The Invisible Cell: Mental Illness Behind Bars in Somalia and Somaliland
Disclosure: I chair the Organization for Prisoners’ Rights (OPR), whose reports I cite below.
In May 2011, a prison in-reach service began weekly sessions at Borama Prison in Somaliland, run by a doctor and a nurse with support from King’s College London clinicians. Over the next year it assessed 161 people, 146 of them prisoners and 15 guards. Fifty-seven of the prisoners had been neither charged nor convicted. The study’s authors say they were held for containment and respite, at their relatives’ request (Handuleh & McIvor).
That number is not a national count. Prison officers chose who was assessed, and the prison held roughly 340 inmates, so the 57 cannot be read as a share of everyone inside. But the study, published in International Psychiatry in 2014, is the most detailed look I found inside a Somali prison at what happens when families and the state have nowhere else to send someone in a mental health crisis. Most of the 57 had a history of violence, which the authors suggest gave families a low threshold for asking the prison to take them. The prison director estimated that 40 percent of inmates showed unusual behaviour that might reflect mental illness or khat, and the authors put psychiatric distress at around half. He acknowledged that prisoners with mental illness might be kept in their cells continuously or chained, because officers did not know how to manage them.
The study also shows what a small intervention can do. After guard training, a prison-wide khat ban and treatment, the authors report less violence, less chaining and coercion, and the release of six inmates who had been arrested while acutely ill. It was one prison over one year, and the authors describe it as a small project.
Somaliland has no mental health legislation. Courts consider a defendant’s mental health, but someone found guilty of an imprisonable offence goes to prison rather than hospital, because no law governs any other disposal, according to the Borama study. Human Rights Watch found in 2015 that the Hargeisa district court had been sanctioning admissions to at least three private centers on the testimony of two witnesses, generally clan relatives, without the person present, without a psychiatric assessment and without a time limit. It said the head of the district court, who asked in May 2015 for such admissions to stop until clear guidelines existed, was dismissed in September 2015.
The clinical side is thinner still. HRW found that Somaliland had only two psychiatrists for approximately 3.5 million people. A needs assessment in late 2017, published in a review of Somaliland’s mental health system, counted four qualified psychiatric doctors in public hospitals for about four million people, with only three hospitals employing a psychiatrist full time.
The strongest evidence of abuse comes from places that are not prisons. HRW’s 2015 report, based on research in Hargeisa, Berbera and Gabiley and interviews with more than 115 people, including 47 with actual or perceived psychosocial disabilities, found that men with such disabilities face abusive restraints, beatings, involuntary treatment and overcrowding in private and public health centers. In private centers in particular it documented punitive and prolonged chaining, confinement and seclusion. The Hargeisa Group Hospital ward was the only center HRW found chain-free. Only one of the 30 residents interviewed in institutions knew his diagnosis, and HRW heard of only one case in which the person himself was brought before the court.
The Borama paper records chaining inside a prison through the director’s acknowledgment and the authors’ report that it fell after the intervention, but it gives no counts. The HRW evidence therefore describes the same population in adjacent institutions, not the prison itself.
The UN’s July 2024 assessment of prisons in federal Somalia and its member states covers 14 operational prisons. Inspections in 2022 in six locations found widespread mental health concerns among detainees and no specialised staff or resources to address them, along with severe overcrowding in three prisons and tuberculosis, cholera and diarrhoea. Medical facilities in prisons are rare. Beledweyne and Kismayo prisons have no infirmary or clinic, and outside care is paid for by the detainee or family. No inspections were conducted in 2023, and the UN sees no plans for sustainable oversight. Among its recommendations: recruit specialised mental health professionals and train staff.
The problem is older than that. A UN team assessing Mogadishu Central Prison in 2012 said it could not obtain much information on how prisoners with mental or intellectual disabilities were treated. It noted that during Siad Barre’s rule a public hospital for people with such disabilities had also served as a detention facility for people declared unfit to stand trial (UNODC/UNPOS).
OPR’s February 2026 report, based on about 200 inmate and 25 staff interviews at nine facilities, found mental illness severely neglected. Most facilities lacked trained professionals, treatment programs or specialised institutions, and staff said inmates with mental illness often deteriorated further in custody. OPR estimates that about a third of inmates were held for family-related “rehabilitation” after complaints of disobedience, khat, cigarettes, alcohol, family disputes or attempted migration, many for conduct that is not a recognised offence. The report gives no basis for the estimate beyond interviews and observation.
OPR’s 2023 annual assessment of Mogadishu facilities says people with mental health conditions receive no counselling or psychotherapy after release, are discharged without prescriptions and have no outpatient care, so people with psychosocial disabilities are frequently chained at home. It gives no figures. The 2025 report repeats the point in softer terms, saying only that such people may end up isolated at home. None of the OPR reports I reviewed documents chaining or solitary confinement of people with mental illness inside federal prisons, and I found no other source that does.
Khat appears in every account. At Borama, every one of the 146 prisoners assessed had a history of khat use, and 45 of the 161 people assessed, or 27.9 percent, were diagnosed with khat-induced psychosis. A case-control study in Somalia notes it remains unclear whether khat causes a psychotic disorder in an otherwise healthy person or triggers onset in someone already vulnerable. A pilot study of 48 Somali refugees in Nairobi found that khat users had more traumatic events and more PTSD than non-users, and that most users had khat-related psychotic symptoms. A survey of 844 adults in Ethiopia’s Somali Region found problematic khat use associated with depression, PTSD and suicidal thoughts. Neither study looked at prisons, so they support the association, not prison-specific rates.
There is no national count of people with mental illness in Somali prisons, or of those held without charge. Among the sources I reviewed, I found no independent assessment of prison conditions for 2025 or 2026 beyond OPR’s own, and no source reporting prison deaths, medication shortages or transfers from private centers to prisons that could be tied to mental illness.
The need is not in doubt. WHO estimated in 2010 that one in three Somalis is affected by mental illness, as cited in the Somaliland review. MSF recorded 4,940 mental health consultations in Galkayo and Baidoa from January to September 2024, and says the needs are enormous while funding and trained staff are lacking.
I did not seek comment from the Ministry of Justice and Constitutional Affairs, the Custodial Corps or Somaliland’s authorities before publication. Any responses I receive will be added as an update.
The evidence points to the outline. Somaliland needs mental health legislation that sets admission criteria and provides prompt judicial review. It should ban chaining and seclusion and regulate private centers. The Borama model deserves a proper evaluation and, if the results hold, replication.
In federal Somalia, the UN calls for specialised mental health professionals and trained custodial staff, regular unannounced inspections with independent civilian oversight, confidential complaint systems, anti-torture legislation and alternatives to detention. OPR calls for reform of laws and practices enabling arbitrary “rehabilitation detention,” and for specialised mental health and rehabilitation facilities and juvenile centers separate from adult prisons. Donors should fund prison health services and the mental health workforce, including psychiatric nursing, and back community-based services so that families have somewhere else to turn.
How to cite this piece
Abukar, Ismail, for the Organization for Prisoners' Rights. (2026). The Invisible Cell: Mental Illness Behind Bars in Somalia and Somaliland. Mogadishu: OPR. https://opr.org.so/news/the-invisible-cell/