Mentally ill shackled and neglected in Africa’s crisis regions

BY Victoria Fleischer  July 10, 2014 at 3:17 PM EDT
Severely mentally disabled men and women are shackled and locked away in Juba Central Prison for years on end. The new nation of South Sudan faces a tremendous challenge to build a modern country capable of caring for all of its citizens. Juba, Sudan. January 2011. Photo Robin Hammond/Panos

In some of the most war-ravaged countries in Sub-Saharan Africa, severely mentally disabled men and women are shackled and locked away for years on end. This photograph of a young man chained to the floor of Juba Central Prison in Sudan (now South Sudan) is featured on the cover of Robin Hammond’s book, “Condemned.” January 2011 photo by Robin Hammond/Panos

Robin Hammond has photographed strife in Africa for a dozen years, from life in Zimbabwe under Robert Mugabe to the use of rape as a weapon of war in the Congo. The Paris-based photographer doesn’t shy away from difficult stories.

In January of 2011 he was on assignment to document the Sudanese referendum for independence, which led to the creation of South Sudan. While driving through Juba, what would become the capital of the new country, Hammond spotted a young mentally disabled girl on the side of the road that gave him pause. Hammond turned to his driver, a local journalist, and asked him what happens to mentally ill people in Sudan.

“He very casually replied, ‘well, we put them in prisons,’” Hammond told Art Beat. “The story became about, yes, this is a very hopeful time for a potentially new country, but at what price had the people paid to reach this point?”

This 14 year old boy has been tied up for six years. His mother refuses to have him admitted to Gulu Hospital which is only two kilometers away. Gulu, Northern Uganda. April 2011. Photo Robin Hammond/Panos

This 14-year-old boy had been tied up for six years in Gulu, Northern Uganda. His mother refused to have him admitted to Gulu Hospital, only two kilometers away. April 2011 photo by Robin Hammond/Panos

That’s when the photographer realized that he had stumbled upon an important story to tell. The project became his new mission and is now collected in a book titled “Condemned,” published this past year.

“After all these many years of war and all these deaths, with the government spending money on bullets and bombs rather than social welfare and development, the people who are most vulnerable in society, there’s nothing for them other than to put them in prison and shackle them to the floor.”

Reverend Apostle S.B.Esanwi, Doctor of Divinity, treats people with mental illness with prayer and traditional medicines which usually consist of roots and leaves crushed in water. He claims to have cured hundreds of patients. Many stay for months in his compound. Some are chained throughout their time there. The Niger Delta, Nigeria. October 2012. Photo Robin Hammond/Panos

S.B. Esanwi treats people with mental illness with prayer and traditional medicines which usually consist of roots and leaves crushed in water. He claims to have cured hundreds of patients. Many stay for months in his compound. Some are chained throughout their time there in the Niger Delta, Nigeria. October 2012 photo by Robin Hammond/Panos

Hammond had never considered the long-term mental health effects on the Africans whose stories of war, famine, and conflict he had previous covered. But this story — the story of the mentally disabled girl on the side of the road — made the photographer realize there was much more to be told.

“We (as journalists) go, we cover famine or conflict or massive displacement and then when the flood waters recede or when the peace treaty is signed or when the people settle down in their refugee camps, we leave as if it’s over.”

Abdi Rahman Shukri Ali, 26, has lived in a locked tin shack for two years. He stays with his family in Dadaab in Eastern Kenya, the world’s largest refugee camp, where Somalis fleeing conflict and famine have sought safety. Dadaab Refugee Camp, Kenya. June, 2011. Photo Robin Hammond/Panos

Abdi Rahman Shukri Ali, 26, has lived in a locked tin shack for two years. He stays with his family in Dadaab in Eastern Kenya, the world’s largest refugee camp, where Somalis fleeing conflict and famine have sought safety. June 2011 photo by Robin Hammond/Panos

But, Hammond explained, it’s not over for the people who live through the disaster.

“What is the mental health impact of living through conflict, living through famine, living through disaster?” said Hammond.

“When soldiers from our countries go and fight in wars, they come back and we know post-traumatic stress disorder is a common impact of being involved in those conflicts … People in Africa don’t suffer any less because they are African, but we don’t often think about the psychological impacts of the issues that they’re living through.”

