The Mental Health Crisis in Somalia: Stigma and Conflict at Play

Mogadishu (AX) — For the past several years, Hodan Ali has been robbed of restful nights. This 32-year-old mother of three is stirred from sleep by terrifying echoes of gunfire, remnants of Mogadishu’s turbulent past. Like countless other Somalis, Hodan finds herself ensnared in a mental health quagmire, exacerbated by years of violence, societal stigma, and a glaring scarcity of professional support.

A recent investigation uncovers a staggering truth: nearly 90% of those in Somalia grappling with mental health issues fail to find the necessary assistance. Decades of armed conflict, along with relentless natural catastrophes and the widespread reliance on khat—a stimulant associated with mental disorders—have culminated in soaring levels of depression, anxiety, and post-traumatic stress disorder (PTSD). “The notion of mental well-being is quite novel here,” shared a psychiatrist involved in the research. The report titled Mental Health Problems in Somalia After Decades of Humanitarian Crises, penned by Yahye Mohamed, Charline Becker, and their diligent team, unveils the nation’s severely lacking mental health framework. Out of a population exceeding 16 million, Somalia boasts merely six psychiatrists and 25 psychologists.

This dismal shortage of mental health professionals leaves the majority of the populace without critical care, often turning to traditional healers who attribute psychological disturbances to spiritual phenomena—such as possession by jinn or curses—thereby hindering timely medical intervention. While these healers hold a respected place in society, they frequently lack the expertise required to tackle complex psychological issues.

The report also delves into the pervasive stigma surrounding mental health, pinpointing it as a formidable barrier to treatment. Many in Somalia interpret mental illness through spiritual frameworks, misattributing ailments like depression, schizophrenia, and bipolar disorder as manifestations of jinn or hexes. This cultural lens profoundly postpones intervention, with individuals typically waiting over three years to seek professional help. Consequently, by the time they navigate to health facilities, many arrive in dire psychological condition.

Cultural expectations significantly shape perceptions and approaches to mental health in Somalia. In a culture that places great value on resilience—especially among men—acknowledging mental illness is often viewed as an infirmity.

The psychological repercussions of Somalia’s protracted conflict are staggering. In urban centers like Mogadishu, where blasts and gunfights become routine, the burden of daily trauma weighs heavily. A public health official remarked, “People endure relentless anxiety and fear for their lives. The trauma in this nation is astronomical.” The study further underscores khat addiction as a substantial contributor to mental health disorders. Widespread khat consumption is linked to psychosis and frequently worsens existing mental health concerns. Hospitals in Mogadishu report that 94% of their psychiatric patients battle substance abuse issues primarily tied to khat.

Mental health authorities participating in the study urge immediate reforms to combat this escalating crisis. “The lack of trained professionals, alongside the pervasive stigma surrounding mental health, hampers our ability to tackle this urgent issue,” a senior psychiatrist asserted. He emphasized the necessity for a cultural shift and augmented resources to make mental health care accessible for every Somali. The report advocates for comprehensive public education efforts to diminish stigma and promote early intervention. Another expert voiced a grave warning, stating, “Without altering our attitude toward mental health, we will consistently witness individuals suffer quietly, unacknowledged and untreated.”

To address this mounting crisis, the report proposes weaving mental health services into Somalia’s primary healthcare framework. Currently, such services are concentrated in a handful of regions, leaving numerous communities devoid of sufficient access to care. The report highlights a noteworthy initiative in Somaliland, where a “sin tax” on khat generated $2 million in 2022 to underwrite mental health services. Expanding similar programs nationwide could inject much-needed resources into Somalia’s woefully underfunded healthcare landscape.

The investigation also underscores the imperative for public awareness campaigns aimed at mitigating stigma and motivating more Somalis to pursue professional mental health assistance.

Collaboration on an international scale holds immense potential, especially with the Somali diaspora. The report advocates for the diaspora’s engagement in offering expertise, funds, and resources to help tackle this pressing issue.