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Many Somalis will take relatives living with mental health problems to traditional or Khoranic healers for treatment. Mogadishu, Somalia. May 2011. (Robin Hammond/WitnessChange.org)

This so-called rehabilitation facility outside the Niger Delta city of Port Harcourt, Nigeria holds more than 170 people with mental illness or mental disability. Run by the government, it was originally designed as a facility to assist widows, but in 1999 it was turned into a place of incarceration for homeless people with mental illness. October 2012. (Robin Hammond/WitnessChange.org)

Chains are used to restrain some of the “guests” at The City of Rest, a facility in Freetown, Sierra Leone. Some are violent and restraints are needed to protect people and property in the facility. However, chaining is sometimes used as a punishment and not for safety. February 2013. (Robin Hammond/WitnessChange.org)

Shooting War | A series by Dr. Anthony Feinstein

Robin Hammond

When the vulnerable suffer

Robin Hammond has dedicated his career to documenting human rights and development issues around the world through long term photographic projects. Originally from New Zealand, he is the recipient of numerous prizes, including a 2014 World Press Photo prize and four Amnesty International awards for Human Rights journalism. His latest work on homophobia and transphobia around the world called Where Love Is Illegal has become a popular social media campaign. Hammond is the founder of Witness Change, a non-profit organization dedicated to advancing human rights through highly visual story telling.

I first saw Robin Hammond’s photography at a Visa D’Or photojournalism Festival in Perpignan. He had been invited to exhibit his work on mental illness in Africa. In the quiet interior of a medieval building given over to his photographs, I made my way from one compelling image to another aware of competing emotions, my admiration for the skill of the photographer bumping up against the pain of those he had photographed. As I lingered over each photograph, I also reflected on how the universal nature of mental illness meant that the inner worlds of many of Hammond’s subjects surely matched those of my patients back in Toronto. And yet the circumstances of their treatment could not have been more different. Here the photographs tell a dreadful story.

A young man sits naked and forlorn on a bare floor, chained to a wall. A husband drags his trussed wife across a field with a look of grim determination; intellectually handicapped children, limbs contracted and stick-thin with malnutrition, lie three to a crib: women in shackles slump across threadbare, filthy mattresses on the floor; men look through the bars of their cage with a mix of desperation, melancholy and dull resignation. Hammond’s photographs provide powerful visual testimony to a troubling reality: mental illness is common, knows no boundaries, spares no social class and in great swaths of this world is largely ignored by governments that spend lavishly elsewhere.

Shooting War

A series by Dr. Anthony Feinstein

Robin Hammond has dedicated his career to documenting human rights and development issues around the world through long term photographic projects. Originally from New Zealand, he is the recipient of numerous prizes, including a 2014 World Press Photo prize and four Amnesty International awards for Human Rights journalism. His latest work on homophobia and transphobia around the world called Where Love Is Illegal has become a popular social media campaign. Hammond is the founder of Witness Change, a non-profit organization dedicated to advancing human rights through highly visual story telling.

Difficult as these conditions are, they turn immeasurably worse when war comes calling, as it often does with a tenacity that soaks up limited health-care resources and lays waste an already inadequate infrastructure. In the vanguard of armies and militia, often rogue, those who can escape do so. The affluent and educated are the first to flee, their foresight given wings by money. The able-bodied, less well-to-do are next, bundling their possessions at the eleventh hour and taking to the road. Those left behind are the most vulnerable and they include the mentally ill. This is what Hammond found when he arrived in Mogadishu on his birthday in the summer of 2011. A 20-year civil war had reduced Somalia to a failed state. The capital was in ruins. Al-Shabab militants were battling government forces and gunfire could be heard a few streets away from the psychiatric facility. His security detail was jittery.

