They come because their body hurts”: bringing mental health care to patients in Somalia.

These are the complaints my team and I hear most often at the hospitals Médecins Sans Frontières (MSF) supports in Baidoa and Galkayo in Somalia. Very few people walk in saying they feel worried, upset, or sad. They come because their body hurts, and often they have been suffering alone, with no one around them able to see the pain. It is only when we sit down and talk that we find what lies underneath: persistent stress, constant worry, and low mood. 

People in Baidoa and Mudug have lived through repeated shocks for years: conflict, displacement, drought, and floods. This year has also brought malnutrition and outbreaks of measles, acute watery diarrhoea, and diphtheria. Each brings loss, hopelessness, and uncertainty, and adds to the weight people carry. 

The World Health Organization (WHO) estimates that nearly one in three Somalis lives with a mental health condition. In 2020, it counted only three psychiatrists for a population of about 15 million. 

For many people, reaching the care is the hardest step. People with mental health conditions face heavy stigma and discrimination.  Many people do not see psychological issues as a health concern at all; in Mudug for example, they are often understood as a neurological problem. Some believe that a person with a mental health condition is dangerous or will never recover. So, families look for other kinds of help first, and by the time someone reaches a hospital, they may have been struggling for a long time. Our care is free, but transport is not, and many families cannot afford it. 

MSF works in collaboration with the Ministry of Health at Bay Regional Hospital in Baidoa, and at Mudug Regional Hospital and Galkayo Hospital in Galkayo. Our teams offer individual, family, and group counselling, including group sessions for women recovering from obstetric fistula, psychiatric consultations and medication, follow-up sessions, counselling by phone, psychoeducation and psychological first aid, all free of charge and confidential. 

We cannot wait for specialists who are not there. Through the WHO Mental Health Gap Action Programme, known as mhGAP, we have trained doctors from several hospital departments to recognise, diagnose, and treat mental health conditions, including with psychiatric medication when it is needed. They work alongside our mental health counsellors and together they review regularly complex cases of patients. It means someone with a serious mental health condition, such as severe depression or psychosis, can be treated in Baidoa or Galkayo, rather than being sent elsewhere for care that most families cannot reach. In Galkayo, mhGAP-trained doctors held 140 consultations in the first six months of this year. 

We also actively look for the people who need our support. Team members regularly visit the emergency room, the paediatric and malnutrition wards, and tuberculosis, obstetric fistula, and reproductive health services. Health promoters and community health workers talk about mental health problems and care in the hospital and in the community, so that people learn that what they are feeling has a name and can be treated. 

More people are coming. Between January and June 2026, our teams held 5,267 individual and family mental health consultations in Baidoa and Galkayo and supported 2,378 patients. Leaving aside consultations by mhGAP-trained doctors, which we only started recording this year, this is 45 per cent more than in the same period of 2025. Part of this rise reflects greater need after a difficult year. Part of it reflects trust: other organisations that cannot offer psychiatric care now refer patients to us, and people who have started to feel better encourage others to come and seek care.  

But our services are not enough. Outside the hospitals we support, there are few places in Baidoa or Galkayo where someone can see a psychiatrist, and those that exist often charge fees. 

Mental health care needs to be treated as a core health service in Somalia, like care for physical illness: part of the services people already use, with trained mental health staff, a reliable supply of psychiatric medication and services close to where people live. This is a shared responsibility for health authorities, donors, and humanitarian organisations. 

Every week, people come to our hospitals with a headache or a sleepless night and find someone who will ask what lies underneath. The task now is to make sure mental health support is always there/available when they do.