Due to insufficient staff numbers, family members are encouraged to stay with patients at Brothers of Charity Sante Mental. This relative would often beat, tie up and drag the patient when she did not obey his instructions. Goma, The Democratic Republic of Congo. June 2011. Photo Robin Hammond/Panos

Due to insufficient staff, family members are encouraged to stay with patients at Brothers of Charity Sante Mental, in Goma, Democratic Republic of Congo. This relative would often beat, tie up and drag the patient when she did not obey his instructions. June 2011 photo by Robin Hammond/Panos

But the New Zealand-born photographer didn’t only focus on the impact of crises on mental health, he also looked at those impacts on the structures set up to care for the mentally disabled.

“What happens to that infrastructure of care when there’s a war or when there’s massive poverty or in a refugee camp? Where are the staff? Where are the facilities?”

Hammond went back to countries where he had often been to document famine and conflict and focused on the mental health impacts of the stories in which he was already versed. In addition to South Sudan, he documented the care for mentally disabled people in Uganda, Somalia and the Democratic Republic of Congo. He also photographed in Dadaab refugee camp in Kenya, in Port Harcourt, Nigeria, where most of Nigeria’s oil comes from, in Sierra Leone and Liberia.

The mentally ill men and women in Juba Central Prison are held in separate cells at night but during the day will mingle with the general prison population. Juba, Sudan. January 2011. Photo Robin Hammond/Panos

The mentally ill men and women in Juba Central Prison in Sudan (now South Sudan) are held in separate cells at night but during the day will mingle with the general prison population. January 2011 photo by Robin Hammond/Panos

He found that mental health services don’t exist. Some have been destroyed. Oftentimes the experts — the doctors and nurses — leave their native countries because they have the resources to get out.

Instead, Hammond found that most people with mental illness are sent to prisons and, in almost every country he visited, the photographer saw people chained to the floor.

“That’s why the project is called ‘Condemned,’ because, for a lot of these people in these societies, that is what they are.”

Native Doctor Lekwe Deezia claims to heal mental illness through the power of prayer and traditional herbal medicines. While receiving treatment, which can sometimes take months, his patients are chained to trees in his courtyard. They are not given shelter or protection from the elements. They are visibly terrified of the doctor. Away from the doctor the patients beg the photographer for food. They say they are only fed once a day, sometimes only once every 3 days. One cries and says how cold he gets and that he is attacked by mosquitoes every night. His body is covered in bites. He says they are sometimes beaten for no reason and if a piece of fruit falls from the tree and they try to eat it they are beaten. In a society that cannot trust corrupt Government organizations, churches have become a sanctuary from the perceived wickedness and greed of the modern culture. In regions where both fortune and sickness are attributed to the spirit world, mental illness is considered a curse. Spiritual remedies are often sought, and chains regularly used as restraints. The Niger Delta, Nigeria. October 2012. Photo Robin Hammond/Panos

Native Doctor Lekwe Deezia claims to heal mental illness through the power of prayer and traditional herbal medicines. While receiving treatment, which can sometimes take months, his patients are chained to trees in his courtyard in Niger Delta, Nigeria. They are not given shelter or protection from the elements. They are visibly terrified of the doctor. Away from the doctor the patients beg the photographer for food. They say they are only fed once a day, sometimes only once every 3 days. In a society that cannot trust corrupt government organizations, churches have become a sanctuary from the perceived wickedness and greed of the modern culture. In regions where both fortune and sickness are attributed to the spirit world, mental illness is considered a curse. October 2012 photo by Robin Hammond/Panos

The cover of his book makes that evident. It pictures a young man, about 18 or 19 years old, whom he met in the prison in Juba.

“He was shackled to the floor in this big thick iron that looked like pre-colonial slave trade shackles. The chain is only about 10 inches long so he can’t move around. He eats and sleeps and defecates all in the same place.”

Many Somalis will take their mentally ill relative to traditional or Khoranic healers for treatment. Mogadishu, Somalia. May 2011. Photo Robin Hammond/Panos

Many Somalis will take their mentally ill relative to traditional healers or imams for treatment in facilities such as this one in Mogadishu, Somalia. May 2011 photo by Robin Hammond/Panos

Hammond saw the same kind of abuse everywhere he went, but for some reason this man stuck with him. Hammond thinks it might be because this was the photographer’s first time seeing a mentally ill man shackled to the floor with no place to move.

Two years later, Hammond ran into a field worker from Handicap International who had just been to the prison and had recognized the man in the photo. For the photographer, that is the hardest part.

“That guy that I photographed in that prison in Sudan, he is likely still there. And that little kid that I met in Somalia in the refugee camp who has been tied to a stick for the last 10 years, I’m sure he is still there. The young former child soldiers are still self-medicating with drugs because they’re still waking up in the middle of the night screaming,” said Hammond.

