What happens to the mental health of a nation when it is devastated by war and poverty?
A walk through the corridors of Mogadishu’s Habeeb psychiatric hospital will give you a pretty good idea.
Patients have a vacant look in their eye they are either laughing sporadically, or just staring into space. Many are just lying down motionless.
According to the World Health Organisation one in three Somalis suffers from mental illness.
The energetic, eccentric Abdirahman Ali Awale, known as Habeeb, runs the institution. He is a nurse who does the work of a psychiatrist. There are dozens of new arrivals here every day.
Abdirahman introduces me to one young woman brought in by her family, who say she is violent, and shouts and laughs without reason. She is not eating or drinking. She weighs only 34kg, and could be anorexic. I ask him what can be done for her?
“Well, we can give her medication, a bed, and food.”
She is extremely lucky her family is understanding enough to have brought her here. Abdirahman tells me many Somalis will blame her condition on “magic, or the evil bad eye, or punishment from Allah”.
He says what they really need is “love, support, and food”.
Many of the people being treated have experienced beatings, torture, or have witnessed members of their family or friends being killed in front of them.
It sounds incredible, but Abdirahman believes that no-one who has lived through the war in Somalia has “good mental health”.
He has treated 15,000 people since he opened his doors in November 2005. He would treat a lot more if he could, but he doesn’t have enough beds.
He starts crying he says: “This state of affairs brings me to tears, seven or eight times a day.”
War and hunger aren’t the only reason for this crisis. Khat chewing is a tradition that dates back thousands of years. It is a plant, which contains a compound with effects similar to those of amphetamines you can find it in the Horn of Africa and in places like Yemen.
The armed group al-Shabab bans khat consumption, so since their fighters left Mogadishu, the streets of the capital have become a haven for khat chewers.
Recent research from the National Institute on Drug Abuse says that “at the end of a khat session, the user may experience a depressive mood, irritability, loss of appetite, and difficulty sleeping”.
At Habeeb Hospital, Abdirahman says the impact is far more worrying. He tells me “there is a link between khat and psychosis”.
Although the World Health Organisation describes Habeeb Hospital as one of the health facilities that implements WHO Somalia’s Chain Free Initiative.
We found people, even one child being chained, apparently “for their own good”. It is clear the hospital does not have enough staff to look after the violent patients.
I left Habeeb thinking about Somalia’s political transition which could be just days away. Discussions about politics, security, and famine are crucial, but the Somali people don’t just need food and jobs. They also must to heal the mental wounds of the past.