Translating mental health — finding language solutions in northeast Nigeria

If the sign at the mental health clinic read, “Services for mad people,” would you walk in for help?

Yet that is the reality for many people in northeast Nigeria because of the difficulty in translating concepts like ‘mental health’ into Nigerian languages. Translators without Borders (TWB) is working with humanitarian experts in mental health to better understand the nuances among languages so that words can encourage use of services rather than hinder access.

Northeast Nigeria is linguistically diverse, with more than 30 mother tongues spoken by 1.9 million people displaced by conflict. Often traumatized by the conflict, many internally displaced people (IDPs) could benefit from mental health services. Yet the translation of ‘mental health’ into the main two languages used in the response – Hausa and Kanuri – carries a heavy stigma, possibly keeping people away from clinics.

How can those working in the mental health and psychosocial support (MHPSS) sector communicate information about services, when the very name of the sector scares people away?

To address this question, TWB worked with affected people and sector specialists to identify terms that need to be communicated more effectively. The resulting terminology recommendations and the proposed language glossary, with terms translated into Hausa and Kanuri, promote the use of unambiguous and less stigmatizing language. Use of these terms may, by extension, increase the use of services by those who need them.

TWB began by identifying 301 key mental health terms that are either difficult to translate, commonly misunderstood, or stigmatizing.

This list was then researched and discussed extensively. TWB facilitated a workshop with the International Organization for Migration (IOM) MHPSS specialists to identify particularly difficult words and discuss alternative translations, aiming to use plain language and to avoid words that stigmatize. A group of 53 internally displaced people then reviewed the translations. TWB tested comprehension among the group and explored alternative translations. Throughout the process, TWB discovered key areas where language posed a significant challenge in the delivery of mental health and psychosocial support services.

Points of confusion

One major finding was that many terms commonly used by English speakers when discussing mental health are heavily stigmatized or misunderstood in northeast Nigeria. “Mental health” in Hausa is literally “services for mad people” — a shocking example of stigma. An alternative way of discussing this sector may lie with the phrase “psychosocial support,” which TWB discovered did not carry the same stigma in Hausa.

Generic terms such as “abuse” and “stress” caused confusion as there is often not a comparable generic term in Hausa or Kanuri. In both languages, the translation of “abuse” was generally understood by respondents to refer only to ‘verbal abuse,’ similar to an insult. Similarly, “stress” meant only physical stress to respondents, such as the physical strain you feel after a day of hard labor. If an aid worker intends to communicate how to relieve “mental stress” or how to heal after experiencing “physical abuse,” it’s clear that miscommunication may occur. Therefore, it is best to always pair descriptive words like “physical,” “verbal,” or “emotional,” with “abuse” and “stress.”

A similar issue was found with the concept of a “safe space.” When used in an English-speaking mental health context, it refers to a physical space where one feels cared for and emotionally supported. However, those surveyed understood this concept as a place with armed guards. This is an example of how sector-specific jargon may not make sense to those who need services. In northeast Nigeria, the concept “accepted space” may translate better.

The TWB MHPSS Glossary

“This is a very laudable work that will hasten the delivery of services to the affected people of north east Nigeria.”
– Dr. Muhammad A. Ghuluze. Director, Emergency Medical Response and Humanitarian Services

To provide a solution for these issues, TWB has updated its Glossary for Nigeria with the 301 MHPSS-related terms. This glossary app includes words, definitions, sample sentences, and audio recordings for the selected terms. It can be accessed on a computer, tablet, Android, or iOS device, and can be used both on- and offline, which is useful given the poor connectivity in northeast Nigeria.

The app is already being used in training sessions with positive results. Thomas Eliyahu Zanghellin, theMental Health and Psychosocial Support / Gender-based Violence Focal Point for the NGO INTERSOS in Maiduguri, Nigeria, has used the glossary in four training sessions already, generating “really fun group work with stimulating discussions.”

Language and terminology play a key role in the delivery of aid. Many sectors, including mental health and psychosocial support, use jargon and generic terms that do not readily translate in some cultures. Discussions about language allow the humanitarian world to challenge this terminology. The TWB Glossary for Nigeria provides a potential solution, allowing affected communities to access services and claim their rights in a language they understand.