“It’s an ongoing thing. In a way, I feel like if my job is to raise awareness, if my job is to make a difference with this, then I feel like I’ve completely failed because these guys are in exactly the same place. If they haven’t died yet, they haven’t moved.”

But the photographer hasn’t given up on helping the subjects of his images.

Former child soldier Mamie Denis, 33, in the informal settlement known as Trench Town in Liberia’s capital Monrovia “We use to kill people who we were not suppose to kill and did a lot of wicked things which is a bad experience for me... In the war when we were fighting, whenever we go and attack, we use to get a lot of things to enjoy ourselves. But since the war is over, we are just suffering. We are not doing anything. Therefore, we have to go on the street…” Thousands of Liberia’s children were conscripted to fight in the country’s bloody civil wars between 1989 and 2003. Emboldened by drugs and sadistic commanders, they killed and mutilated their fellow citizens in conflicts that left 250,000 dead. At the end of the war, thousands were left leaderless and homeless in the country’s capital Monrovia. Shunned by the civilian population around them they formed their own communities. They continue to call each other by their war names, and respect ranks held in a war everyone else is trying to forget. Post Traumatic Stress Disorder (PTSD) is rife in these former child soldier ghettos. Time has not healed the deep psychological scars that the violence has left. The impacts of trauma can be especially severe when inflicted as a child. PTSD can cause, amongst other symptoms, aggression, depression, sleeplessness, and flashbacks of the traumatic events experienced. Drugs helped these former child soldiers commit atrocities. Without the intensive mental health assistance they require, many of them now take drugs to help them forget. The marijuana and heroin they smoke numbs the pain, and allows a deep dreamless sleep where the faces of those they have mutilated are blurred and their screams silenced. Photo Robin Hammond/Panos. Liberia, January/February 2013.

Former child soldier Mamie Denis, 33, in the informal settlement known as Trench Town in Liberia’s capital Monrovia “We used to kill people who we were not suppose to kill and did a lot of wicked things which is a bad experience for me… In the war when we were fighting, whenever we go and attack, we use to get a lot of things to enjoy ourselves. But since the war is over, we are just suffering. …” January/February 2013 photo by Robin Hammond/Panos

“I have a real deep belief in the power of art and media to shape how we see and regard the world and treat the people in it … the whole point of the work — of any real art of photography — is to somehow make a connection with the viewer.”

Hammond doesn’t want this project to simply be a piece of journalism; he wants it to be a piece of activism and he hopes that his photographs will spur action. He receives weekly emails from people asking how they can help and he has a laundry list of ways that he is expanding the scope and reach of the project.

Last year, he received the W. Eugene Smith award, which will help fund continued work in the region. He plans to use that money to revisit the same countries and go deeper into the project, including telling the stories of the people on the ground who are fighting for the dignity of the mentally ill.

“While there aren’t that many of them and while there are little-to-no resources, there are some people who are working very hard under very difficult circumstances to make a difference on this … It would provide a little bit of hope, which to be honest, is really hard to find with this issue.”

The gutted Euro Bank building in Liberia’s capital Monrovia has become a home to ex-combatants of Liberia’s civil wars. Thousands of Liberia’s children were conscripted to fight in the country’s bloody civil wars between 1989 and 2003. Emboldened by drugs and sadistic commanders, they killed and mutilated their fellow citizens in conflicts that left 250,000 dead. At the end of the war, thousands were left leaderless and homeless in the country’s capital Monrovia. Shunned by the civilian population around them they formed their own communities. They continue to call each other by their war names, and respect ranks held in a war everyone else is trying to forget. Post Traumatic Stress Disorder (PTSD) is rife in these former child soldier ghettos. Time has not healed the deep psychological scars that the violence has left. The impacts of trauma can be especially severe when inflicted as a child. PTSD can cause, amongst other symptoms, aggression, depression, sleeplessness, and flashbacks of the traumatic events experienced. Drugs helped these former child soldiers commit atrocities. Without the intensive mental health assistance they require, many of them now take drugs to help them forget. The marijuana and heroin they smoke numbs the pain, and allows a deep dreamless sleep where the faces of those they have mutilated are blurred and their screams silenced. Photo Robin Hammond/Panos. Liberia, January/February 2013.

