In the late 1980s, the people of northern Somalia rebelled against the government of General Mohammed Siad Barre. After four years of fighting, they separated from the rest of the country, forming the Republic of Somaliland.

The cost of their de facto independence was heavy. Tens of thousands of people were killed during the conflict, many during bombardments by the Somali Air Force. Half a million more fled across the Ethiopian border, settling in refugee camps. A struggle for control of the breakaway republic followed in the mid-1990s.

Rebuilding has been slow. The last camp was dismantled just a few years ago.

Today, as Somaliland thrives in the shadow of its troubled neighbours, the scope of the war’s psychological toll has only begun to register. As many as two-thirds of people over the age of 25 have suffered from post-traumatic stress disorder in some form. Abuse of khat, a plant-based amphetamine chewed all over the Horn of Africa, complicates this and other mental health issues.

There are no psychiatrists in Somaliland.

The patients at Hargeisa Mental Health Unit receive professional treatment for only one month per year, when a Somali-Canadian psychiatrist returns to the country on holiday. He provides free treatment and diagnosis.

What follows are portraits from Somaliland’s only mental health hospital.

See also Separation Anxiety: Caring for civil war survivors in Somaliland’s only mental health hospital in The Walrus.

Okay, here’s the assignment — myself and a stylist, plus a little help from Vova the fixer, drive around rural, western Ukraine in an Opel, purposely avoiding the big cities, sticking to the back roads, looking for “real” people to be our models. In the trunk of the car, thousands of dollars worth of high fashion from Europe and New York. Change in the car, you look great! Try to get real people in real situations wearing absolutely modern clothing. And that’s our Ukrainian road trip.

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Ada Aden Hussein lives in the Mental Health Ward of Hargeisa Hospital, where she has worked for five years as an attendant. Ada took the job so she could take care of her daughter, who suffers from bipolar disorder, and her granddaughter. Hargeisa, Somalia. 2007.

Akaiyu, twenty-one, on a visit to a health clinic. Her infant son needed medicine for an eye infection. Her people, the Turkana, are nomads who migrate across the arid plains of northern Kenya in search of water and pasture. Akaiyu belongs to one of the settled communities near the Sudanese border. 2008.

Agness Nyirandibanzi lives on a government reserve in the hills above Gisenyi, Rwanda. Her people, the Twa, face discrimination because of their short stature, which distinguishes them from other Rwandans. They were murdered in great numbers during the 1994 genocide — a tragedy sometimes overlooked in historical accounts. The government moved Agness’s community from their forest home because it was designated as part of a national park. 2009.

Name unknown, a resident of Conneh Internally Displaced Persons Camp near Kakata, Liberia. The camp took its name from warlord Sekou Conneh. His rebels forced many of the people here to flee their homes during the civil war. 2005.

While in Ghana researching my article on African Pentecostalism now in The Walrus, I also spent time observing and interviewing people involved in African traditional spirit worship. In particular, I visited the Black and White Powers Shrine in Kumasi several times, and spoke with its founder and fetish priest, Nana Abas.

Gallery of images from Black and White Powers Shrine (Kumasi, Ghana)

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An earlier draft of the article included a section on the resurgence of African traditional religion as a parallel phenomenon to Pentecostalism’s spectacular growth, in part because they’re both competing in the same marketplace of faiths, but also to illustrate how Ghana’s culture of spirit possession and “witchcraft” has influenced Pentecostalism; as I mention the Pentecostals don’t at all deny that “witchcraft” is real and affects peoples’ lives, and they offer the process of being born again as protection against its malignant power.

A low-slung, four-square compound with offices and sleeping quarters, the Black and White Powers Shrine clings onto a hilltop scenically overlooking the suburbs of Kumasi, capital of the Ashanti and Ghana’s second city. The shrine is Abas’s creation; a complex dedicated to the revival of traditional African religion. In Ghanaian ancestor worship there is a pantheon of “dwarf spirits”, each possessing a particular character and moral purpose. The night photographs were taken during an all-night festival at the shrine, during which Abas was possessed by a sequence of spirits, dancing and adopting their different personalities whenever he interacted with the crowd.

Abas began by channeling Adiyapu, He who hates greed, the spirit with whom the gluttonous must reckon. “You eat and eat and he makes you vomit it out.” Abas/Adiyapu danced and twirled non-stop for more than forty-five minutes, and when he finally stopped he regarded the crowd imperiously through a mist of light rain and talcum that had been tossed about him by a trio of attendants: “We’re not going anywhere tonight until we hear the good news from the spirits.”

After shrugging off Adiyapu, Abas left the courtyard briefly and returned in new robes, this time resembling a white hospital gown and smock, red medical crosses embroidered at the ankles. This is Boafu, I’m told. The “helper” spirit, feminine and temperamental. Again Abas danced, more gently it seemed, but Boafu clearly was temperamental because she soon became grumpy about the lack of involvement from the crowd and departed after only ten minutes. Offege arrived next—a trickster type, jovial, drunken in demeanor. He likes to play with humans, maybe likes money even more, but if you offend him he will leave. (Abas claims this spirit nearly killed him once and stole some money to teach him a lesson.) Offege walked into the crowd, mugging and cracking jokes. People handed him money.

Charismatic preachers frequently inveigh against the traditional worshippers as diabolical and idolatrous, practitioners of witchcraft, whether from the pulpit or in the media. Traditional fetish priests like Abas, meanwhile, insist that many of Africa’s social problems are a result of abandoning its own gods and taking up the white man’s. “If we are not listening to our ancestors and spirits, we are not listening to God,” he told me on another occasion, after a Sunday morning service (the daytime photos). “If we don’t go back to our own traditions we will always be struggling. If you dream at night you can’t dream in another’s language. We must commit to our own religion to prosper.”

While Abas took donations from worshippers to fund the shrine, it was supported mostly out of his own pocket—made possible by his substantial plantation holdings and small businesses. He knew the traditionalist could hardly compete with the money-raising prowess of the Pentacostals.  “It’s a marketplace,” he said. “They are selling god to get money, because they don’t have any work apart from the church. I built this shrine myself, with my hands, my money. This is not a business.”

Despite the harsh words exchanged by the Pentecostals and traditionalists, I came away from the shrine struck by how much they had in common. Among both, there is a glaring focus on petitioning God and wish fulfillment. There’s the language of self-empowerment and prosperity. But most importantly, Pentecostalism’s unique emphasis on the Holy Spirit—the feature that separates it from evangelicals and other charismatics—and its supposed power to enter ordinary lives, grafts easily onto a culture whose imagination is already rich with spirits. They only transference is from the many to the one.

The reality is that many Ghanaians move comfortably between both worlds, a fact the traditionalists are more willing to admit than the Pentecostals. Occasionally the two worlds clashing play out in newspaper scandals; while I was in Ghana it was revealed that a preacher in Accra had secretly been visiting a fetish priest in order to enhance his “powers”; the fetish priest out-ed the preacher in the media because the preacher was refusing to pay back money he had borrowed.