These are some of the testimonies that my team and I have heard during mental health consultations with people in the Galkayo and Baidoa districts of Somalia, where Doctors Without Borders (MSF) works. Some of the issues we hear are related to violence, climate change, lack of professional psychiatric services, chronic illnesses and extreme poverty.
Somalia, a nation burdened by decades of conflict, is no stranger to humanitarian crises. Amid the ravages of conflict, displacement, climate crises and poverty, a mental health crisis looms, affecting the lives of millions of people. However, the mental well-being of those affected is often overlooked, leading to a silent epidemic of distress and psychological disorders.
Mental health problems in Somalia They are closely related to the socioeconomic and political problems of the nation. Existing social problems and discrimination faced by vulnerable groups, especially women and children, lay the foundation for mental health problems. This is compounded by natural disasters, protracted conflicts and disease outbreaks, which bring with them additional layers of psychological trauma, family separation, lack of security, loss of livelihoods and disrupted social territories. All of this contributes to acute emotional stress. In these environments, resources are scarce, which further deepens the crisis.
The humanitarian response to the crisis in Somalia, Although often well-intentioned, it can also inadvertently exacerbate mental health problems. Overcrowding in camps, lack of privacy, and the weakening of traditional community support systems can increase feelings of anxiety and insecurity among affected communities.
The most common problems we see in Somalia include psychosomatic complaints, depression, stress, psychosis and substance abuse. However, the stress of conflict also leads to new conditions or illnesses such as post-traumatic stress disorder (PTSD), bipolar disorders, types of anxiety, and acute stress reactions. For some people, humanitarian response can lead to hopelessness, especially when basic needs such as food, water and access to health services are uncertain.
The World Health Organization (WHO) The prevalence of mental disorders among conflict-affected populations is estimated to be 13 percent, with reports of mild forms of depression, anxiety, post-traumatic stress disorder, bipolar disorder and schizophrenia, while 4% still experience moderate forms of these. disorders. In general, women, older people, children and people with disabilities are disproportionately affected by mental health problems. People with serious mental health disorders are especially vulnerable during emergencies, requiring both clinical care with medication and access to basic needs. However, these essential services remain out of reach for many. Unfortunately, Somalia’s story is no different.
In Somalia, MSF works in collaboration with the Ministry of Health, offering essential mental care in Baidoa and Mudug. For us, mental health cuts across all medical activities. The teams provide psychosocial support, counseling and specialized psychological care in healthcare facilities. However, the needs are many and our services are not enough.
Currently, the Ministry of Health offers support and advice to people living with HIV, tuberculosis (TB) and multidrug-resistant tuberculosis, focusing on chronic patients to strengthen adherence and impact quality of life. Some local organizations offer mental health services to survivors of sexual, psychological, social and economic violence. Although there are great efforts made by the Ministry of Health and local organizations, it is not enough. Many people who require pharmacological and psychological treatment to regain functionality and integrate into their usual activities are left out of the loop.
Between January and September 2024, MSF mental health teams working in Somalia have carried out a total of 4,940 mental health consultations. In addition, we carried out 7,644 group mental health and psychological education activities, promotion of healthy coping strategies, training community leaders, health workers and non-medical teams in the management of psychological first aid, and peer support, benefiting a total of 38,476 people. The mental health needs of communities are enormous, but the magnitude remains invisible. Lack of funding for mental health services, lack of trained health workers, supplies, limited data and scientific research, and a fractured health system have worsened the problem.
There is an urgent need for an effective mental health response and it is clear that addressing Somalia’s mental health requires an immediate and coordinated response. Clinical mental health care should be integrated into broader humanitarian efforts, promoting coverage of basic needs such as food, safe spaces, shelter, including basic mental health support such as psychological first aid, community sensitization, psychosocial groups , recreational activities, clear referral pathways to secondary mental health services. Mental health specialists, such as psychiatric nurses, psychologists and psychiatrists, must oversee mental health services, ensuring access to quality care.
Somali communities, resilient despite the adversity they face, must be empowered to take an active role in supporting mental health. Strengthening community self-help and social support systems will help address the needs of people in the absence of clinical specialists. By creating or reestablishing community groups, Somalis can collectively solve problems and offer psychological support to those who suffer. This social cohesion not only restores a sense of normality, but also provides emotional relief to those affected by the crisis.
Additionally, psychological first aid should be a key component of emergency response efforts. Trained workers, including health staff, teachers and volunteers, must offer emotional and practical support to people in distress. These interventions, although seemingly small, can make a significant difference in the early stages of trauma.
Failure to address this pressing issue will only perpetuate the cycle of suffering. The time has come for humanitarian agencies, local authorities and the international community to prioritize mental health care, ensuring it is fully integrated into the broader emergency response. In doing so, we can offer hope and healing to the millions of Somalis whose mental well-being hangs in the balance.
Somalia’s future depends not only on rebuilding its infrastructure, but also on healing the minds and hearts of the people affected.
About the author: Alberto Macin is a mental health professional who has been working with Doctors Without Borders (MSF) for the last eight years. During this period, he has worked in various locations including Mexico, El Salvador, South Sudan, Ukraine, Libya-Mediterranean Migration Routes, Mozambique, Kenya and now in Somalia. Their role involves the development of a mental health strategy and the integration of mental health services into ongoing MSF activities in the Somali region, the implementation of the Mental Health and Psychosocial Support component, the analysis of events and factors risk for mental health, training and supervisory support for field teams, discussion of more complex cases for the adequate management of symptoms, diagnoses and comorbidities associated with the mental health of people who attend clinics and hospitals in the regions where MSF works in Somalia.
