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The mental costs of being a refugee in America

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TONIC — When Ahmed Hassan decided to major in psychology at Southwest Minnesota State University, his Somali-born community assumed he was training to be a psychic. Not an unexpected reaction, given the popularity of psychic hotlines in the early 2000s—and the lack of anything equivalent to psychotherapy in Somalia.

Hassan, of course, had no interest in the likes of Miss “Call Me Now!” Cleo. He’d gotten an A in his intro to Psychology course, and wanted to learn more.

But there’s no word for mental illness in Somali. “You are either sane or insane,” says Muna Mohamed, a Somali-born case manager at a mental health support clinic in Minneapolis. “There is nothing in between.”

Despite a lack of descriptive language, refugees suffer from depression and post-traumatic stress disorder at a much higher rate than the general population. It’s estimated that between 14 and 37 percent experience PTSD and major depression, compared to between 6 and 8 percent of the general population. It’s not known how many immigrants living with mental health issues go undiagnosed and untreated. When refugees arrive in the US, an initial medical exam screens for everything from malaria to intestinal parasites. But screening for mental health disorders is tricky—there’s no equivalent to a tuberculosis skin test for diagnosing depression—and has only been recommended by the CDC since 2011.

Minnesota is currently piloting mental health screening for refugees, and this is part of an upward trend: About half of states now offer some sort of mental health screening for refugees or new immigrants, up from about four in 2010. This includes California, where most of the 12,000 Syrian refugees in the US have landed. “One reason for doing the screening is that about a third of refugees will have a diagnosable condition such as PTSD or depression, and 50 percent will have experienced torture—themselves or an immediate family member,” says Patricia Shannon, associate professor in the School of Social Work at the University of Minnesota. “But not all will have a diagnosable condition. Many of those who don’t are still vulnerable to mental health issues, however: Many were exposed to trauma in the course of being a refugee, fleeing through jungles or other unsafe conditions. We need to get them help sooner rather than later so they can get to a healthy resettlement.”

The importance of long-term mental healthcare on a population level has become increasingly evident. As recent research illustrates, unmet mental health needs contribute to crowded jails and prisons, higher suicide rates and student populations with more challenging behavior, absenteeism, dropout rates, and underachievement.

But successful treatment is complex, requiring a multi-pronged approach to effect change. Immigrant hubs across the country face a steep learning curve of setting best practices for newly-arrived refugees who do not share the Western concept of mental health. That means everything from systemic reorganization (starting with the screenings in that first medical exam), to overcoming language barriers and confidentiality issues with unregulated interpreters, to basic Western psychoeducation. None of those things can happen without people who can bridge cultural gaps, who understand that “mental illness” translates to “crazy” in another language. Hassan is one of a small but growing number of Somali-born psychotherapists who connect the two cultures.

During a time when Somalis were fleeing the country’s civil war, fighting between clans, and a famine, Hassan won a lottery for a Diversity Immigrant Visa that granted him entry to the US. Even now, Hassan’s deep brown eyes sparkle when talking about it: “I don’t get excited easily, but that’s one moment I was just so excited I didn’t even feel my body,” he says. “I was so excited, I was jumping, screaming, doing crazy things. Even when I graduated from college, I didn’t feel that way.”

When his plane landed in Virginia in 2002, he had a backpack and $20 in his pocket. He and the Somali family he stayed with would go to a mall and a bowling alley and watch the crowds, unaccustomed to seeing people who looked different from them: Asians, whites, African-Americans. Within a few months, Hassan, eager to pursue a college degree, decided to move to Marshall, Minn., population 13,680, to attend Southwest Minnesota State University. Marshall was home to a community of Somalis ever since the town’s turkey plant started hiring Somali workers in 1992. Of the approximately 84,000 Somali refugees in the US, about 40 percent live in Minnesota because of the state’s active voluntary agencies that work with the State Department to resettle refugees.

Before majoring in psychology, Hassan’s experience with mental health was typical of any kid growing up in Somalia. When he was 15, he remembers being with a friend at a mosque when a nearby woman fainted. A bystander told them the woman was experiencing jhin, or being possessed, and asked them to read Quranic verses.

“My friend and I read random verses, and after an hour she woke up,” Hassan says. “At the time, we attributed everything to the verses, because we’d read the Quran and she felt better and woke up.”

Studying psych in the US, he enjoyed learning about theories of human behavior. But gaps between cultures persisted: It wasn’t until graduate school that Hassan fully understood talk therapy. “No one did the ABCs of what it was,” he says. He learned while working as an interpreter on an assignment to take a Somali woman who was having trouble sleeping, presumably due to PTSD, to a psychiatrist. When the doctor referred her to a healthcare provider next door, Hassan helped the woman set up an appointment, assuming the provider would take X-rays or blood samples.

“But we went the next day, and the [provider] kept asking question after question,” Hassan remembers. “After 30 minutes the client looked at me and said, ‘Why is she asking so many questions?’ I said, ‘I have no idea.’ Finally she handed her a slip of paper and said, ‘Come back next time.'”

