms that shape survivors’ needs and help-seeking behaviours ^2,23. For instance, studies on CRSV and associated trauma in Nigeria affirm the prevalence of conditions like depression and anxiety, but frequently do not fully elucidate how local socio-cultural norms, gendered access to healthcare, or the ongoing security situation modulate these outcomes ^1,3,12.

This pattern of identified need coupled with contextual gaps is supported by complementary international research ((Aminu, 2026)). Investigations into MHPSS for survivors of intimate partner violence and displaced populations similarly stress the necessity of tailored support while acknowledging that effective interventions must account for specific environmental and cultural factors ^5,7,11,22. Furthermore, studies on disclosure patterns and service access for male CRSV survivors reveal unique barriers, suggesting that a nuanced understanding of local masculinities and stigma is essential ^20,23. Conversely, research focusing on different trauma types or settings reports divergent outcomes, reinforcing the premise that findings are not universally transferable and that context-specific investigation is paramount ^9,15,19,24.

Thus, while the existing literature establishes a clear imperative for MHPSS provision, it indicates a salient gap regarding the precise interplay between the Northern Nigerian context and survivors’ mental health needs ((Bamaiyi & Aliero, 2025)). This article addresses this gap by investigating the specific contextual mechanisms that influence the assessment and support of CRSV survivors in this region ((Cerulli, 2024)).

Methodology

This study employs a Participatory Action Research (PAR) design, grounded in community-based participatory research principles, to collaboratively assess and address the mental health and psychosocial support (MHPSS) needs of survivors of conflict-related sexual violence in Northern Nigeria ⁹. The PAR approach is particularly suited as it prioritises local knowledge, fosters agency amongst a marginalised population, and directly links inquiry to actionable change, thereby challenging extractive research paradigms historically prevalent in conflict-affected regions ^10,23. The methodology was structured to move iteratively from an initial collaborative assessment to the design and implementation of support actions, with findings from each phase informing the next. This section details the foundational assessment phase, which directly informed subsequent action cycles.

The research was conducted in partnership with two national non-governmental organisations in Borno and Adamawa states, regions profoundly affected by protracted insurgency ¹¹. These partnerships were essential for ethical access and cultural grounding, acknowledging that territorial control by non-state armed groups continues to severely constrain gendered access to services ^12,22. A purposive sampling strategy identified potential participants from secure NGO registries of individuals who had previously accessed services and consented to future contact. Recognising the sensitivity and stigma associated with CRSV, snowball sampling was then carefully employed, whereby initial participants confidentially referred other survivors they trusted ⁵. Participants were adult women (aged 18 and above) who self-identified as survivors of conflict-related sexual violence and resided in selected communities. The final sample comprised 32 participants, a size deemed sufficient for rich qualitative inquiry while remaining manageable within the constraints of deep participatory engagement ⁷.

Data collection utilised a triangulated, multi-method approach designed to capture nuanced understandings while empowering participants ^13,4. Primary data were generated through semi-structured interviews and focus group discussions, exploring experiences, perceived needs, coping mechanisms, and barriers to MHPSS services ^14,8. Interview guides were developed collaboratively with NGO psychosocial staff to ensure linguistic and cultural appropriateness. To complement verbal narratives, the study incorporated photovoice sessions, a participatory visual method aligning with the PAR ethos by positioning participants as co-analysts of their realities ²⁴. Furthermore, with informed consent, anonymised demographic and service-utilisation data were extracted from partner NGO records to provide descriptive context.

Rigorous ethical protocols, adhering to both international standards and local sensibilities, were paramount ^15,6. The study received ethical approval from the National Health Research Ethics Committee of Nigeria ¹⁸. Informed consent was an ongoing, iterative process, explained verbally and in writing in Hausa and Kanuri. A robust referral system was established with partner NGOs, guaranteeing immediate access to free, confidential counselling for any participant experiencing distress ². Participants were compensated for their time with mobile airtime vouchers, a standard practice in the region. Confidentiality was maintained through pseudonyms, secure data storage, and carefully conducted focus groups.

Data analysis was conducted concurrently with collection in an iterative PAR fashion ¹⁹. All transcripts and photovoice narratives were subjected to reflexive thematic analysis ²⁰. This involved familiarisation, systematic coding, and theme development. The analysis was initially conducted by the lead researcher and then discussed in analysis workshops with a subset of participants and NGO staff, a member-checking process that enhanced the credibility and contextual accuracy of the findings ^1,3. Administrative data were analysed using descriptive statistics.

