Nairobi — ONE IN every five families in the self-declared Republic of Somaliland is caring for at least one family member with severe mental health problems, says a report that was recently presented at the Somali peace talks being held in Nairobi.
Most of those members with mental health problems are former fighters. And, in virtually all cases, they had abused khat, a local plant - which contains an amphetamine and whose leaves are chewed - according to a study conducted jointly by the Italian-based non-government organisation Vivo and the German aid agency GTZ.
The study, released in February this year, says that 20 per cent of former fighters suffer from some form of post traumatic stress disorder (PTSD) and a further 20 per cent from depression, conditions that led most of them to abuse khat.
"Increasing evidence emerged that the interaction between traumatisation (PTSD) and drug abuse of khat can have devastating effects on the mental health of the ex-combatants by leading to a high prevalence of severe drug-induced psychosis: paranoid delusions and hallucinations elicited subsequent de-realisation, fear, aggression and mental incapacity," said the study.
The Vivo-GTZ study, titled War-Trauma, Khat Abuse and Psychosis: Mental Health in the Demobilisation and Reintegration Programme in Somalia, arose out of GTZ's demobilisation and reintegration programme in Somaliland, said Dr Harald Hinkel, DDR specialist with GTZ.
Two years ago, programme staff noted that an unusually high number of ex-fighters referred to GTZ's programme seemed "not 100 per cent normal," but there were no mental health professionals on hand to verify this observation, Dr Hinkel explained.
At first, staff thought that their partners had "pre-selected" and sent GTZ the "difficult" cases to reintegrate back into Somaliland society. After linking up with Vivo, GTZ decided to research the matter in late 2001.
The results were startling: a full 30 per cent of ex-fighters had mental health problems and many more men than women suffered from these problems (usually, an equal number of men and women suffer from mental health problems). GTZ and Vivo then decided to conduct a second study to determine the prevalence of mental health problems in the Somaliland population as a whole.
In early 2002, they randomly surveyed 612 households in Hargeisa, Somaliland's capital, to determine the incidence of mental illness. The results were even more disturbing. Researchers discovered that 2.8 per cent of those surveyed displayed schizophrenia disorders: the percentage in all populations in the world is about one per cent.
"We have a significantly higher percentage only in Somalia," said Dr Hinkel. Khat abuse was found to be present in 80 per cent of the cases of schizophrenia disorders, said the study. The study also noted that ex-fighters "are four times more likely to suffer from severe mental ill-health than the general Somaliland population and two times more likely than civilian war survivors."
The studies confirmed GTZ's darkest thoughts: "Our assumptions or fears about any pre-selection by our partners were wrong; this is the reality," said Dr Hinkel.
Although this is one of the first studies of its kind related to khat use, Dr Hinkel said the literature contains similar reports of cases of amphetamine-induced psychosis in Europe and the United States. Other former fighters have suffered similar fates.
"You have a similar situation among American soldiers, after the Vietnam War, who abused alcohol," he said, adding that alcohol exacerbated problems of violence due to PTSD flashbacks and other situations.
"The problem with khat seems to be that there are indications of the damage being irreversible."
Before the outbreak of the war in 1991, people traditionally chewed khat on Thursdays, which enabled them to pray and read the Qu'ran before Friday, the Muslim day of worship. Following the outbreak of the war, many people - particularly fighters - would chew khat constantly for three or four days on end, then take tranquillisers to sleep. After two days of sleep, they would wake up to repeat the cycle again. They would only drink sodas or tea, as khat is a "de-appetiser", said Dr Hinkel.
The equivalent in the West is that "if you would drink two bottles of hard liquor every day [for three days] without eating, then take valium to sleep [for two days] for three years, I would assume that you would not be considered a normal person either," he said.
The results of this abuse have been devastating. Most mentally ill people are chained to concrete blocks inside their homes and are cared for by women who are subsequently marginalised because it is believed that mental illness is contagious.