Hassan and the client assumed the paper was a prescription, but the provider explained that she didn’t dispense medication; the paper was to be given to the receptionist to set up another appointment.

“The client looked at me and said, ‘I will never go back to that woman,’ and I said, ‘Well, I don’t blame you. After all that, all she can give you is this piece of paper?'”

The theory of talk therapy struck Hassan as completely bizarre. Months later, he ran into the client. He asked the woman if she’d gone back.

“She said, ‘Yes. I like her now.’ I think she went back because she felt the [therapist] cared about her.”

It’s a concept that requires experience to appreciate, says Hassan, who says talk therapy is what he now enjoys most in his work.

When care providers don’t completely comprehend the chasm between cultures, patients are often misdiagnosed—or go undiagnosed.

Hassan witnessed this while working as an interpreter: A psychologist started asking a patient if she was seeing people who weren’t there. The woman, who believed in Sufism, or Islamic mysticism, told him she saw and talked to dead people all the time, even threw food to them (a common practice to give the spirits something to eat). Alarmed, the psychologist decided the woman needed to be hospitalized for hallucination. “Everyone who knew her knew she was just normal,” Hassan says. After much struggle and explanation, the woman avoided being hospitalized, but the experience frightened Hassan, knowing that many in the Somali community are scared about being institutionalized against their will.

That was an extreme case, he says; more common are situations in which patients describe mental illness in terms of headaches, stomachaches and heaviness in their legs—and as a result get prescribed inappropriate medication. In 2004, Mayo Clinic researchers analyzed hospital records of Somali immigrants to Minnesota, noticing references to “Sick Somali Syndrome.” Often, the researchers concluded, the culprit of the mystery symptoms—vague physical symptoms such as headaches or stomachaches that couldn’t be traced to a root cause —was undiagnosed mental illness. Mental illnesses often manifest as physical headaches and stomachaches when left untreated.

“When mental health and stress are not addressed in refugee populations, there can be long-term adverse health consequences such as diabetes, hypertension, chronic pain, and other chronic health conditions,” says Shannon. “We know now that physical health and mental health are connected.”
After graduation, Hassan founded Summit Guidance in 2011, billing itself as a culturally competent mental health clinic. Almost every time a new client walks in the door of the clinic, located in a nondescript office building in St. Paul, Hassan sits down with them for a free consultation in which he answers their big questions: ‘if you diagnose me will it prevent me from finding a job or ruin my son’s future?’ … or ‘if i tell you this and this, will immigration arrest me?'” He explains exactly what will happen in psychotherapy [i.e., lots of talking, no drugs, no X-rays.] He walks them through HIPAA forms, explaining the concepts of privacy and confidentiality, which don’t exist in the same way in many countries, especially those with rogue governments. He points out the numbers listed on the form they can call if they feel that he violates the agreement.

Still, he finds that clients ask the same questions he’d initially asked after his introduction to talk therapy: “Well, what good will you do if we just sit here and talk?” So Summit Guidance also offers services to help people find housing and employment. The combination, he says, works better than psychotherapy alone.

“If a client comes in and says, ‘Oh, I am depressed and sad because I don’t have good housing,’ then once they have housing and are still depressed, they may be willing to explore what’s going on,” he says.

Research has been able to identify some best practices (Shannon points to a study that found that 76 percent of patients kept an appointment when a doctor personally introduced them to the therapist, vs. 44 percent of patients who kept appointments when they were not introduced), but in general, “Mental health is not a cookie-cutter system,” says Ellen Frerich, a refugee health nurse consultant for the Minnesota Department of Health. “One person might need a psychoeducation group, whereas another might need in-patient care.”

Every single client requires a unique treatment plan, says Andrea Northwood, director of client services at The Center for Victims of Torture. “There are no shortcuts,” she says. “So we need to work with each individual’s family, tribe, social class. I have some Somali clients who ask me to explain the neuroscience of trauma, whereas for others, simple psychoeducation [educating patients about their mental health conditions] offered by an imam could be enough.”

While some of those challenges will always be inherent in treating immigrants with mental health issues, other challenges are surmountable. Take interpreting. “Interpreters are regular folks with not enough training about ethics and confidentiality,” says Hassan, who knows from personal experience.

Because medical interpreters aren’t regulated in most states, “anyone can put up a shingle,” says Northwood. “Interpreting is a very challenging profession. There are codes of ethics; that’s what we train people in.”

For $50, anyone can add their name to a registered list in Minnesota, ethics training or not. Some organizations and agencies provide training, and individuals can apply for accreditation through two new national organizations, but the need far surpasses the number of properly trained interpreters.

“Talking to an older gentleman, I asked about his experience with a previous therapist,” Hassan says. “The man said, ‘after a while, I thought the interpreter wasn’t telling the therapist what I was saying, so the whole thing didn’t work and that’s why I left him.”

