Somalia is a country with an approximate area of 638 thousand sq. km. (UNO, 2001). Its population is 10.312 million, and the sex ratio (men per hundred women) is 99 (UNO, 2004). The proportion of population under the age of 15 years is 48% (UNO, 2004), and the proportion of population above the age of 60 years is 4% (WHO, 2004). The literacy rate is 25.1% for men and 13.4% for women (UNESCO/MoH, 2004).
The country is a low income group country (based on World Bank 2004 criteria). The proportion of health budget to GDP is 2.6%. The per capita total expenditure on health is 15 international $, and the per capita government expenditure on health is 7 international $ (WHO, 2004). The main language(s) used in the country is (are) Somali, Arabic, English and Italian. The largest ethnic group(s) is (are) Somali (fivesixths), and the other ethnic group(s) are (is) Bantu. The largest religious group(s) is (are) Muslim. The life expectancy at birth is 43 years for males and 45.7 years for females (WHO, 2004). The healthy life expectancy at birth is 36 years for males and 38 years for females (WHO, 2004).
There is a paucity of epidemiological data on mental illnesses in Somalia in internationally accessible literature. Elmi (1983) conducted an epidemiological research on khat chewing in a random sample of about 7500 people. He suggested that the prevalence of the khat chewing has continuously increased in all social groups and that the excessive use of khat may create considerable problems of social, health and economic nature.
MENTAL HEALTH RESOURCES
Mental Health Policy A mental health policy is absent. There is no unified health policy.
Substance Abuse Policy A substance abuse policy is absent.
National Mental Health Programme A national mental health programme is absent.
National Therapeutic Drug Policy/Essential List of Drugs A national therapeutic drug policy/essential list of drugs is absent.
Mental Health Legislation Details about the mental health legislation are not available.
Mental Health Financing There are no budget allocations for mental health. Details about expenditure on mental health are not available. The primary source of mental health financing is grants. The financing of mental health services is almost entirely dependent on grants from WHO and NGOs. The country does not have disability benefits for persons with mental disorders.
Mental Health Facilities Mental health is not a part of primary health care system. Actual treatment of severe mental disorders is not available at the primary level. Recently, a Mental Health Coordinator was appointed for North West Somalia to initiate integration of mental health care in primary health care and training of primary health care personnel. Regular training of primary care professionals is not carried out in the field of mental health. The voluntary workers of GAVO have been trained about the principles of psychiatric interview, introduced to DSM-IV, given training about psychopharmacology, psychosocial rehabilitation and hospital management. The training had lasted for 2 years and is not on a regular basis. There are no community care facilities for patients with mental disorders. Limited community care through NGOs and WHO are available in very limited areas of one region in northwest Somalia. A psychosocial centre was established in Berbera in 1990.
Psychiatric Beds and Professionals
psychiatric beds per 10 000 population
- Psychiatric beds in mental hospitals per 10 000 population
- Psychiatric beds in general hospitals per 10 000 population
- Psychiatric beds in other settings per 10 000 population
- Number of
psychiatrists per 100 000 population
- Number of neurosurgeons per 100 000 population
- Number of
psychiatric nurses per 100 000 population
- Number of neurologists per 100 000 population
- Number of
psychologists per 100 000 population
- Number of
social workers per 100 000 population
There are only three centres for psychiatry, the mental hospital in Berbera and the general psychiatric wards in Hargesia and Mogadishu. Until the arrival of the NGO from Italy, the condition of the mental hospital was appalling. Patients were kept in chains, and supply of food was largely dependent on charity. UNDP is supporting the psychiatric ward in Hargesia in terms of structural facilities and supplies. There is no private psychiatric inpatient facility though there are a few private clinics in Mogadishu and Hargesia. There is no specialized drug abuse treatment centre and there is no mental health training facility in the country. Only limited data about one area of Somalia, Somaliland is available. Psychiatrists have private clinics.
Non-Governmental Organizations NGOs are involved with mental health in the country. They are mainly involved in advocacy, promotion, prevention, treatment and rehabilitation. The whole mental health set-up of Somalia is based on the efforts of NGOs – GRT-UNA of Italy and General Assistance and Volunteer Association (GAVO), a local Somali NGO. They help in the provision of services to mental patients and street children and provide training for primary health care personnel.
Information Gathering System There is no mental health reporting system in the country. The country has no data collection system or epidemiological study on mental health.
Programmes for Special Population No programmes for special population exist. UNDP and NGOs are supporting the Government’s plans for reintegration of militia including those that are mentally ill into the mainstream through projects involving occupation.
Therapeutic Drugs The following therapeutic drugs are generally available at the primary health care level of the country: unknown.