People with psychosocial disabilities in Somaliland have been abused and abandoned by the state, by either entering poorly-run institutions against their will or being left in the care of of ill-informed family members, according to allegations in a Human Rights Watch report released on Monday.
"One of the reasons why we actually decided to do the work in Somaliland instead of in south-central Somalia is because the government has prioritized mental health as one of its health priorities," said Laetitia Bader, Africa researcher for Human Rights Watch and an author of the report.
Yet the report found that Somaliland's government and its public facilities fell short of being able to adequately meet the need for better healthcare.
Based on interviews with 115 people including 47 people with actual or perceived psychosocial disabilities in three of Somaliland's major cities, researchers found that patients across the board experienced a number of abuses.
Most experienced involuntary admission, involuntary medication, overcrowding, few opportunities for sunlight and - with the notable exception of Hargeisa Group Hospital spent a significant amount of their time locked up in chains.
The report particularly zeroed in on privately-run facilities, which were the worst offenders and have been less reported upon, according to Bader.
"As you'll see in the report, we don't really call them mental health institutions, because we don't really see them as providing mental healthcare," Bader said.
Up until the last few years, mental health had not been prioritized a trend not just seen throughout Somaliland, but also through many other post-conflict societies. Only two qualified psychiatrists serve an unknown number of individuals experiencing psychosocial disabilities within a general population of 3.5 million people.
"In Somalia, the health programming is focusing on mother and child care. And we don't question the prioritization of that, but there is also, given the rates of mental health problems, given the impact it has on the economy, on security, on the household, I mean, ignoring it does appear to be a real mistake," Bader said.
One of those psychiatrists is Dr. Liban Hersi, who was trained in Ethiopia because Somaliland does not currently have schools to train doctors. Hersi said he is doing his best to treat patients as well as train new staff, but it's not enough.
"The problem is that one person cannot do all of it," Hersi told Al Jazeera America.
"We don't have the governmental support or other international organizations who can work with the few people who are willing to make change. So far."
As for the Somaliland government, Faisa Ibrahim, director of policy planning and strategic information for the ministry of health in Somaliland, says it wants to "embrace the report" with a "degree of understanding."
"I think the assessment generally captures the idea that the health sector needs investment," she said
The report points out that there isa concern with the prevalence of shackling and the lack of counseling and trained professionals that exist throughout Somaliland.
At the same time, it indicates that Somaliland has made strides in the last few years and is already in the process of rolling out both next year's strategic plan and a strategic plan for the next five years specifically addressing mental health issues.
"Unfortunately, Somaliland is a country that is largely funded by external aid, and internal revenues are still really small. It's really difficult, because the needs outweigh all of the things you need to do," Ibrahim told Al Jazeera.
She added that because of this, Somaliland has tended to focus on addressing issues like saving lives, rather than chronic diseases like mental health.
"[We] sometimes forget that this country has a double burden of disease, both communicable and non-communicable," Ibrahim said.