TIME LightBox Out There

Harrowing Photos of the Mentally Ill in Sub-Saharan Africa

Robin Hammond was awarded a $30,000 grant for his work documenting mental illness in sub-Saharan Africa.

At its most elemental, photojournalism documents conflict — conflict between individuals, between nations, between ideologies, between humanity and nature. Literally and figuratively, photographers capture conflagrations large and small. Some burn strong and fast; others — often the more frightening, and more destructive — burn more slowly. They smolder.

Tonight, Robin Hammond, a New Zealand-born photojournalist, received the $30,000 W. Eugene Smith Grant in Humanistic Photography for his attention to one of the sub-Saharan Africa’s slowly burning fires: the plight of the mentally ill.

“Where there is war, famine, displacement, it is always the most vulnerable who suffer the greatest” says Hammond. The mentally ill, he notes, are a “voiceless minority condemned to lives of quiet misery.”

Based in South Africa, Hammond traveled for two years to regions of severe crisis — eastern Congo, Mogadishu, northern Uganda, Liberia and South Sudan — photographing in stark detail the barbaric conditions endured by tens of thousands of Africa’s mentally ill. Broken, largely forgotten, the mentally ill suffer abominable degradations, literally chained and caged throughout their days.

Time and time again while working on his project, Hammond found himself at a loss for words in the face of the unspeakable.

“I discovered a entire section of communities abandoned by their governments, forgotten by the aid community, neglected and abused by entire societies,” he said. “This is not just a document of what shouldn’t be. This work is my protest.”

Hammond will use the $30,000 grant to finish the project. A book of the winning work, titled Condemned, is now available through FotoEvidence.

Javier Arcenillas, a Spanish photographer and clinical psychologist, received a $5000 runner-up award from the W. Eugene Smith Memorial Fund for his project, Red Note: Violence in Latin America. Documenting some of Latin America’s most violent communities — cities like Mexico City, San Salvador and San Pedro Sula — Arcenillas photographed the perpetrators of violence and their victims.

LightBox previously featured the work of 2012 winner Peter van Agtmael and 2011 winner Krisanne Johnson.

Robin Hammond is a photojournalist based in South Africa. TIME previously featured Hammond’s work documenting Zimbabwe under Mugabe.

Vaughn Wallace is the producer of LightBox. Follow him on Twitter @vaughnwallace.

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 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 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 Former child soldiers smoke marijuana laced with heroin at the informal settlement known as Trench Town in Liberia’s capital Monrovia. 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. In Hargeisa, the capital of Somaliland, there are seven private clinics ‘treating’ people with mental disability. They house at least 600 patients. I went to see 4 of these institutions. All but one used chains. In 2 of the clinics up to 80% of the patients were shackled. Treatment at these places is the bare minimum – they are in fact businesses that take advantage of desperate families and a population denied a say in their care. The families of patients pay up to $US120 a month. A large sum in Somalia. For this the patients receive some food and some medication. What I saw were often confused people crowded into dark spaces on dirty mattresses lined up side by side. Many told me they wanted to leave but were not allowed to. One young man agreed he needed treatment “I am sick” he said, “you put sick people in hospital, not a prison.” Hargeisa, Somaliland. May, 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. Dadaab Refugee Camp, Kenya. June, 2011. Photo 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 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 Sheikh Hussein Mahmood Dirir, Khoranic healer and Director of The Healing Centre treats a patient with a mental illness by reciting The Khoran to her. Hargeisa, Somaliland. May, 2011. Photo 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 prison. 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 Many Somalis will take their mentally ill relative to traditional or Khoranic healers for treatment. Mogadishu, Somalia. May 2011. Photo 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 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 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 mosquitos 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 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 A female patient at Galkayo Mental Health Centre in Puntland, Somalia tries to escape the hospital. 44 year old Fatima Farah is a British trained Counseling Psychotherapist at Galkayo Mental Health Centre in Puntland “people still attach a huge stigma to mental health, they don't know how to handle mental ill patients, they chain them, they isolate them, they take them to any source of spiritual healers and all of that; and the last thing they result to is bring them here for medication. I’ve seen patients who have been ill for the last 7 years and have never been taken to a mental hospital. I've seen people who have been brought in chains and you think like they have been possessed by some evil spirit, and you just tell them look they are just sick, they just need medication, treat them like someone who has a headache and that's all.” Her facility is a zero tolerance for chains. Regardless of the patients state of mind, all chains are removed at the gates.Fatima has no doubt why there are so many people with mental illness in Puntland – “The instability in Puntland has had a huge impact on the mental stability of the patients we see here. Human beings need security and if there is no security then people are fearful. The last 20 years of civil war has affected the peoples well being and stability, they come here and talk about how a relative has been killed or a relative has disappeared. When the society is not in peace then the individual is not in peace.” 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. Relatives of mentally ill men and women drop off family members to The City of Rest, a facility where an elderly Pastor claims to heal people with mental illness. Healing can take months. Chains are used to restrain some of the “guests”. Some are violent and restraints are needed to protect people and property in the facility. Often though chaining is used more as a punishment than for safety. The war in Sierra Leone, known for the looting of diamonds and the amputating of limbs by rebels, hindered the country’s progress. Health services were not severely impacted though as they hardly existed in the first place. After independence in 1961 corruption led to the wholesale looting of the country’s resources including stocks of medicine. The skilled left and those who had the resources to be trained in medicine did so elsewhere, few returned. The continents first psychiatric hospital opened in the country’s capital Freetown in 1823. Alas, the treatment of patients there has not changed much since then: modern medicine is rarely available, chains still immobilize patients, and staff have little knowledge of what mental health really is. Given that it is impossible to access for most and care is so poor, many Sierra Leoneans turn to religious and traditional healers to treat mental disability. Freetown, Sierra Leone. February 2013. Photo Robin Hammond/Panos 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 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 Former mental health facility on the outskirts of Monrovia, Catherine Mills Psychiatric Hospital, destroyed in the civil war and now occupied by refugees from the war. Dr Janice Cooper, country representative for health and the Project Lead for mental health for The Carter Center in Liberia: “We had a state of the art mental health hospital that provided services all the way from screening, assessment, and treatment, to rehabilitation and vocational rehab. At any given point, the facility had 12 to 15 psychiatric nurses that were trained abroad as well as at one point 6 psychiatrists from different countries as well as from Liberia… Fighting forces went into the hospitals, opened up the doors and many of the people who were mentally ill were shot because they were not rational enough to follow the orders or not rational enough to understand the dangers. And on the part of the fighting forces they were not used to people not following their orders. Catherine Mills is completely destroyed… Today we are rebuilding a system for mental health but I always like to remind the nurses and physician assistant we trained that we did have a system before.” Photo Robin Hammond/Panos. Liberia, January/February 2013.

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