The Life of the mentally ill Patients in Somaliland

In Somaliland, one in three families has at least one relative with psychiatric disorders. In a land where traditional medicine is far more widespread than modern health care, psychiatric patients in Somaliland are chained, immersed in “healing” waters and subjected to prayers, exorcisms and miraculous herbs. The sheikh, the old sages, are consulted more than the medical professionals are.

The knowledge and administration of mental health in Somaliland is considered one of the poorest in the world and would require a more careful consideration by the Ministry of Health (MoH) and international NGOs: the distribution and organization of mental health services they are very few, with overlapping functions, poorly organized and above all not subordinated to the health ministry.

Chained to the trees and treated with exorcisms: the inhumane life in Somaliland, where it is thought that the mentally ill are possessed by demons

The Private Religious and Traditional Healing Centers are subordinated to the approval of the MoH. Traditional medicine is duly considered in the planning of health programs since it has popular support rooted in the cultural values ​​of the Somali community.The majority of the strongly believing population (Somalia has 98.9 percent of the Muslim population, among the highest in the world), has a very spiritual conception of the disease. Very often, it is thought that the psychiatric patients are taken over by demons called Jiin: according to Islamic tradition the Jiin are spirits of the invisible world, inhabited also by demons and angels.

They are invisible but inhabit the world of humans, with the particularity that they can see us and we can not see them. The jiin can enter directly into the soul of the people or use curses such as Il (similar to the evil eye) and Sixir (Witchcraft done with the help of the devil). The Sheikh is an elder or religious leader who takes care of exorcising people from the Jiins.

As stated by Massimiliano Reggi, Transcultural Relations Group (GRT) Regional Representative: “The” choice “itself to undertake or not an attempt to care with external medical resources is therefore bound to the local social dynamics within which the person is in relationship with one’s own context. The possibility of access to certain therapeutic resources, as well as the availability of the latter, also changes the perception of one’s own illness and the possible strategies to deal with it”

Salam-Aleikum, Aleikum-Salam, Salam-Aleikum. Inside the mental health department of the Hargeisa Group Hospital, Somaliland, the powder sticks to it, like the smell of urine and damp cloths. There are huge camels that lenses walk in the female section. The staff has syringes in hand and speaks quickly. Some patients gather around the main office door. We are going to the salon where the weekly family counseling just introduced by GRT is held, waiting for a room used for the purpose. Yellow-tisied walls and wooden benches

The blue cataract eyes of the man sitting on my right move in small steps behind the black frame. In his hands, a heavy handkerchief comes repeatedly to his mouth to silence the hoarse cough. The deep lines of the face in pitch-colored skin have the center in two huge black dimples on the sides of the cheeks. Salmon shirt, sand-colored trousers, black and red Jordan. Koofiyad. “The most important thing is to make the community understand that the traditional method is not the right one”. The big hall falls silent. The other man seems to be from the upper middle class, very neat, crosses his legs and gesticulates slowly.

His rimless glasses make one think of someone within the public administration, of health: the violet of his trousers seems to be in contrast with the color of the room and of those inside it. He has clear ideas like only his candid sclera. Not far away a young, powerful boy in military uniform stares into space. He has his elbows resting on his knees, his fingers intersecting each other: he seems to listen carefully to distant speeches. One often touches the leather strap to which daily attaches his AK-47, now wrapped around the left shoulder. You can hardly breathe it. A woman wears a niqab and her black eyes keep spinning through the slits of the veil, which is also black. Spelled hears without speaking. He does not want to tell his story.

The mental health department was inaugurated in 1972 and, following the civil war that gripped Somalia between 1982 and 1991, psychiatric patients were tripled. The current Republic of Somaliland, the former British protectorate of Somalia, became independent of Great Britain on June 26, 1960. Following the independence of the Italian colony of Somalia, the two Somali states merged into a voluntary union, never ratified by their respective peoples. The annexation was condemned from the beginning: the two countries had profound tribal, cultural, administrative and educational differences that each had inherited from their previous colonial governments.

