SOMALIA: Puntland, Homing On Mental Health
Indifferent to the devastation that surrounds him, a small child keeps sucking at the breast of his mother, a young Somali woman that stares in the emptiness in front of her. Only the night before, more than 500 huts made of twigs, trash and plastic, have been tragically wiped out by a fire that suddenly and quickly devoured Shabele camp. Of the few things that thousands of displaced Somali families possessed, nothing was left untouched and everything now needs to be rebuilt. Shabele rests next to the small coastal town of Bosaso, the commercial capital of the semi-autonomous Somali region of Puntland and one of the hottest spots on earth. The camps that have been formed inside and outside the town in the past 20 years host an explosive mixture of internally displaced people (IDPs), Ethiopian refugees, and asylums seekers coming from different parts of Africa, Democratic Republic of Congo and Mauritania included. Very few are the international humanitarian organizations that, despite such a volatile and dangerous situation, dare to start aid projects that feed the people and provide some minimal infrastructures for the town.
Besides, there is an important side of the human healthcare that too often lacks proper investments by donors who finance aid projects in war-torn spots: that is mental health. Since 2003, the Italian nongovernmental organization GRT (Group for the Trans-cultural Relations) has been dealing with the only Mental Health unit in Puntland: “When we first established the department of mental health in the public hospital of Bosaso, it was very hard to listen to individuals, as well as to collective stories of desperate families living in the harshest conditions”, says Dr. Massimiliano Reggi, GRT psychologist-anthropologist and pioneer of the project. “For the most part they were stories of migrations and displacements, inside and outside Somalia. But also tales of war and narrow escapes from Mogadishu, trying to reach northern Somalia where many people have ties with various clans”. As soon as the Mental Health department started its operations, news spread fast and people from even the most remote areas managed to reach the hospital for treatment and medicines. Some were coming from Galkayo, a town at about 800 km from Bosaso, or even from the Ogaden, a conflict-prone region in Ethiopia inhabited mostly by Somalis. “In Somalia you can find a wide range of mental illnesses” - claims Reggi - “it is very important to understand that the medical categorizations used in Europe often do not apply to Somalia. It would be madness to assume that the way we practice in the West would yield the same results in this contest. That is why I choose to work with Somali doctors that help me understand how a patient really feels”.
Mental illnesses, sometimes genetic but usually provoked by the extremely difficult life conditions, include hallucinations, stress-related problems, and uncontrolled bursts of rage. In many cases, relatives resort to chain the patient in a corner of the house for years. Everybody knows that chaining a waali (a “crazy person”) is a must when he or she threatens to hurt himself or other people. “Almost everyone has a relative that is affected by a mental illness,” confirms Dr. Abdikadir Kalif Ali, the Somali director of the department. “Due to a lack of proper awareness, many families are convinced that mental illnesses cannot be cured, therefore they isolate the patient hoping that he calms down sooner or later”. Ali is probably one of the busiest doctors in Puntland, maybe the whole of Somalia. After the tenth phone call received during the interview, without stop talking, he quickly removes the battery from his mobile and gives me his total attention. “You have to forgive me, but sometimes the relatives of my patients walk miles under the sun to reach an area where they can find network, that’s why I never switch off my phone unless I really have to. They are usually asking me for advice before coming here to get the medicines”. After his studies and before becoming the director of the Metal Health department, Ali has been partly trained by Reggi, with whom he is still in contact. “We really need medicines” the director insists “without enough drugs and well-trained staff, many of our patients worsen by the day”.
The high rate of employment and the constant chewing of khat (a mild stimulant herb very popular in East Africa) to escape reality seem to be the main causes of the aggravation of patients’ mental health. Although no official statistics have been produced, the authorities estimate that about half of the population is affected. “Mental health in Somalia is a big problem, and it is ignored by the international community, presumably and, at times, understandably, because the cures for this kind of sicknesses cannot give immediate results and because the patients need constant monitoring through the years”, Reggi says. “People are tired and angry at the situation in our country” Dr. Ali explains, “the stress that they have accumulated during 20 years of civil war piles up day after day, and my department alone cannot face all the work that needs to be done. We need help, funds, trained doctors and medicines, otherwise the entire Somali population will literally go crazy”.
Matteo Fraschini Koffi
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