Living in Fear: The Wound That Does Not Bleed

A kind of exhaustion sometimes shows up that has nothing to do with physical labour. It settles quietly in the body: a tightness behind the breastbone, a reluctance to sleep too deeply, and a habit of checking the door twice, then three times. This is the exhaustion of people who live inside ongoing threats, real or anticipated. It is one of the most poorly understood public health burdens of our time.

Now, the fear of insecurity is not the same as insecurity itself. It is the sustained psychological anticipation of harm, and it is doing enormous damage to millions of people who will never appear in casualty statistics. They have not been shot. Their homes have not been razed. However, they are, in every clinically meaningful sense, unwell. The mind under chronic threat does not distinguish neatly between what has happened and what might. It responds to possibility as though it were already fact, flooding the body with cortisol and adrenaline and keeping the nervous system in a state of low-grade emergency that, sustained over years, corrodes health from the inside out.

The World Health Organisation has documented what researchers have been putting together for decades. Populations living in conflict-affected or high-crime environments carry disproportionate burdens of anxiety disorders, depression, post-traumatic stress, and a cluster of somatic complaints. These include persistent headaches, gastrointestinal disturbances, hypertension, and disrupted sleep.

A study estimated that anxiety disorders alone affect roughly 301 million people worldwide, with conflict-exposed populations recording prevalence rates up to three times higher than those in stable environments. In sub-Saharan Africa, where large portions of the population live within reach of communal violence, armed insurgency, or pervasive petty crime, these numbers are not abstractions. They are the daily reality of ordinary people.

Sadly, Nigeria is one of the most affected countries by this reality. The northeast has endured more than 16 years of Boko Haram insurgency. The north-west is convulsed by banditry and mass kidnapping. The Middle Belt has seen farmer-herder conflicts displace hundreds of thousands and leave entire communities in states of protracted grief. Even in Lagos, Port Harcourt, or Abuja, the fear is palpable. It lives in the way a mother calculates which route her child should take to school. It lives in the entrepreneur who will not expand because visible wealth feels like a danger. It lives in the civil servant who cannot sleep until her husband texts to say he has arrived safely. These are not dramatic examples. They are a reality.

Research from conflict-affected regions of Nigeria consistently finds rates of probable post-traumatic stress disorder (PTSD) and major depressive disorder far above the national average. Clinicians increasingly report what they cautiously call “stress-related somatic syndromes” — a formal way of saying the body is keeping score of what the mind cannot fully process.

What makes this situation particularly insidious is that the fear of harm, unlike harm itself, is invisible. A gunshot wound gets treated. Fear becomes normalised. People adapt to living inside it. By adapting, they stop recognising it as something that deserves attention. They call it “alertness” or “being careful”. They pass it to their children as practical wisdom. However, collective suffering is not the same as acceptable suffering, and a neighbourhood that has stopped sleeping well has a health problem, not a lifestyle.

The government’s failures deserve to be named unequivocally. Apart from its failure to provide adequate security for the citizenry, it has majorly fallen short in the provision of essential health services. And here is a tip of the iceberg. According to the Association of Psychiatrists of Nigeria, there are fewer than 200 psychiatrists available to serve a population of over 220 million people. Mental health has historically received less than 1% of the national health budget. This proportion has not changed significantly despite years of advocacy.

The National Mental Health Act, passed by the National Assembly in 2021 and signed into law in January 2023, is a genuine step forward. However, legislation without sustained funding is a document, not a solution. Community psychosocial support and trauma-informed care are largely still available only as pilot projects sustained by international NGOs rather than as permanent features of the health system. In too many displacement camps across the northeast, there is no counsellor, no structured psychosocial programme, and no one whose job it is to ask how people are holding up. When government falls short at this scale, the burden shifts to individuals and communities. That is not how it should be. It is, however, how it is.

The truth is that people living inside insecurity-driven distress have more agency than they are encouraged to believe. Managing the mental health effects of chronic fear begins with acknowledgement. Suppression is not resilience. Naming an experience accurately is not exaggeration. It is the first step in psychological recovery, and the research on trauma is unambiguous: the people who do least well are not those who feel the most fear; it is those who carry it in complete silence.

The evidence equally points to a list of available, low-cost practices that can help. Consistent sleep and waking times, regular meals, and modest physical activity are among the most powerful regulators of a nervous system under chronic stress. Slow diaphragmatic breathing with extended exhalation activates the parasympathetic nervous system and genuinely interrupts the stress response. These are physiological facts, not wellness trends, and they are taught in every credible trauma programme. Regular, substantive contact with people who provide genuine presence is neurologically protective. Isolation amplifies threat perception. The brain under stress catastrophises most when it is alone. In Nigerian communities where extended family and neighbourhood structures still function, that social resource exists even where formal mental health services do not. Choosing to lean into those connections, rather than allowing mutual wariness and exhaustion to erode them, is a healthy decision.

Numerous Nigerian non-governmental organisations, such as the Mentally Aware Nigeria Initiative (MANI), Asido Foundation, and She Writes Woman, provide free or subsidised mental health support. Peer support groups facilitated by trained community health workers have also shown strong results in low-resource settings. Using those services should be as commonplace as attending a general outpatient clinic. The traditional stigma attached to mental health support in Nigeria is real, but it is costing people years of unnecessary suffering.

None of this replaces what the government owes its citizens: physical safety, properly funded mental health services, and a social contract that does not treat ordinary people as acceptable collateral. However, waiting for any system to be optimal before attending to one’s own psychological survival is not a strategy. Fear, when it becomes the permanent background noise of a life, reshapes personality, erodes the capacity for joy, damages relationships, and shortens lives. It deserves to be taken seriously as a health matter, not endured as a character test.

Ojenagbon, a health communication expert and certified management trainer, lives in Lagos.

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