Learn more about the TWB Glossary for Nigeria, and other TWB glossary projects here.

Using language to support humanitarians

Humanitarian emergencies know no language boundaries.

In the 13 countries currently experiencing the most severe crises, people speak over 1,200 languages. Yet, humanitarians operating in these crises often do not have the necessary language support, making their jobs even more difficult.

World Humanitarian Day on 19 August is an opportune moment to reflect on this challenge. On this day, we honor all aid workers risking their lives to help people facing disasters and conflicts. At Translators without Borders (TWB), we believe that language should not stand in the way of the ability of these dedicated and brave people to deliver life-saving support.

Yet, too often, aid agencies do not give their staff the appropriate resources and tools to engage with communities and local responders in a language they understand. Translation is a consistent challenge, but mostly overlooked in humanitarian budgets amid other more tangible items. As a result, humanitarian workers are often forced to rely on unsupported national colleagues, untrained interpreters, English-centric jargon, and procedures that may exclude those who speak local languages.

The consequences of overlooking the need for language support are dire for the people in need of humanitarian aid – and pretty tough for humanitarian workers themselves.

Many of these aid workers are forced to rely on national staff or local community members to act as translators or interpreters. These staff members are largely expected to deal with the many challenges that differences in languages present on their own, although translation skills are rarely what they are recruited for. Program documentation such as guidelines, manuals, and other materials including specialized terminology is translated without training or support. Some may be working between two languages when neither is their first language.

Situations where interviews with community members pass through three or four languages are not uncommon. An international aid worker may speak in English, a national staff member interprets into the national language, and then a local school teacher interprets into the language of that village, and back again. This approach multiplies the potential loss of information in translation and lacks proper quality assurance. It also forces under-supported humanitarian staff or community members to perform a stressful task with little or no confidence that people’s information and communication needs are being met.

Mustapha (left), TWB - Hausa Team Lead, works with enumerators from the Danish Demining Group / Danish Refugee Council to conduct research on comprehension of information in various languages and formats at Farm Centre IDP Camp in Maiduguri, Borno State, Nigeria. — On World Humanitarian Day, we honor all humanitarian aid workers, including our staff, and commit to ensuring language does not stand in the way of their ability to support and empower those who need it most. Here, Mustapha (left), TWB Hausa Team Leader, conducts language comprehension research in Maiduguri, Nigeria.

The fact that complex humanitarian terms and concepts in English are not directly translatable into other languages compounds the problem for humanitarians. TWB’s research in different contexts has found that even aid workers do not always understand the English concepts they are asked to interpret. For example, “violence against women” was translated into Rohingya as “violent women” and “food security” in northeast Nigeria as “food protected by guards”. Comprehension rates among humanitarian data collectors are as low as 35 percent in some places. The result may be, at best, confusion or misunderstanding, and, at worst, inaccurate data upon which response plans are built. It is also undoubtedly stressful for those trying to do their best in challenging circumstances.

A lack of language support can also undermine coordination with and involvement of local responders. When meetings are held in a national or international language, for example, local language speakers are excluded from decision-making. This is not only a matter of dignity and mutual respect, but it is also a crucial precondition for tapping into local knowledge and capacities, allowing those on the frontline of a response to avoid delays in making potentially life-affecting decisions.

In short, humanitarian aid workers are better equipped to ensure people affected by crisis receive timely and relevant aid when they have proper language support.

This support begins with collecting the data needed to plan for language needs, and resourcing those needs appropriately. Training and capacity development programs can help build translation and interpreting capacity in languages for which there are no professional translators. A library of resource materials and tools in the relevant languages can be built up for all aid providers to make use of.

As we mark World Humanitarian Day on August 19, it is time to shift our attention to how we can use language services to support humanitarian workers trying to help in the most dire of circumstances. Addressing language barriers between humanitarians and crisis-affected communities can deliver the humanitarian world’s commitment to quality and accountability across responses, helping support and empower those who need it most.

Join us as a partner to benefit from our translator community, or sponsor us and enable TWB to provide humanitarian workers with the language support they need.

Written by Mia Marzotto, Senior Advocacy Officer for Translators without Borders.