These differences led to divisions and disputes, culminating in a long civil war. The war destroyed 95 percent of the cities of Somaliland, causing the death of about 250,000 people and an additional million refugees. Abdirizak Baraco, head of the Hargeisa Group Hospital and Private Clinics, experienced the tragedy of the civil war in person: “I risked being killed twice, when I was 10 and 12 years old”, he smiles, “a soldier in the in the middle of the night – “AM!”, shouts Abdirizak making the hall rumble – after making a sudden raid at my family’s house he grabbed me, dragged him into the bathroom and ordered to give him all the money and gold we had. He had a big gun in his hand. I begged him not to kill me.”

We must underline the fact that in those years the macro-civil war in Somaliland has deeply intertwined with other disputes, also because of its particular geographical position: it was affected by the pressure of the Ogaden war (1977-1978), between June and August 1982 the border war between Ethiopia and Somalia culminated. At the same time, after the coup in 1969 the totalitarian regime of Siad Barre had been established: the general, who was seen by his supporters as the new and far-sighted political leader who had been able to unite revolutionary Islam and socialism, pursued the ‘goal to rebuild the Great Somalia: tried to completely eradicate the clan society (at the base still of Somali society) condemning to death anyone who promoted, made sure to expel the military personnel from the US embassy in Mogadishu and at the same time did not want to to establish relations with the USSR.

The attempt to theoretically equate Islamic principles and atheistic Marxism Leninist, however, provoked, as comprehensible, tensions with the theological authorities of the country. In July 1990, Barre opened fire on a crowd of protesters in the Stadium of the capital. Subsequently a Somali liberation movement was developed which was violently repressed by Barre’s aviation by bombarding the city of Hargeisa in January 1991. The conflict quickly degenerated into the civil war mentioned above (more than 50 thousand deaths between 1988 and 1990). “Most people in Somaliland, excluding the newest generations, are Affected or Unaffected: that means they either experienced the drama of the war in person, or they lived it through their own family. If you are more than 20 years old your father certainly did the war “, says Abdirizak.

“I still remember clearly when all my class, in elementary school, had joined together to write with chalk on the SNM (Somali National Movement) blackboard: we wanted liberation, we wanted to not drop bombs on schools or torture people, we wanted to peace. Besides the civil war itself, the problems, when we came out, were multiple; there have been so many other civil micro-wars between clans of which no one speaks: obviously no one tortured us more heavily, no one killed us or threatened us with weapons but in fact the tension between the great Somaliland families was palpable, there is no it was job opportunities … and it’s not there yet! “, laughs Abdirizak.

“The rebels, in Hargeisa as well as in Berbera and other cities, continued to fight among themselves without understanding what they were fighting for. Are we fighting to fight or are we fighting to fight a regime that has already fallen and start to have a better life? The real, profound problem is that there was no desire for real post-conflict rehabilitation and post-independence, no laws existed. Everything seemed to have calmed down on the surface but I actually think it was just a stalemate which, perhaps, still lasts, despite the small improvements that the Somaliland society has made in these 25 years of peace, “he continues.

“What worries me momentarily is the increase and continuous abuse of qat as a result of this lack of rehabilitation and employment, evident abuse and growing among the youngest. In Hargeisa, the government seeks to contain the abuse of this legalized drug by placing the green barracks where men find themselves chewing only in the market areas. In fact, they are everywhere in the city. During the government of Siad Barre there was a period in which the qat was forbidden but, I remember, it was the most total chaos “.

Today psychiatric patients in Somaliland have subdivision macrogrops. There are those who undergo the practice of chaining for many years accusing, in addition to the psychiatric disorder, also that linked to the chain itself. Then there are those who have post-traumatic stress disorder due to civil war or following a long desperate voyage to Europe in search of more humane living conditions, which has led some patients to cross Libya and suffer torture from traffickers of men and then be repatriated.

