People in Somalia have been deeply traumatized by political instability, prolonged violence and humanitarian crisis, according to a new health study.
The joint study by the United Nations, the Somali Ministry of Health and the country’s national university found that mental disorders are prevalent across the country. It said the number of cases is about 77 percent higher than a previous World Health Organization (WHO) study, which suggested nearly 40% of the population in Somalia had a mental or psychological disorder.
The study further said that the prevalence of mental disorders among young people is significantly higher than previously reported.
“There is a high prevalence and wide range of the various mental disorders (76.9%), substance abuse disorders (lifelong, 53.3%; current, 50.6%) and poor quality of life in both non- clinical as clinical populations,” the study said.
The study obtained by VOA Somali Service was conducted between October 25 and November 15, 2021. The data was collected from 713 participants in the cities of Baidoa, Kismayo and Dolow. The majority of participants (68.1%) were under the age of 35 and 58.5% were male.
All three cities are home to internally displaced people affected by conflicts and droughts that forced pastoral communities to migrate to urban locations in search of food, water and safety.
“Conflict and clashes have led to mental illness because we face many of these challenges in our country,” a youth in Kismayo who was interviewed for the study told researchers. “For example, explosions happen and the witness can live with the shock and trauma that can affect their state of mind and even cause mental illness. Stress caused by unemployment also leads to mental health problems.”
The study is a collaboration between WHO, the United Nations Peacebuilding Fund, the United Nations Children’s Fund (UNICEF), the International Organization for Migration (IOM), the Federal Ministry of Health and the Somali National University (SNU).
According to the WHO, which led the study, this is the first-ever epidemiological study of mental health in Somalia.
“The study findings clearly indicate that the prevalence of mental disorders is higher in the younger population than we initially thought or assumed based on various estimates,” said Dr. Mamunur Rahman Malik, WHO Country Representative.
“Our earlier WHO study suggested that only 40% of the population in Somalia could have a mental or psychological disorder. But what we’ve seen now is 76%, which is a high prevalence,” Malik told VOA.
Somali Health Minister Dr. Ali Haji Adam agrees that the mental health situation of the population is “very bad”.
“There has been armed conflict, poverty, fear, instability and unemployment for a long time; this causes mental wounds,” said Adam. “They can’t handle what’s happening in front of them; mothers and children are killed in front of them and that damages their mental health.”
Malik said a worrying finding is that the most common mental illness among this population is panic disorder and post-traumatic disorder.
“Panic Disorder 39% and Post Traumatic Disorder 37%. And this is among the young age group,” Malik said.
He said if left untreated it could lead to suicidal tendencies. He said in previous estimates that the WHO considered Somalia’s youth suicide rate to be one of the highest in the world, 14 to 15 per 100,000 inhabitants. This new study shows that the risk of suicide among young people in Somalia is 22 per 100,000.
The study authors said this is surprising for a community where Islam is the predominant religion and where education prohibits suicide. They urged clinicians to discuss suicidal thoughts with their patients during evaluation, regardless of religious beliefs or practices.
The study’s other discovery is the high prevalence of substance abuse among the young population.
Adam said the younger generation most affected by mental illness is turning to substance abuse.
“A young person with an ambition and a future where they cannot realize their ambition and aspiration cannot find a job, they are under mental pressure,” Adam told VOA. “It’s likely they’ll turn to drug abuse.”
Malik agrees that the hopeless situation and lack of adequate access to mental health services are driving the mentally ill to resort to the abuse of illicit substances.
“These are coping mechanisms, but this is self-destruction, which is the most concerning factor for me,” he said.
The most commonly used substance was tobacco, at 38%, followed by sedatives, which is 37%, and these are not regulated in the country, Malik said.
He said Somalia is the only country that has not ratified the WHO’s global convention on tobacco control. He urged the Somali government to ratify and commit to controlling the drug abuse of tobacco and sedatives.
“We risk losing a whole generation because these young people have no hope for the future and they make up 70% of the people in this country,” said Malik. “Instead of using them as human property, we risk losing them because there is a high burden of mental health and substance abuse, and this makes them unproductive and they become a huge economic burden.”
The increase in mental illness can be seen in mental health clinics.
Dr. Liban Mohamed Omar opened a mental health clinic eight months ago after returning from Europe. He says his outpatient clinic and psychiatric center see dozens of patients every week.
“Of the patients I receive, two to three out of four people have mental health problems,” Omar told VOA.
In addition to the country’s political and social unrest, women face specific challenges that exacerbate their mental health situation.
“Women have to deal with a lot [cases of] abuse, such as rape,” said Omar.
Omar cited a lack of awareness and a shortage of trained counselors and mental health services, forcing many to resort to substance abuse and even consider ending their lives.
The researchers see improving mental health as an integral part of peacebuilding in Somalia, a country ravaged by civil war since the collapse of the state in 1991.
Malik said that in conflict-affected countries, the burden of mental health is high.
“These young people who were carrying a huge mental burden can be easy targets for radical forces because these are disillusioned young people,” said Malik.
“Our assumption is that if these people can be socially integrated after addressing their mental health condition, social cohesion and reconciliation within the community can increase and lead to peace building in a way that these mentally ill young people are not targeted by radical forces so that they can contribute to society.”
Malik said that currently only 5 to 10 percent of primary health care centers in Somalia can provide mental health services, far fewer than necessary.
“The total number of mental health professionals in Somalia is 82 out of a population of over 15 million,” said Malik. “And if you compare it in terms of mental health professionals, 100,000 residents is less than one. The future therefore lies in investing in mental health care at the primary health care level.
The study recommended training of primary care professionals, increased awareness, and routine screening of mental disorders at the primary care level.