Photographs by Eric DeLuca, Monitoring, Evaluation and Learning Manager for Translators without Borders.

TWB Glossary for North-East Nigeria

How a glossary helps increase access to life-saving information in north-east Nigeria

The humanitarian community in north-east Nigeria is well aware of the challenges of communicating with a population who speak more than 70 languages. Yet until now, they have largely lacked satisfactory solutions. There are few if any trained interpreters and translators for most local languages. Local staff and volunteers do their best to relay information to communities and listen to the people they meet, but it is not surprising that messages can become distorted when they have to be translated through a succession of languages. The question must be asked, what constitutes ‘access’ to humanitarian relief when language is not taken into account during implementation?

Field teams in north-east Nigeria have not been using standardized terminology in local languages. Even when providing messages in just the two main languages of the response, Hausa and Kanuri, humanitarian organizations have found that translations were not consistent. As a result, already vulnerable communities could receive inconsistent information. This can confuse or prevent people from taking protective actions, accessing available assistance, and claiming their rights. Until that time when the sector communicates in the wider range of regional languages, it must, at least, ensure that what is written and spoken in these two languages consistently and accurately conveys key concepts in a way affected people can understand, as a necessary first step.

Understanding this problem, Translators without Borders (TWB) partnered with the Norwegian Refugee Council and other protection specialists to develop an English/Hausa/Kanuri glossary for two fields: general protection, and housing, land, and property rights.

The process

To create the glossary, TWB pulled out key terminology from internal and external communication documents created by organizations active in each field. Hausa- and Kanuri-speaking staff and sector specialists came together to review and expand the glossary list. In small groups, they analyzed the English meaning of each word and agreed on the best word or phrase to describe it in Hausa and Kanuri. The result is a glossary which conveys as much of the meaning as possible, chooses words which do not stigmatize, and is based on local usage of the two languages.

Challenges arose throughout the process about the intent and meaning of certain words. For example, the term ‘access’ emerged as an issue. The land rights specialists understood ‘access’ as referring specifically to roads, paths, and physical accessibility. For the protection specialists ‘access’ meant removing cultural and gender barriers. ‘Access to information’ was identified as a third meaning, and ultimately the group selected three translations appropriate to the three contexts.

One group of specialists then checked the other’s lists.

After all, if a protection specialist cannot understand the vocabulary of the land and housing team, what hope is there for someone who is not a humanitarian professional?

After two days of debates and corrections, TWB presented the glossary lists to professional translators. They removed inconsistencies in spelling and corrected any grammatical mistakes before the new terms were entered into TWB’s glossary app for Nigeria.

TWB is happy to announce that the glossary is now available for viewing on mobile phones and other devices here: https://glossaries.translatorswb.org/nigeria/. It is designed to support interpreters, translators, field staff, community outreach workers, and enumerators in using the most appropriate and accurate terminology to communicate with affected people.

The glossary can be viewed on Android or iOS devices and will automatically cache, making it available for offline viewing. This glossary is a living document and TWB welcomes feedback and questions, which will help us improve it over time. Our aim is to expand the glossary app to cover further sectors and more of the languages of the people caught up in the humanitarian emergency in north-east Nigeria. We hope you find it useful in the meantime.

Written by Alice Castillejo, Country Program Manager, Translators without Borders Crisis Response

TWB’s Words of Relief program is supported by Elrha’s Humanitarian Innovation Fund – a grant-making facility supporting organizations and individuals to identify, nurture and share innovative and scalable solutions to the most pressing challenges facing effective humanitarian assistance. The Humanitarian Innovation Fund (HIF) initiative ‘Accelerating the Journey to Scale’ is funded by the Netherlands Ministry of Foreign Affairs (MFA).

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Putting language on the map in Nigeria

Without data on the languages of affected people, humanitarian organizations are ill-equipped to communicate with them effectively. In May of this year, Translators without Borders (TWB) started trying to better understand what data is available regarding the language preferences of populations affected by humanitarian crises. The short answer is that there isn’t much. In September 2017 we published a report highlighting the major gaps in data regarding what languages migrants and refugees arriving in Europe speak. The report also describes the difficulties organizations have in providing information in the appropriate languages. Around the same time, we began a similar research initiative in Nigeria.