Finally, there is a very heterogeneous group made up of all the patients who suffer from disorders related to the abuse of Qat: the dependence on Qat is often intertwined with other traumatic events such as the practice of chaining. The elderly gentleman pushes his handkerchief away from his mouth: “My son was treated by me for more than twenty years before entering this hospital. Following the first signs of imbalance, the family did not know how to improve the situation, we had no idea it was a disease, we thought it was Jiin. Everyone in the family wanted to chain him except me: I did not find him human, I did not think that Allah wanted something like this for my son, “says the elder.

“I was forced to chain him in a room, he was extremely resentful towards the whole family, he refused to eat. After three years, one day in the grip of a crisis, completely destroyed the space in which he was used to staying and it was no longer possible to keep it inside the house. I myself chained him to a tree not far from the front door: every time it rained, in this earth so terribly desirous of water, I thanked Allah profoundly but also implored him to stop sending rain because my son was out there, chained, alone, in the pouring rain. My heart remained chained with him for 18 years, “he says.

“I was just a child when my uncle started to experience the first signs of imbalance. I remember a little but in my mind is its violence to me and towards my cousins. He chewed qat all day and beat us: initially he thought it was simply a statement of authority but later started to become violent with all family members, threatening them, “he continues.

“After a few years he started talking to himself and dreaming of his own deceased mother, trying every night to go to sleep in his bed, in a house not far from ours. After turning to a spiritual leader, we unanimously decided to follow Sheikh’s advice and bring our uncle to bathe in a healing lake outside the city. The situation in the following months seemed to improve but then fell into the most total abyss. Therefore, we decided to chain him, without giving him food or water, as if he were in prison. After having found it several times in the middle of the night walking around the city in search of qat we turned to the authorities who brought him here, to this hospital. Only here I see it improve and the thing that I would like to underline is my current opposition to the traditional method: it is important to take it into consideration because it is part of our culture and in some cases it works but for most people it is not. It is to the detriment of families: now I would just like to be better informed about my uncle’s condition by the hospital staff, but I know that he is safe from himself, “he explains.

As if waking up from a dream the young man raises his white look. Untangling the fingers: “I’m a patient’s brother. My brother was a soldier during the civil war: he was hit by a grenade and admitted to a hospital room where only people were nearing death. The grenade had damaged part of his skull and had lost his eye and left arm. Since there were no means in Somaliland to treat him or improve his situation, together with his family he decided to take him to Ethiopia; even in Ethiopian hospitals they did not have adequate equipment for their situation. When we returned to Somaliland, he began to experience the first symptoms of schizophrenia. “Look down

I can finally get up from the salon chair. The counseling room is finished. I cannot take those eyes full of black kajal from the head behind the black niqab. “My sister tried to immigrate to France. It is not easy to get a passport in Somaliland, so he decided to look for another way. I do not know what happened on the trip but I think nothing good. Now she is obsessed with escape: she always wants to go out, wherever she is. As soon as he returned, he killed our sister’s baby, drowning him in a basin full of water. This is the reason why it is here, “says a woman. Massimiliano Reggi, who together with the GRT team has carried out several projects aimed at helping the mentally ill and their families, as well as providing them with better mental health centers and institutions, explains: “The order in which the possibilities are covered of available care can initially follow an etiological logic, but the use of more resources, as happens in practice, follows the logic of healing. In our research context, as in other Somali settlements, there is no incompatibility between “local” or “traditional” and “foreign” or “modern” interventions.

“The Quranic healer is in most cases the first to be consulted, but is followed by it, when the perceived effectiveness of the intervention is weak, another Sheikh or Wadaado or a doctor or a Mingis healer. What, so far, can be defined as a typical path that we have observed most frequently in any Somali territory, is the circuit that from the Koranic healer leads to the doctor, then to the healer and to the doctor again “, says Reggi. What the Somaliland Ministry of Health and GRT set out to achieve with their common project is to improve the quality and effectiveness of mental health services and to challenge social norms that perpetuate stigma and discrimination against mental health. To do so, the project aims to educate and raise public awareness and develop the capacity of local authorities to take an active role in the supervision of stakeholders in mental health. The first step, however, is to give voice to those born dumb and return it to those who lost it: this is the goal of the newborn counseling room.

Source: The Post Internazionale (TPI)