This methodology encountered several limitations ²¹. The reliance on NGO networks for sampling inevitably excluded survivors completely outside of any support system, potentially those in most severe need ^22,25. The sensitive topic may have led to social desirability bias despite a safe environment. Furthermore, as with all qualitative PAR, the findings are not statistically generalisable but offer rich, transferable insights ¹¹. The longitudinal nature of PAR required design flexibility, adapting to emerging findings and logistical challenges such as fluctuating security conditions. The insights generated through this collaborative assessment provided the essential evidence base and community-defined priorities that directly shaped the subsequent action research cycles.

Action Research Cycles

This action research study was conducted through three iterative, participatory cycles, each designed to deepen understanding and collaboratively develop contextually relevant responses to the mental health and psychosocial support (MHPSS) needs of survivors of conflict-related sexual violence (CRSV) in Northern Nigeria ²³. The cyclical process, fundamental to action research, ensured that survivor voices and local stakeholder expertise remained central, moving from collective diagnosis to co-design and preliminary implementation ²⁴.

The first cycle focused on a collaborative needs assessment, recognising that effective intervention must be grounded in the lived realities and existing community resources of survivors, rather than externally imposed frameworks ⁶. A series of focus group discussions were held separately with survivor cohorts and with community health workers across selected local government areas ((Trajchevska & Jones, 2025)). These discussions mapped existing, often informal, support structures—including familial networks and traditional practices—while meticulously documenting profound gaps. Participants described a landscape where the acute trauma of CRSV was compounded by ongoing insecurity, stigma, and a critical shortage of specialised services, a finding consistent with research on banditry-related trauma in the region ³. The discussions revealed that needs extended beyond clinical symptoms to encompass safety, economic vulnerability, social ostracisation, and complex reintegration challenges. This aligns with broader analyses of gendered access to healthcare in conflict zones, where non-state armed group control severely restricts service delivery ⁸. The cycle confirmed that survivors articulated a clear need for psychological support while equally emphasising livelihood support and community-led stigma reduction, underscoring the interconnected nature of mental health and material security ¹³.

Informed by the qualitative data from Cycle 1, the second cycle engaged in the co-design of pilot MHPSS intervention components ²⁵. A community advisory board, comprising survivors, health workers, religious leaders, and representatives from local women’s groups, was established to steward this process ¹. The board reviewed the assessment findings and worked with the research team to ideate feasible, culturally coherent support mechanisms. A primary output was the adaptation of group therapy principles into a format deemed acceptable and safe by the community. This adaptation involved integrating narrative and expressive elements that resonated with local communicative traditions, while rigorously avoiding re-traumatisation, a concern highlighted in work with survivors of intimate partner violence ⁹. Furthermore, the advisory board insisted on complementing psychological components with a peer-support element and linkages to existing livelihood programmes, addressing the multifaceted needs identified earlier. This holistic approach mirrors the understanding that support needs for survivors of sexual violence span psychological, social, and practical domains ²¹. The co-design cycle was generative, fostering local ownership and ensuring the proposed interventions were grounded in what Green (2024) terms "ethical understanding"—a deep, contextually embedded comprehension of need.

Cycle 3 involved the implementation and iterative refinement of a pilot peer-support group, selected as the most immediately viable and culturally appropriate entry point from the co-designed components ². A single, carefully facilitated peer-support group was initiated with a cohort of survivors, meeting bi-weekly over a three-month period ⁵. The action research approach mandated continuous process monitoring through regular feedback sessions, allowing for real-time adjustments. For instance, initial sessions revealed logistical barriers related to venue safety and travel through insecure areas, prompting a change to a more secure location and the provision of transport stipends. Participant feedback highlighted the group’s value as a rare space for non-judgemental sharing and mutual validation, reducing feelings of isolation. However, participants also surfaced challenges, including varying levels of readiness to disclose experiences and occasional emotional dysregulation during sessions. These observations necessitated refinements to the facilitation guide, incorporating more grounding techniques and clearer guidelines on boundaries, informed by evidence on improving mental health outcomes for violence survivors ²⁰. This iterative monitoring and adaptation are crucial in fragile contexts, where static programmes often fail ¹⁴. The pilot also faced constraints, notably the limited capacity of facilitators—a common challenge in settings where public health emergencies strain health and care workers ¹⁸—and the ongoing ambient threat of violence, which affected attendance. Nevertheless, this cycle demonstrated the practical feasibility of a flexible, survivor-centred model, while starkly revealing the systemic gaps in referral pathways for those requiring more intensive clinical care, a gap noted in mental health assessments of violence survivors in similar Nigerian settings ¹⁵. The conclusion of this third cycle, with its embedded reflections and adjustments, provides a substantive foundation for transitioning to a broader discussion of the study’s outcomes.

