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.
That was back in 1991, when the toppling of dictator Mohamed Siad Barre plunged Somalia into more than two decades of chaos. Subsequent fighting under clan warlords and Muslim hard-liners drew in the United States, Ethiopia, U.N. blue helmets, and a coalition of African forces. Now that African Union troops have dislodged al-Shabab militants from most major cities and a new government is shining a dim ray of hope over parts of the country, the battle-scarred Hersi serves as a reminder to the many challenges Somalia has yet to overcome.
"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.
Abdirahman Ali Awale, who founded Mogadishu's first mental clinic in 2005, has been working feverishly over the years to improve and expand care. The energetic father of nine, known locally as Dr. Habeb -- despite his lack of formal medical training -- is now one of Somalia's main mental health-care providers, running half a dozen centers across the country. Relying on paying relatives, private donations, and drugs from the WHO, he has provided care to some 14,000 patients over the last eight years.
"War and conflict is the biggest problem causing mental disorder," says Habeb, his vocal chords straining from the combination of a birth defect and near-constant yelling. "Nobody supports the mental ill people in Somalia."
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.
"I speak English in many different dialects, but I'd rather speak Latin," says a young male patient, who claims to have lived in London but whose actual identity remains unclear. "Latin is a general word for English. A word for Latinos. Now the World Cup is Latin. Brazil is hosting the World Cup next year. And I wish you all the best," he says, wandering out of the overcrowded ward.
To hear Habeb tell it, curing mental illness is cheap and simple -- just a case of drugs, know-how, and some rest. Most patients stay for between a few days and several months, though some have been locked up for years. Once his patients are discharged, however, there is little follow-up to assess whether they relapse. Patient records are barely four pages long, and on many documents, most sections are left blank.