The gutted Euro Bank building in Liberia’s capital Monrovia has become a home to ex-combatants of Liberia’s civil wars. January/February 2013 photo by Robin Hammond/Panos

Hammond is also hoping to raise money for an anti-stigma campaign in Africa. He believes that it’s important to raise awareness not just in the western world, but in the places where these issues are taking place.

In the end, Hammond wants his viewers to know that most of the mentally disabled people he interacted with were coherent and aware of both their condition and their often cruel treatment.

“For some of them, it was the first time they were able to express what was going on and they had someone to listen to them,” said Hammond.

This so called Rehabilitation facility outside the Niger Delta city of Port Harcourt holds over 170 people with mental illness or mental disability. Run by the government, it was originally designed as a facility to assist widows, but in 1999 it was turned into a place of incarceration for homeless people with mental illness that were cleared off the streets in a ‘clean up’ in anticipation of the FIFA World Youth Soccer Championship. The Niger Delta, Nigeria. October 2012. Photo Robin Hammond/Panos

This so called Rehabilitation facility outside the Niger Delta city of Port Harcourt, Nigeria, holds more than 170 people with mental illness or mental disability. Run by the government, it was originally designed as a facility to assist widows, but in 1999 it was turned into a place of incarceration for homeless people with mental illness that were cleared off the streets in a “clean up” in anticipation of the FIFA World Youth Soccer Championship. October 2012 photo by Robin Hammond/Panos

“Mental health is an incredibly neglected issue everywhere, but especially in countries like this, where there are so many competing priorities.”

Hammond just returned from another trip to Africa, this time in the hope of combating Western conceptions of the continent. He flew to Lagos — a mega-city with growing wealth and prosperity — to provide an alternative to the “death and misery” often displayed in his work.

“I really hope that if we, as in the West, can see Africans having the same hopes and aspirations as us, that hopefully we can connect with them a bit more,” said Hammond. “And, when the bad stuff does happen, we can have the same empathy for them as we would if it happened in any European or American community.”

See more photographs from “Condemned” below:

While the staff at this Rehabilitation facility outside the Niger Delta city of Port Harcourt denied that they house children, the photographer found, one mentally impaired child (around 8 years old) sleeping on the floor in the room for the “high risk” male inmates. The child had been there for 3 months. Another, around 14 years old was also sleeping on the floor in the same room. In another room the photographer found a young man who had one leg amputated. His other leg looked to be rotting. The smell was confirmation. He had a catheter leading to a urine bag but he was sleeping in soaked trousers. He lay on car floor mats - an attempt to keep the urine he lay in and the liquid oozing from his leg from soaking the dirty mattress below him. When the photographer arrived staff hurried to the back of the main building. A car then went to join them. They were removing a dead body. The staff claimed another of the patients that was lying on the concrete floor of the cell was dying. Many patients were in chains and one in handcuffs that were so tight his wrist either side of the cuff was severely swollen. A human rights activist said that it wasn’t that the facility lacked funds but that those funds were being shared out amongst the staff rather than being spent on the care of the vulnerable people staying at the institution. The oil industry that has brought billions of dollars into the Nigerian economy has arguably been a disaster for the Delta region from where it is extracted. Corruption, mass inequality and violence have plagued the region ever since the discovery of the resource. The Niger Delta, Nigeria. October 2012. Photo Robin Hammond/Panos

While the staff at this Rehabilitation facility outside the Niger Delta city of Port Harcourt, Nigeria, denied that they house children, the photographer found, one mentally impaired child (around 8 years old) sleeping on the floor in the room for the “high risk” male inmates. The child had been there for 3 months. Another, around 14 years old was also sleeping on the floor in the same room. In another room the photographer found a young man who had one leg amputated (below). His other leg looked to be rotting. The smell was confirmation. He had a catheter leading to a urine bag but he was sleeping in soaked trousers. Many patients were in chains and one in handcuffs that were so tight his wrist either side of the cuff was severely swollen. The oil industry that has brought billions of dollars into the Nigerian economy has arguably been a disaster for the Delta region from where it is extracted. Corruption, mass inequality and violence have plagued the region ever since the discovery of the resource. October 2012 photo by Robin Hammond/Panos

