Mental Health Beyond Conflict: Cultural and Structural Barriers to Psychiatric Care in Somalia.

Mental health challenges in Somalia are shaped by a complex interaction between fragile healthcare infrastructure and sociocultural factors influencing psychiatric care utilization. This commentary critically examines how stigma, spiritual and supernatural interpretations of mental illness, informal healing systems, limited mental health literacy, and severe shortages of psychiatric services shape help-seeking behaviors and access to formal mental healthcare in Somalia. In many Somali communities, mental illness may be interpreted through frameworks involving jinn possession, the evil eye, and black magic (sihr). Consequently, religious leaders and informal healers often serve as initial sources of help-seeking. However, reliance on informal systems of care also reflects broader structural barriers, including shortages of trained mental health professionals, inadequate integration of psychiatry into primary healthcare, financial constraints, inconsistent availability of psychotropic medications, and limited access to specialist services outside major urban centers. Stigma and limited public familiarity with psychiatric care may further contribute to delayed presentation and prolonged untreated illness. This commentary argues that cultural and structural barriers are deeply interconnected rather than separate explanations for poor psychiatric care utilization. Improving mental healthcare in Somalia therefore requires integrated and culturally responsive approaches that strengthen mental health systems while engaging trusted community and religious structures to improve accessibility, acceptability, and long-term sustainability of psychiatric care.