On September 21, 2013, unidentified gunmen entered the upscale Westgate shopping mall in the Westlands neighborhood of Nairobi, Kenya. Since its opening in 2007, the mall has been a popular shopping spot among ex-pats and wealthy Kenyans, but has also served as a gathering place for many Nairobi youth. Over the course of a few days, in a 30-hour siege, terrorists claiming to be members of Somali terrorist group al-Shabbab (“the youth” in Arabic) killed over 61 civilians and 6 security officers were killed.
Although Kenya has dealt with terror threats in the last few years, largely due to its proximity to volatile Somalia and its other unstable neighbors, the nation has not dealt with an attack of this scale since the devasting 1998 United States embassy bombing in which over 200 people were killed and 4,000 people were injured.
In the Kenyan community and large Kenyan diaspora, reactions to the attack ranged from deep sadness to rage. Although Somali religious clerics have denounced the actions of al-Shabbab in a fatwa, numerous news agencies have reported Somali communities’ fear of reprisals. In a masterful bit of calculation, this is just the opportunity that al-Shabbab has been waiting for. As the organization loses its ground in Somalia, analysts have hypothesized that the Westgate attack is meant to provoke Kenyan anger and increase the number of disaffected Somalis looking for an outlet.
To avoid playing into al-Shabbab’s hands, it is imperative that Kenyans resist the urge to react viscerally in spite of terror and pain. Nevertheless, while Westgate offers an opportunity for Kenyans around the world to come together across the divisive lines of ethnicity, it also offers a critical opportunity to address the oft-neglected topic of mental health.
In the wake of 9/11, over 10,000 firefighters, police officers and civilians in New York were found to be coping with post-traumatic stress disorder (PTSD), a disease that can have debilitating effects and severely alter quality of life. Although the U.S. government has spent millions treating these people through the James Zadroga 9/11 Health and Compensation Act, people coping with PTSD around the world do not have this luxury.
Although Kenya’s high growth rates and large middle class have made it one of the recent darlings of the development world, 45.9% of the nation is still at the national poverty line (World Bank Data). While the global health community may be pouring millions of dollars into the treatment and prevention of communicable diseases like HIV/AIDS and malaria, mental health is often put on the back-burner of the public health agenda.
Kenya’s psychiatrists are trained almost exclusively at the University of Nairobi, which produces only around 6 new psychiatrists per year. In 2009, there were only 46 psychiatrists working in public practice, with another 24 psychiatrists working in private practice In Kenya. For a nation of over 40 million people, this number is woefully inadequate.
There are only four major mental facilities in the nation: Mathari National Psychiatric Hospital (the national referral center), University of Nairobi, Gil Gil hospital and Moi University. While Mathari receives the largest number of patients, it is not only under-staffed but under-resourced. Mathari has a 500 - 600 occupancy, but the hospital is overcrowded with over 750 patients.
Country-wide, 70% of the in-patient beds are in the Nairobi area. The majority of patients hoping to receive out-patient care experience massive delays or cannot find treatment.
Earlier this year, the escape of 30 mentally ill patients from Mathari Hospital sparked a national conversation in Kenya about mental health, however reforms have largely been in name only. Although the Mental Health Bill of 2013 takes steps towards addressing the need for prevention and discusses the idea of recovery, it largely deals with criteria for hospitalization instead of making substantive changes to the national health budget. As it stands, expenditures for mental health has remained at less than 1% of the annual public health budget.
Westgate is a critical opportunity to pressure the Kenyan government and international donors to increase the allocation of resources for mental health. Mental health has key implications not only for physical health, but for the resurgence of conflict in Kenya. Mental health can greatly influence the development, prognosis and outcome of physical diseases. Under-addressed trauma leaves salt in the nation’s wounds; if we do not take steps to help Kenya’s people cope with conditions like PTSD, depression, or anxiety, affected persons may translate anger and frustration in hostile outbursts across their fellow countrymen. For there to be peace in the nation, there must first be peace in the people.