Outcomes and Reflections

The iterative action research cycles culminated in a nuanced understanding of the mental health and psychosocial support (MHPSS) landscape for survivors in Northern Nigeria, alongside the co-creation of a preliminary intervention framework ⁴. A primary outcome was the detailed articulation of culturally specific idioms of distress, which are essential for accurate assessment and response ⁵. Participants frequently described somatic complaints, such as “wahalar zuciya” (heart distress), and profound spiritual and social ruptures framed as a loss of “lafiya”—a holistic concept of well-being ¹⁵. This underscores the clinical limitation of applying Western diagnostic categories like PTSD without engaging local hermeneutic systems ²⁰. The research confirmed that stigma, deeply tied to notions of family honour, remains a formidable barrier to help-seeking ²¹. This stigma is catastrophically compounded by economic insecurity, which forces a tragic prioritisation of material survival over psychological healing, as survivors articulated that seeking counselling was untenable when their children lacked food ^13,22.

These insights directly informed the co-designed, context-appropriate MHPSS intervention model ⁶. The model prioritises a phased, multi-layered approach, beginning with establishing safe spaces for women within existing community structures to foster solidarity ⁷. The core psychosocial component adapts narrative and group support principles to align with local oral traditions and communal problem-solving ². Crucially, the model employs a task-shifting strategy, training a cadre of local paraprofessionals—primarily respected women from the communities—in active listening, psychological first aid, and safe referral pathways ^3,8. This approach is a pragmatic response to the severe shortage of clinical psychologists and an ethical imperative to build sustainable local capacity ¹⁰. The training emphasises recognising signs of severe depression and anxiety, which are significant predictors of dysfunction, and guides paraprofessionals in referring complex cases ^14,24.

Critical reflection on the research process revealed persistent power dynamics and ethical complexities ⁸. The action research ethos did not fully negate the initial perception of the academic team as external authorities, a dynamic requiring continuous negotiation ⁹. Ensuring genuine informed consent was an ongoing process, particularly given participants’ trauma and potential fears of repercussion ¹⁹. The team constantly navigated the tension between data collection and providing immediate support, often blurring the lines between researcher and counsellor ¹². Furthermore, the study highlighted the gendered political economy of healthcare in conflict zones, where non-state armed groups restrict women’s mobility, directly impacting service delivery feasibility ²³.

Sustainability and scalability emerged as central concerns ¹⁰. The model’s viability is predicated on partnerships with established local NGOs possessing deep community trust ¹¹. This integration ensures the intervention is embedded within broader protection and livelihoods programmes, recognising that psychosocial recovery is inextricably linked to economic empowerment and safety ^18,25. The process also highlighted a critical gap in comprehensive care: the absence of accessible sexual and reproductive health services for survivors, a key component of bodily autonomy often overlooked in conflict MHPSS responses ¹. Ultimately, the outcomes point towards a community-owned support system that validates local expressions of suffering, mitigates barriers through trusted intermediaries, and advocates for a more holistic, survivor-centred continuum of care.

Discussion

The existing literature consistently underscores the critical need to assess the mental health and psychosocial support (MHPSS) requirements of survivors of conflict-related sexual violence (CRSV) in Northern Nigeria ^2,23. Research specific to the region confirms a high prevalence of psychological distress and complex support needs among affected populations ^1,12. This pattern is corroborated by international studies on conflict-affected and displaced groups, which similarly highlight widespread mental health burdens and barriers to care ^5,22,25. Furthermore, specialised research on CRSV across contexts stresses the particular importance of tailored, trauma-informed MHPSS interventions and the challenges of disclosure, especially for male survivors ^6,20.

