
MOGADISHU - Mohamed Abdulla Hersi reclines on a foam mattress in the Habeb Rehabilitation Treatment Center's crowded mental ward. His eyes are glazed over from antipsychotic drugs, probably some combination of chlorpromazine and haloperidol, but we can't be sure. His medical files, in a bundle in the facility's office, do not list his drug regimen. Hersi doesn't even bother to swat away the flies gathering on his face and body. Loose-fitting combat fatigues, emblazoned with the light blue and white-star emblem of Somalia's tattered army, expose his chest and two bullet-sized scars -- evidence of the battlefield violence he has suffered since joining one of the country's myriad militia groups as a boy.
"Where is my M-16? My Kalashnikov?" he murmurs, seemingly unaware that he is miles from the front lines, where his fellow soldiers fight an enemy with links to al Qaeda and ambitions to overthrow the U.N.-backed government. Hersi speaks in a muddled stream of consciousness about gunfights, explosions, and mangled comrades from his years serving under various militia leaders, generals, and presidents. He mumbles about a car-bomb blast he survived in Kismayo, about Osama bin Laden, and about his father, who apparently died in Minneapolis.
"I was 7 when I joined the soldiers. My life has been for fighting only," he says. "I fought for all the warlords. In Jubaland, Puntland, Mogadishu. I grew up with the war. I joined Somalia's national forces. I killed al-Shabab, but I do not know how many."
The 29-year-old calls himself a general -- though his fatigues suggest he is an ordinary foot soldier -- and yearns to exit the locked compound and return to his comrades in arms. "I have more experience at the bad things," he says.
Somalia has among the highest rates of mental illness globally, affecting at least one-third of its estimated 10 million people, according to the World Health Organization (WHO). Rates are higher in Mogadishu and the turbulent south, where civilians have endured harsher stresses of war, drought, and instability. Many witnesses of bloodshed and atrocities face post-traumatic stress disorder (PTSD). Without treatment, sufferers can experience depression and maniacal, violent fits, and they are more prone to substance abuse -- often of the khat plant that sends chewers' minds and pulses racing. A psychosis, such as schizophrenia, can follow, though the number of Somalis who have been formally diagnosed pales in comparison with the number who are afflicted.
After decades of civil war, Somalia has virtually no capacity to cope with widespread mental illness. The country's only trained psychiatrist died last year in a car crash; the better-trained staff members at mental health clinics like the Habeb Rehabilitation Treatment Center have only three-month diplomas in basic psychiatry from the WHO. Most are untrained volunteers.
At the Mogadishu facility where Hersi lies, vacantly staring into space, mattresses are strewn across floors, squeezed into storerooms and onto porches. Patients while away the hours in idle gossip and argument, hunkered down under flimsy steel roofs. A few years back, many patients were chained to their beds, but they have since been freed after WHO officials intervened.
As limited as the care is for patients in Habeb's clinics, however, the situation for the majority of Somalis suffering from mental trauma is far worse. In much of the country, modern medicine is not the first approach to curing mental illness. Because conditions ranging from epilepsy to schizophrenia are widely believed to be the result of possession by spirits or djinns, cures are often sought in faith and folklore. Mullahs routinely tie sufferers to trees and flog them with branches in order to exorcise demons. In rural areas, according to WHO officials, the mentally ill are sometimes locked indoors with a hyena for three-day stretches. Local legend has it that the arched-back scavengers possess mystical powers and can eat the evil spirits that poison the mind. Uncontrollable victims of mental trauma have simply been beaten to death by villagers.
Even in downtown Mogadishu, it is clear that few of the city's wild-eyed denizens receive treatment. On one street, a dreadlocked woman pulls down her dress and exposes her breasts. Locals say her husband and seven children perished from disease. Elsewhere, a man grimaces by the roadside. In his hand is a bunch of khat, a socially accepted but addictive stimulant. Under a nearby bridge, unemployed homeless men with bloodshot eyes rest on flattened cardboard boxes after a night's leaf-chewing.
These sufferers roam free. Others are locked down, out of sight. Abubakar Mohamed Sheikhow, 23, was chained by his wrists and ankles in a metal shack in southwest Mogadishu for 12 months before one of Habeb's rescue teams located him last year. Neighbors had restrained him after he violently attacked his mother.
Dowlay Hassaney, a 27-year-old schizophrenic, was chained to a bush in Eel-Adde, some 55 miles southwest of Mogadishu, when health workers found her in 2011. Her husband had been apparently undeterred by her mental state: She gave birth three times during eight years spent shackled in the sun, according to Habeb. Mobile teams from Habeb's mental-health facilities have saved roughly 2,500 mentally ill Somalis from chains in the southern part of the country, but Habeb guesses that another 5,000 remain shackled by their families in Mogadishu alone.
Read on if you have the stomach to.