This so called Rehabilitation facility outside the Niger Delta city of Port Harcourt holds over 170 people with mental illness or mental disability. Run by the government, it was originally designed as a facility to assist widows, but in 1999 it was turned into a place of incarceration for homeless people with mental illness that were cleared off the streets in a ‘clean up’ in anticipation of the FIFA World Youth Soccer Championship.  The photographer found a young man who had one leg amputated. His other leg was rotting. He had a catheter leading to a urine bag but he was sleeping in soaked trousers. He lay on car floor mats - an attempt to keep the urine he lay in and the liquid oozing from his leg from soaking the dirty mattress below him. When the photographer arrived staff hurried to the back of the main building. A car then went to join them. They were removing a dead body. The staff claimed another of the patients that was lying on the concrete floor of the cell was dying. Many patients were in chains. A human rights activist said that it wasn’t that the facility lacked funds but that those funds were being shared out amongst the staff rather than being spent on the care of the vulnerable people staying at the institution. The Niger Delta, Nigeria. October 2012. Photo Robin Hammond/Panos

A young man who had one leg amputated, lays on a mat while his other leg appears to be rotting at a rehabilitation facility outside the Niger Delta city of Port Harcourt, Nigeria, the same place as is pictured above. October 2012 photo by Robin Hammond/Panos

This Government run facility in the Niger Delta town of Eket is meant to be a Psychiatric hospital. In reality it is a merely a place of incarceration for people with mental disability. The oil industry that has brought billions of dollars into the Nigerian economy has arguably been a disaster for the Delta region from where it is extracted. Corruption, mass inequality and violence have plagued the region ever since the discovery of the resource. The Niger Delta, Nigeria. October 2012. Photo Robin Hammond/Panos

This government-run facility in the Niger Delta town of Eket, Nigeria, is meant to be a psychiatric hospital. In reality it is a merely a place of incarceration for people with mental disability. October 2012 photo by Robin Hammond/Panos

A female patient at Galkayo Mental Health Centre in Puntland, Somalia tries to escape the hospital. The World Health Organisation (WHO) says 1 in 3 Somali’s suffer from some kind of mental illness. From the camps for Internally Displaced People dotted around the region to the bombed out streets of Mogadishu is a generation of Somalis who’ve only known war, famine, displacement, and loss. The most common response though is forcible restraint. The use of chains in homes – or as is more common in huts or under trees outside the home - to restrain a family member with a mental illness is widespread. WHO says that in the last decade 90% of the treated patients it surveyed were subjected at least once in their lifetime to chaining. Chaining patients is seen as an alternative medication, which not only leaves the patients stigmatized but also causes physical injuries on hands and legs. Some of the chained patients end up committing suicide. The person is usually chained not only during the ‘acute crisis’ but throughout his or her life. To say there is a skills shortage in mental health practitioners in Somalia would be an understatement. WHO say there are only 3 psychiatrists in the whole region and that their skill levels are insufficient. Photo Robin Hammond/Panos. May, June 2011, Somalia.

A female patient at Galkayo Mental Health Centre in Puntland, Somalia, tries to escape the hospital. The World Health Organisation says one in three Somalis suffer from some kind of mental illness. May, June 2011 photo by Robin Hammond/Panos

Pastor Richard Mika of Eglise Evangelique Au Service de L’Eternal travels door to door praying over mentally ill/disabled children. Goma, Democratic Republic of Congo. June 2011. Photo Robin Hammond/Panos

Pastor Richard Mika of Eglise Evangelique Au Service de L’Eternal travels door to door praying over mentally ill/disabled children in Goma, Democratic Republic of Congo. June 2011 photo by Robin Hammond/Panos

A chained patient awaits treatment at the clinic of traditional healer Dr Serwadda Hassan. April 2011. Kampala, Uganda. Photo Robin Hammond/Panos

A chained patient awaits treatment at the clinic of traditional healer Dr Serwadda Hassan in Kampala, Uganda. April 2011 photo by Robin Hammond/Panos

Mineyro Jean-Marie describes to Médécines Sans Frontières Psychologist Serge Nzuya Mbwibwi how he felt when The Lord’s Resistance Army attacked his family and attempted to kidnap his daughter. Niangara, Democratic Republic of Congo. June 2011. Photo Robin Hammond/Panos

Mineyro Jean-Marie describes to Médécines Sans Frontières Psychologist Serge Nzuya Mbwibwi in Niangara, Democratic Republic of Congo, how he felt when The Lord’s Resistance Army attacked his family and attempted to kidnap his daughter. June 2011 photo Robin Hammond/Panos

A Witch Doctor diagnoses a patient with mental illness by reading the way pieces of bone and shell fall on a goats skin. Northern Uganda. March 2011. Photo Robin Hammond/Panos

A witch doctor in Northern Uganda diagnoses a patient with mental illness by reading the way pieces of bone and shell fall on a goats skin. March 2011 photo by Robin Hammond/Panos