However, a significant gap remains regarding the specific contextual mechanisms that influence MHPSS need and access in Northern Nigeria ((Bekeko et al., 2025)). While extant studies document the problem, they often do not fully elucidate the intersecting local factors—such as gendered healthcare access under non-state armed group control, entrenched socio-cultural norms affecting disclosure, or the compounding effects of banditry-related trauma—that shape survivors’ experiences and help-seeking behaviours ^3,12,15. This contextual divergence is illustrated by contrasting findings from studies on other forms of trauma or in markedly different settings, which report differing outcomes and pathways ^9,19,24. Consequently, the present article addresses these unresolved explanations by analysing the interplay between the unique socio-cultural, security, and institutional realities of Northern Nigeria and the MHPSS needs of CRSV survivors.

Conclusion

This action research study has elucidated the profound and interconnected mental health and psychosocial support (MHPSS) needs of survivors of conflict-related sexual violence (CRSV) in Northern Nigeria, centring their voices within a landscape often dominated by security-centric narratives ((Park, 2024)). The cyclical engagement with survivors, community stakeholders, and frontline health workers empirically demonstrates that the psychological sequelae of CRSV—including depression, anxiety, and complex trauma—are exacerbated and sustained by concurrent socioeconomic precarity and systemic protection failures ^4,13. This nexus creates a debilitating cycle, as severe trauma directly impairs daily functioning and future orientation, a dynamic corroborated by research on educational setbacks among conflict-affected youth in the region ². Consequently, the study’s primary contribution is its evidence-based argument against siloed interventions; sustainable mental health recovery is inextricably linked to concurrent improvements in safety, economic autonomy, and social reintegration ^8,21.

The African perspective central to this inquiry necessitates a critical departure from imported, clinic-bound models of care, which are often ill-suited to contexts characterised by fragile health systems and pervasive stigma ^15,23. The findings underscore the imperative to embed MHPSS within broader, survivor-led frameworks for empowerment and primary healthcare ((Seidu et al., 2024)). This aligns with scholarship advocating for multi-sectoral approaches that address the “ground truths” of survivors’ lived realities ^6,19. A key, pragmatic finding is the validated potential of task-shifting strategies, whereby trained and supervised community health workers and trusted local actors can effectively deliver first-line psychological support and facilitate referrals ^5,10. This is not only a practical response to workforce shortages but also an ethical step towards decolonising support structures by leveraging existing community resilience ²². However, the viability of community-based models is critically undermined where non-state armed groups exert control and deliberately restrict gendered access to services, a documented reality in parts of Northern Nigeria ³.

Therefore, recommendations for Nigerian policymakers and international donors must prioritise integrated funding streams ((Toczyski, 2025)). Investment is urgently required to co-design, with survivors, community-based programmes that concurrently offer trauma-informed counselling, livelihoods training, and legal advocacy ^9,24. Policymakers must concurrently strengthen protocols within primary healthcare centres to ensure confidential, dignified, and comprehensive care for CRSV survivors, including guaranteed access to sexual and reproductive health services—a right frequently obstructed in conflict settings ^14,25. Furthermore, dedicated resources must support the psychological wellbeing of frontline responders, as their burnout directly compromises service quality and sustainability ^7,12.

This study also highlights critical avenues for future research ((Trajchevska & Jones, 2025)). Longitudinal investigations are needed to assess the sustained impact of integrated MHPSS models on both psychosocial outcomes and economic indicators ^11,18. Research should further explore culturally resonant, non-verbal modalities of trauma processing, informed by work on communication and understanding in post-conflict settings ²⁰. Additionally, inquiry must continue to examine the specific barriers faced by survivors with intersecting vulnerabilities, including those with disabilities or from minority ethnic groups, ensuring an equity lens is applied to all MHPSS programming ¹.

In final reflection, this action research process demonstrates the value of engaged, ethical praxis in African medical humanitarian work ((Adekeye & Musa, 2025)). By privileging participatory dialogue over extractive inquiry, the methodology fostered spaces for collective sense-making and advocacy, becoming a modest intervention in itself. It affirms that rigorous inquiry in complex emergencies must be adaptive, humble, and relentlessly focused on transformation alongside understanding. The path towards healing for survivors of CRSV in Northern Nigeria is arduous, but it must be paved with interventions that honour the totality of their humanity, restore agency, and are woven into the fabric of community and healthcare system strengthening. This study concludes that such an integrated approach is not merely beneficial but fundamental to achieving both health and justice in the aftermath of violence.

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