Separation Anxiety

hargeisa — Abdillahi Abdi has stripped naked and set his clothes and bedding alight. His shouts ring out across the courtyard of Hargeisa Hospital’s mental health unit, where patients doze on foam mattresses in the afternoon sun. They barely stir as orderlies douse the flames. Abdi has learned there’s a doctor visiting the ward, and he wants him to know the CIA has bugged the place. When the doctor in question crosses the string of rag-piled beds to the smoking cell, the other patients rise and shuffle over: this, now, is something new.

“Ah-ah-s-s-salaam aleikum!” Stuttering and smeared with ash, Abdi shakes the doctor’s hand. Like most patients here, he has never met a psychiatrist. Words spill from his mouth in a torrent, as though he’s been waiting his whole life to unburden himself. The doctor, a jovial, greying Somali-Canadian named Aden Ismail, interrupts: how long has the cia been spying on him? Abdi isn’t sure. As they talk, in Somali, the young man grows calmer. Ismail hands him two tablets of chlorpromazine, an antipsychotic, and pencils his name into an appointment book.

“Probably bipolar,” Ismail says. “He believes he’s a freedom fighter and the American government is persecuting him. It’s a common delusion in this place. They see movies like Black Hawk Down and they fixate. I’m told he’s admitted to the hospital every few months.”

Ismail has been visiting Somaliland’s only mental health facility, which happens to be in his hometown, every year or two for nearly a decade. The de facto republic broke away from Somalia in 1991 after a brutal war of secession. Tens of thousands of people were killed during the four-year conflict, and half a million more fled across the Ethiopian border, most settling in refugee camps. Ismail himself lived in the camps for a time, before emigrating to Toronto in the late ’80s.

Though Somaliland is now relatively stable, rebuilding has been slow — the last refugee camp was dismantled just four years ago — and the scope of the war’s psychological toll is just beginning to register. “When I come here,” Ismail says, “I see a lot of veterans, a lot of women who lost children and husbands. The war acted as a trigger for incipient mental health problems, particularly schizophrenia.”

Much of the time, the psychiatric unit functions as a repository for the ill rather than a treatment centre. A high wall encloses the ward and divides it in two, separating men from women. The men sleep in an L-shaped dormitory furnished with beds and little else. The hospital depends on patients’ families to clothe them and subsidize their meals. When Ismail visits, there’s a rush to diagnose and treat as many people as possible. Abdi is one of 300 to 400 patients he’ll see during his month-long stay in the breakaway republic, which has no psychiatrists of its own.

Ismail meets Mohamad and his sister, Nura, in one of the small outbuildings clustered behind the main dorm. Mohamad has lived here on and off for the past three years. An obese man, he lies on a mat in the corner of his tiny room, sweat boiling off his impassive face. Murals of dried excrement cover the walls. Nura, who visits every week, is mopping the floor. The room is muggy with antiseptic.

A flicker of amusement animates her brother’s face. “I remember you — you’re the doctor from last time. You were here, let me see, it was May. . . two years ago.”

“Yes, yes, that’s about right. I’m surprised to see you here.”

“They discharged him,” Nura, a tall, cheerful woman, says in English. “But at home he was making life difficult for us.”