 

Men and women living with mental health problems are shackled and locked away in Juba Central Prison in South Sudan for years. The new nation faces a tremendous challenge to build a modern country capable of caring for all of its citizens. January 2011. (Robin Hammond/WitnessChange.org)

In a more peaceful time, an Italian NGO had run the hospital. Now the danger was too great and the doctors and nurses had left, the pharmacy was empty and into this professional void had stepped the Imams. The only “therapy” given came from religious leaders who bellowed verses from the Koran into the ears and psyches of their captive wards using bullhorns. Such is the power of the image, it is easy to overlook a peripheral detail. In the top right-hand corner of the photograph one can see the minaret of a nearby mosque. Prayer has become the default treatment for mental illness. Somali society has slipped its tether and is back in the Dark Ages. Only religion has had the power to endure in the midst of war. Presumably the bullhorn is considered some sort of behavioral modifier, although the men sitting inches away from the verbal blasts appear oddly unresponsive. Perhaps they have become inured to the daily message? Maybe their illness has rendered them catatonic, incapable of movement irrespective of the decibel level? Or perchance they just are more interested in the unusual sight of a white man with camera who has braved grave danger to record their plight?

When Robin Hammond took this photograph, he had to work quickly. There was no time to linger. One wrong move, one small miscalculation and kidnap for ransom, or worse, would be his fate. His motivation comes from a fierce determination to document the plight of the mentally ill in countries in crisis. The idea first came to him on a trip to South Sudan to photograph the independence celebrations of the world’s newest state. He recalls that Juba, the capital, was awash with journalists, and rather than replicate what they were doing he went in search of a story with a difference. While traveling down a dusty road, he came across a woman with obvious intellectual disability, begging. Learning from his local driver that the government often imprisoned those with mental-health problems, he managed to gain access to Juba Central Prison. What he saw shocked him. Here the mentally ill were shackled, not treated. Some were kept naked. They were fed and defecated in the same place.

Hammond’s photographs, which appeared in the Sunday Times, were the very antithesis of the celebratory press coverage that elsewhere greeted the dawning of a new country. “It is said that no one truly knows a nation until one has been inside its jails,” observed Nelson Mandela. “A nation should not be judged by how it treats its highest citizens, but its lowest ones.” So yes, it was a time of high hope for newly minted South Sudan, recollects Hammond, a fresh start for a people long at war and under the yoke of their northern masters in Khartoum, but as his photographs revealed, all was not well at the birth.

Hammond’s work in South Sudan gave his career a direction that meshed well with his longstanding focus on human-rights issues. He had always taken inspiration from the photographs of W. Eugene Smith, citing in particular Smith’s work in Minamata, Japan, where his photographs, acquired at great personal cost which included an assault that left him visually impaired, exposed the effects of toxic industrial waste on the health of the local inhabitants. The prison in Juba opened Hammond’s eyes to a world of suffering, one that is often hidden from view behind high walls and in dark recesses, enveloped in a silence that reflects a pernicious mix of shame, guilt, ignorance, indifference and state-sanctioned cruelty. He was determined to expose the plight of the mentally ill in countries in crisis, and his self-funded project has since taken him to 10 African countries. His photographs were subsequently published in a book he aptly called Condemned.

Notwithstanding the critical acclaim that greeted his work, the subject matter remained in the shadows. The mentally ill did not have a voice and could not advocate for themselves. The very nature of their illness had silenced them. How could it be otherwise when delusions derail thoughts and hallucinations distort how the world is seen? Even depression, the most frequent of disorders, can reduce motivation, induce apathy and impede those afflicted from bringing about positive change. In the absence of moral outrage, the treatment of choice often involved putting a chain around an ankle. Some of the authorities saw nothing wrong in this and opened their doors to Hammond, but others seemed more sensitive to how their actions would be perceived and were reluctant to grant access. He was arrested once, in Zimbabwe, interrogated for four days and spent 26 nights in jail. He counted 38 people crammed into his small cell. A single toilet was shared by 250 detainees. Lice were ubiquitous and there were weevils in the food. Hammond recalls that his first night in captivity was “like walking into one of my photographs.” But his incarceration also gave him first-hand insights into just how terrible was the plight of those on the other side of his lens. He emerged from his captivity a stronger person, fortified in his resolve to continue his work.