In June 2017, TWB worked with the International Organization for Migration’s (IOM) Displacement Tracking Matrix team to add language -related questions to their ongoing data collection efforts with internally displaced people in four conflict-affected states in north east Nigeria: Yobe, Gombe, Adamawa, and Borno. This was the first time any routine language data collection had been done in the current response. There are over 500 languages spoken in Nigeria, making it one of the most linguistically diverse countries in the world. For humanitarian organizations working in the north east, this diversity of language is an incredible challenge. Organizations report difficulties in knowing what language pairs they should recruit interpreters in, in designing communication materials that use the most appropriate languages, or in understanding what formats are most effective. One of the main reasons for these difficulties is that they do not know what languages their intended audience speaks, or to what extent they understand various lingua francas such as Hausa. As one NGO staff member in Maiduguri explained, “In a focus group discussion, we may hear that somebody only speaks Marghi, but then we have no way to respond to them.”

IOM’s DTM team gathered input from key community members to identify sites where language was a major barrier to effective aid delivery.

Following this, we worked with a team at Map Action who designed a web map to help visualize some of these geospatial patterns and trends. We combined this map with qualitative and quantitative comprehension research that we conducted in partnership with Oxfam and Girl Effect. The combined findings gave a clearer picture of the language landscape for humanitarian responders. We have summarized the findings in an interactive storymap - see below or click here for a full-screen version.

Bringing down the language barriers in Nigeria

In November 2014, when Boko Haram forces occupied the north-eastern Nigerian border town of Damasak, in Borno State, the population fled north into Niger. Two years later, after the Nigerian army retook much of Damasak, thousands of people returned. They found homes destroyed and the hospital stripped of beds and supplies. Many had lost family members; many had witnessed or been subjected to physical and sexual violence by armed men on all sides of the conflict.

Earlier this year, an inter-agency team went to Damasak to assess humanitarian needs. One aim was to find out whether women and girls were experiencing violence or exploitation, but with no one on the team who spoke the women’s language, Kanuri, they could find only a male soldier from the local barracks to help them communicate. Unsurprisingly, the women claimed to have no protection concerns.^[1]

It was a stark example of what can happen when humanitarians cannot communicate in the language of the people they are trying to help. Yet a recent assessment by Translators without Borders (TWB) suggests such challenges are common in north-eastern Nigeria.

All the operational organizations interviewed by TWB in Borno State said language barriers hamper their efforts to understand and respond to the needs of internally displaced people (IDPs) and others affected by conflict and hunger. With 28 first languages spoken in Borno alone and low levels of education and literacy across the wider area affected, aid organizations struggle to recruit staff with the right combination of language skills and technical ability. Professional translators and interpreters are in short supply, particularly for languages other than the regional lingua franca, Hausa, so communication materials and program documentation tend to be available only in English, often in Hausa, and sometimes Kanuri.

As a result, humanitarians interviewed from six program sectors feared they lacked a full picture of needs and priorities across the target population, as speakers of minority languages risked going unheard. Without the right languages, ‘We can talk to the host communities, but not the IDPs.’

They also described challenges with providing assistance: Was information about the services available getting through? Were mine awareness communications understood, or were the various explosive remnants of war all being translated as ‘bomb,’ without the distinctions that determine how to stay safe? In short, how much was being lost in translation?

Despite lacking even basic data on the languages of affected people, organizations find ways around the language barriers. Some work through three informal interpreters in succession to communicate with affected people. Some have documents laboriously translated back into English to check their accuracy. Some provide non-professional interpreters for minority-language speakers so they can take part in training sessions.

All those we spoke to knew it was not enough.

Happily, solutions are available. Simple means of mapping the languages of affected people can provide humanitarians with a basis for planning communication. TWB has the expertise to work with subject specialists and language professionals to develop a library of multilingual humanitarian materials everyone can use and train translators and interpreters for minority languages. A protection glossary app designed by TWB’s Head of Technology, Mirko Plitt, has already proved popular and expansion is planned.

Together we can bring down the language barriers that impede recovery for affected people in Nigeria, now and for future emergencies.

An example of the TWB Protection Glossary App

By Ellie Kemp, Translators without Borders Head of Crisis Response