Report by Human Rights Watch calls on Britain, the biggest donor to health services in the region, to push for more humane mental health provision to handle a large number of patients.
British citizens are among hundreds of mentally-ill patients enduring prison-like conditions in hospitals in Somaliland where they are routinely chained, beaten and abused, a new report claims.
The Human Rights Watch (HRW) report released on Monday found a proliferation of private health care facilities across the semi-autonomous region in the Horn of Africa were holding people either against their will or in terrible conditions.
Laetitia Bader, the report’s author, told the Telegraph men from the British diaspora were among hundreds stuck in private centres in the capital Hargeisa having been sent there by their families to deal with drug abuse or mental health issues.
Britain is the leading donor to the country’s health sector and had a responsibility to ensure humane mental health care was among the provisions, she added.
“The diaspora are paying to lock up relatives they can’t deal with. One man from Cardiff had been inside a private centre for over a year,” she said.
“If these men really have mental health conditions, you who would have thought they’d be better served locally or by the National Health Service.”
Somalia has been considered a failed state due to decades of fighting. Somaliland, a former British protectorate on Somalia’s north-western coast, declared independence from Somalia in 1991 but has never been formally recognised by any other country. Photo: Alamy
Considered relatively peaceful, it is home to an under-resourced and dilapidated public health system which it is trying to overhaul but has largely outsourced mental health care provision.
The region is believed to have one of the highest rates of mental health issues in the world because of violence and trauma from the civil war, lack of health services, and widespread use of the chewed plant khat, an amphetamine-like stimulant.
“Mental health is a serious concern in Somaliland and its communities and yet the government isn’t providing enough, quality, services for people with mental disabilities. Lately, these private centers have sprung up to fill the vacuum,” Miss Bader said.
She said she had met several Britons during her visits, including an elderly man from Birmingham “who clearly had a severe condition” but could not remember how long he had been in one the centres.
“There was also a 28 year-old from London who had been in four different centres since 2011,” she said.
Dr Liban Hersi, one of only two psychiatrists serving Somaliland’s 3.5 million people, said he regularly told health facilities to unchain patients.
“A lot of the centres are unaware of the harm they are doing. They think they’re doing good as they are feeding and looking after patients, who are people usually living on the streets,” he said.
HRW found rather than providing appropriate medical care and counseling, privately-run for profit centres were largely places of detention and solitude, where residents spent most of their time locked in their rooms, often in chains and sometimes in darkness.
The report said most of the people interviewed had been admitted by their relatives against their will. Some had been detained for up to five years, with no means of challenging their detention.
Some residents at both public and private centres were subjected to involuntary medical treatment, through force and sedation. Psychotropic drugs were widely prescribed based on insufficient medical assessments, the report’s researchers found.
Residents who refused to take their medication, follow orders or those who showed signs of aggression were sometimes beaten by guards at the centres, HRW said.
Dr Hersi, a 32 year-old who trained in neighbouring Ethiopia, said a lack of government planning, coordination and limited resources meant mental health remained “a huge issue” in Somaliland.
“There really needs a big effort to address this as often more bad than good is happening,” he said.
Somaliland’s ministry of health officials did not answer calls or return messages seeking comment. A UK government spokesman said it took allegations of human rights abuses “very seriously”.