When viewed from afar in the comfort of an air-conditioned office, it is all too easy to pass blanket judgment on those who, at first glance, appear to be perpetuating gross human-rights abuses in their treatment of the mentally ill. Hammond is aware of this transcultural trap and correctly makes a distinction between government officials who spend extravagantly on themselves or armaments, and local functionaries without a budget or family members forced to manage disturbed, often violent behaviour. He recalls initially feeling appalled when at a refugee camp in in Puntland, northeast Somalia, he came across a mentally unwell child who had been tied to a stake for nine years. But his opinion changed, even if his distress did not, when the child’s mother, a single parent living an impoverished existence, explained that she had another four children to look after. What was she to do, she challenged Hammond? Devote all her resources to her sick son and let the others starve, for that is what surely would happen, or instead tend to his four healthy siblings? These are moral dilemmas we in more affluent societies are thankfully spared courtesy of an accident of birth.

Left: This 14 year old boy has been tied up for six years. His mother refuses to have him admitted to the hospital in Gulu, Northern Uganda, which is only two kilometers away. April 2011. Right: Home of Hope in Jinja, Uganda cares for abandoned children living with mental health problems. April 2011. (Robin Hammond/WitnessChange.org)

Viewing a relentless procession of manacled sick people, or visiting psychiatric institutions where all the patients, irrespective of diagnosis, had been sedated to the point of stupor and left drooling can test the strongest resolve. A couple years into his project, Hammond felt drained. Prior to visiting Liberia and Sierra Leone, he recalls having to push through his exhaustion to lift a flagging motivation. He was also starting to realize that bearing witness had altered nothing in the lives of his subjects. While documenting their plight was important, he felt a moral imperative to bring about change as well. The subjects of his photographs had let him into their world with all its pain, helplessness and despair. Implicit in this relationship was the hope, fragile but never abandoned, that some good would come of it, that lives shorn of dignity and respect could be made just that little bit better.

Driven in part by guilt, misplaced but no less powerful for it, Hammond took a break to rethink his strategy. When he returned two years later, he had expanded his remit from mental illness to vulnerable people in general. He formed a not-for-profit organization, Witness Change, with the aim of effecting transformation. Now the emphasis was on what he calls “disabling environments” such as refugee camps and prisons and the effects that these can have on mental health.

Shifting strategies made it easier for Hammond to keep going and justify to himself why he does so. But it does not blunt the cruelty of what he has witnessed. He still seethes when he thinks about what he saw in Port Harcourt in the Niger Delta, visiting what had euphemistically been called a rehabilitation centre. Incarcerated within were 170 mentally ill men and women who had been rounded up off the streets 15 years back and kept in detention. Masquerading behind a pretense at convalescence and reintegration, the state authorities had addressed an inconvenient truth by making it disappear from public view. Hammond could see that those caught up in the sweep would never get out.

Due to insufficient staff numbers, family members are encouraged to stay with patients at Brothers of Charity Sante Mental in Goma, The Democratic Republic of Congo. This relative would often beat, tie up and drag the patient when she did not obey his instructions. June 2011. (Robin Hammond/WitnessChange.org)

Notwithstanding the horrors of the Port Harcourt Rehabilitation Centre and others like it, Hammond remains upbeat about his work. When he repeats Surgeon General David Satcher’s well-worn truism “there is no health without mental health,” an idea that can be traced back to the Roman’s Mens sana in corpore sano philosophy (“healthy minds, healthy body”), he does so with compelling conviction linking mental illness to another African scourge, malaria. “The mother with severe depression,” explains Hammond, “is not going to worry about the mosquito netting for herself or her children.” His hope is that in time mental health will receive the same attention and resources that malaria now attracts from philanthropic bodies like the Gates Foundation. The change in attitude towards HIV, which went from pariah status to cause célèbre, is held up as another example to emulate.

A camera and a nascent not-for profit organization are Robin Hammond’s instruments of change. Arrayed against him is a list of negatives that could fill a Thesaurus. And yet he remains undaunted. “I cannot afford to believe the task is hopeless,” he said. If one adds conviction, a perceptive eye, consummate skill and a focused energy to the mix, the odds shift a little more favourably. And let us not overlook emotion as a great motivator, a mover of causes. When one has been touched profoundly by what one has witnessed, this too can be the spur to action. Hammond has not been traumatized by what he has seen and, in Zimbabwe, endured. Which is not to gloss over the fact that every time he returns to his home in Paris from farflung places in which humanity has lost its way, there is always one story, one face the memory of which simply breaks his heart.