Chained in Somaliland: Inadequate mental health system

View across Hargeisa, the capital of the breakaway northern region of Somalia. [Zoe Flood/Al Jazeera]

Hargeisa, Somaliland – Abdirisak Mohamed Warsame is one of just a handful of professionals working to improve the lives of people suffering from mental health problems in the Horn of Africa country, people who are largely neglected and often abused.

“Mental health is an abandoned field in Somaliland,” Warsame said.

There is no official data on the prevalence of mental health conditions in Somaliland but research points to high levels caused by – among other factors – the violence of the ongoing civil war, the widespread use of the stimulant khat, entrenched unemployment, and the lack of health services.

Some families, who often don’t understand the condition of their relatives, admit relatives to one of a small number of under-resourced public and private mental health facilities.

But in most centres, there are few or no professional staff who understand how to care for those with mental health conditions.

Chaining of patients is widespread – only the mental health ward at the Hargeisa Group Hospital is currently chain-free – and psychotropic drugs are often unavailable.

A female patient reaches out through the bars at the entrance of the Hargeisa Group Hospital’s mental health ward. This ward is one of four under-resourced and dilapidated public mental health facilities across Somaliland. In response to demand, expensive and under-regulated private centres are springing up across the capital Hargeisa. [Zoe Flood/Al Jazeera]

A patient looks out through the bars at the front of the mental health ward at the Hargeisa Group Hospital. Patients are kept locked in the ward, although they are allowed to move freely within the separate male and female sections of the facility. [Zoe Flood/Al Jazeera]

According to a Human Rights Watch investigation both public and private mental health facilities in Somaliland largely serve as places of confinement, and subject many residents to involuntary treatment and unlawful detention. [Zoe Flood/Al Jazeera]

Maryam Hassan Dahir, nurse at the Hargeisa Group Hospital mental health ward, hands out medication to patients. There are two qualified psychiatric doctors in Somaliland for an estimated population of 3.5 million. [Zoe Flood/Al Jazeera]

The male section of the mental health ward previously used chains to restrain patients for long periods of time, but is currently chain-free. [Zoe Flood/Al Jazeera]

While the Hargeisa facility does run some activities for the patients, most spend their time almost completely inactive. [Zoe Flood/Al Jazeera]

While there are some female patients at this public facility, most of the privately run centres only house men. [Zoe Flood/Al Jazeera]

This man, who asked not to be named but usually lives in the Netherlands, was on a long visit to Somaliland when relatives placed him at the privately run Raywan centre in Hargeisa two months earlier. He could not clearly identify his condition. [Zoe Flood/Al Jazeera]

Human Rights Watch found that most people with psychosocial disabilities have been placed in institutions against their will. [Zoe Flood/Al Jazeera]