Somalia's battle with mental illness By ABDULKADIR KHALIF in Mogadishu | Wednesday, October 2  2013 at  09:51

Patients in one of Dr Hebab's mental hospitals. Somalia's battle with mental illness gets little support from both the donors and the government. ABDULKADIR KHALIF | NATION MEDIA GROUP 

Somalia has the highest rate of mental illness in the world, according to the World Health Organisation (WHO), with one in three Somalis suffering some form of psychological disorder.

The high prevalence of mental health disorder considers that Somalis have had to endure the stress of more than two decades of civil war, plunging the country into a Hobbesian-like state, where life could aptly be described as "poor, nasty, brutish and short".

In addition to witnessing untold atrocities and horrors visited upon their families and friends, many Somalis have also lived through harsh drought.

The disturbing portrait of the horrors Somalis have been through gives a depressing outlook of the state of mental health in this tentatively-recovering country of 10.2 million.

Many are also routinely diagnosed with post-traumatic stress disorder (PTSD).

As Somalia starts the process of economic and political revival following the military successes of the African forces, there is one final battle which cannot be won through the barrel – mental illness.

As I pondered the state of mental health in Somalia, my attention quickly shifted to the now lively Abdulle International Airport in Afasiooni – a corruption of the Italian word Aviazione (meaning aviation).

One can hardly remember the last time one sat down in the streets to admire the panoramic Mogadishu coastline, let alone gaze lazily at the dozens of passenger planes landing and taking off – a clear indication of a country getting its act together after years of civil war and instability.

I was on my way on the 21 October Road along the magnificent oceanic view to see Abdulrahman Ali Awale, who founded Mogadishu’s first mental hospital in 2005.

Dr Hebab, as he is fondly called by locals, despite lacking formal medical training, is one of Somalia’s main mental health providers alongside the World Health Organisation (WHO).

A camel's feelings

The doctor looked noticeably younger than I expected. The last I saw of the man was a couple of years ago when he was running a diarrhoea treatment centre in north Mogadishu.

I found him talking to two gentlemen, one of them a former deputy chairman of the Red Crescent Society, about a patient named Mohamed Ahmed Sheikh.

"Mohamed was brought from Germany two years ago. The reason of (sic) his return to Somalia was mental disorder," Dr Habeb said, as the two men nodded in agreement.

"He developed mental disturbance while in a camp for asylum seekers in Germany. He calls the camp a 'prison,'" he added.

Dr Habeb diagnosed Mohamed with PTSD. Two years ago, Mohamed left Germany, where he was on antipsychotic drugs, to seek treatment in Ba’do, a pastoral region some 550 km north of Mogadishu.

Mental health treatment is still a fairly new concept among many Somalis. So when they are experiencing depression, many of them are most likely to report physical pain.

A WHO report says psychological problems are often expressed physically as headaches, chest pain, forgetfulness, sleep problems, nightmares and sweating.

Depression, for example, has no direct translation in Somali, it is instead described as Qulub, referring to the feelings a camel has when its friend dies.

Asked why would a patient receiving modern mental treatment in Germany seek alternative tradition treatment in a remote area in central Somalia, the doctor said “His [Mohamed] relatives are mainly nomadic pastoralists and believe that camel milk is good for mentally disturbed persons."

While in Germany, Mohamed was put on antipsychotics for two years and showed no improvements. "The patient is now here. He made no improvements," he said.

Dr Hebab described Mohamed’s symptoms as ranging from chronic insomnia, restlessness, violence and excessive obsessive thoughts to compulsive behaviour.

He also diagnosed him with schizophrenia.

The hyena treatment

Cautioning against the use of alternative traditional healing practices for mental sickness, Dr Hebab said many Somalis believe that the ‘Djinni’ or the ‘devil’ is the cause of mental disorders and the only way of getting rid of the devil is by scaring it away from the patient.

A common way of this scaring is by locking the mentally ill patient in a room with a hyena. "Exposure to a hyena, especially in an enclosed environment drives the devil away," Mr Nour Dhere, a traditional healer, said with confidence.

"I’ve founded six mental hospitals in Somalia over the past seven years," the doctor said, adding that three of them were in Mogadishu.

"One is Marka town (110 km south of Mogadishu). Another one is in Bulo Hawo town (at the border between Somalia and Kenya)."

His mental health clinics cover the major regions in Somalia, with the furthest one on Buhodle town, about 1,300 km from Mogadishu.

Armed with a three-month medical training by WHO, and $1.5 earned from selling his son's two pigeons, Dr Hebab set out to open his first mental hospital in Mogadishu in late 2005.

"At the time I was jobless and almost broke," he said.

But his determination has seen more than 14,000 patients with mental disorders treated in his hospitals, and not just in Somalia but from across the world.

He says he has treated patients from Europe, America, Dubai, Kenya and South Africa.

Where is the UN?

But despite the tremendous effort by the doctor, there is no mental health policy in Somalia, and authorities show a general lack of appreciation of the magnitude of mental illness in the country.

"I shed tears on daily basis for failing to convince the government officials to show political commitment towards the mentally ill people," Dr Hebab said.

"I met Sheikh Sharif Sheikh Ahmed (the former President of Somalia), the current Prime Minister Abdi Shirdon and the minister of Health," the doctor added.

"I told them the real situation of the mentally disordered people in Somalia, nobody wants to support the mentally ill people at this difficult time," Dr Hebab said dejectedly.

The majority of the 150 humanitarian agencies in Somalia focus only on health issues such as diarrhoea, malnutrition, sanitation and hygiene.

Dr Hebab says these agencies, while doing a great job, are missing the big picture. The state of mental health in Somalia requires a Marshall Plan-like intervention.

"Why is the UN and the international community failing to see the plight of the mentally ill Somalia? Where is Ban Ki-moon to offer assistance by means of his influence?" he asked.

"I believe no Somali has good health, be it physical, mental, social and even spiritual health, right from the President to the layman," he said.

He added that Somalis live in constant state of fear of being killed, inevitably leading to mental stress. “Look, the President fears death and hides inside bulletproof trucks manned by AU peacekeepers in Somalia,” he said.

Paranoia

According to a WHO report, three per cent of Somalis suffer from paranoia while more than 18 per cent abuse drugs, mainly hashish.

The doctor is an extremely busy man, running his hospitals, some hundreds of kilometres away. "Six hospitals keep me busy. This week I am travelling to Bulo Hawo (at the border between Kenya and Somalia)."

He calls the hospital in Bulo Hawo town ‘the triangle.’ "The hospital draws mentally ill people from three countries; Kenya, Somalia and Ethiopia," he said.

"Despite my tiring schedule, my mother is sick and I cannot leave her (in Mogadishu). I bought her a ticket to accompany me because she told me she is about to die and I do not want her to feel lonely."

As I was wrapping up the interview with this remarkable man, his phone rung. It was his mother was on the other end.

"Come home for breakfast," his mother asked.

"Mom, I’ll be with you, but eat a little before I reach you," the doctor responded.

-- Khalif is the Africa Review's correspondent in Mogadishu