According to medical ethics, interpreters are supposed to translate everything a medical provider says and everything a client says. But untrained interpreters may pick and choose how much of a conversation to translate from either end, making experiences such as the older gentleman’s common.

Conflicts of interest often arise as well: a patient is paired with an interpreter who came from a warring tribe in their home country, or someone who lives in their building. And some interpreters are fluent in one language but not entirely in the other, so can’t make perfect translations.

Minnesota is currently considering a bill for a registry recommended by the Minnesota Department of Health similar to Oregon’s, one of the few states that regulates interpreters.

After the election, many Somali Americans in Minnesota are on edge. Without citing any evidence, Donald Trump suggested at a pre-election rally that Somali immigrants to Minnesota hadn’t been fully vetted, and vowed that his administration would “not admit any refugees without the support of the local communities where they are being placed.” Also in November, nine Minnesota men were sentenced to decades in prison after being found guilty of trying to join ISIS.

Hassan discusses such current events in sessions he holds at mosques to talk to young people directly about mental illness, in addition to questions about substances, anxiety, depression and explaining how therapists can help.

Today’s children of immigrants may face new issues, Hassan says, pointing to an African proverb: A mule that eats grass with a horse thinks of himself as a horse. He’s been exploring African proverbs recently, with the idea that ancient nomads predated Western thinkers and that many of the messages relate to mental health and “get to the core where everyone can get access and use it.”

The mule proverb “talks about the young people who are going to school here with this culture, but that culture doesn’t think they’re quite American and their own family doesn’t think they’re quite Somali,” he explains.

“But if the culture is rejecting them and parents are not letting them assimilate, they end up with an identity crisis. Then often they’re using substances to deal with their confusion.”

Hassan is now well-known as a Somali-speaking psychotherapist in Minnesota, and no longer gets mistaken for a psychic. But what he talks about more enthusiastically is his growing number of Somali colleagues.

“Younger people are kind of looking at us and saying, ‘Oh, I want to do something similar,” he says.

Health

Vaccination in Somalia: “It’s my job”

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In Somalia, determined women are the face of polio eradication.

Somalia, polio-free since 2002, is currently at risk of circulating vaccine-derived poliovirus type 2, after three viruses were confirmed in the sewage in Banadir province in early January 2018. Although no children have been paralyzed, WHO and other partners are supporting the local authorities to conduct investigations and risk assessments and to continue outbreak response and disease surveillance.

Underpinning these determined efforts to ensure that every child is vaccinated are local vaccinators and community leaders – nearly all of whom are women.

Bella Yusuf and Mama Ayesha are different personalities, in different stages of their lives, united by one goal – to keep every child in Somalia free from polio. Bella is 29, a mother of four, and a polio vaccinator for the last nine years, fitting her work around childcare and the usual hustle and bustle of family life. Mama Ayesha, whose real name is Asha Abdi Din, is a District Polio Officer. She is named Mama Ayesha for her maternal instincts, which have helped her to persevere and succeed in her pioneering work to improve maternal and child health, campaign for social and cultural change, and provide care for all.

Protecting all young children

Working as part of the December vaccination campaign, which aimed to protect over 700 000 children under five years of age, Bella explains her motivation to be a vaccinator. Taking a well-deserved break whilst supervisors from the Ministry of Health and the World Health Organization check the records of the children so far vaccinated, she looks around at the families waiting in line for drops of polio vaccine.

“I enjoy serving my people. And as a mother, it is my duty to help all children”, she says.

For Mama Ayesha too, the desire to protect Somalia’s young people is a driving force in her work. A real leader, she began her career helping to vaccinate children against smallpox, the last case of which was found in Somalia. Since then, she has personally taken up the fight against female genital mutilation, working to protect every girl-child.

She joined the polio programme in 1998, working to establish Somalia as wild poliovirus free, and ever since to oversee campaigns, and protect against virus re-introduction. In her words, “My office doesn’t close.”

Working in the midst of conflict

The work that Bella and Mama Ayesha carry out is especially critical because Somalia is at a high risk of polio infection. The country suffers from weak health infrastructure, as well as regular population displacement and conflict.

For Bella, that makes keeping children safe through vaccination even more meaningful.

“Through my job I can impact the well-being of my children,” she says. “For every child I vaccinate, I protect a lot more”.

Mama Ayesha echoes those words when she contemplates the difficulties of working in conflict. For most of her life, the historic district where she works, Hamar Weyne, has been affected by recurrent cycles of violence and shelling. With her grown children living abroad, she could easily move to a more peaceful life. But she chooses to stay.

“This is my home, and this is where I am needed. I am here for my team, and all the children.”

Ongoing determination

Looking up at a picture of her husband, who died many years ago, Mama Ayesha considers the determination and courage that drives her, Bella, and thousands of their fellow health workers to protect every since one of Somalia’s children. Behind her thick wooden desk, she is no less committed than when she began her career. “If I had to do it again it would be my pleasure.”

Bella has a similar professional attitude, combined with the care and technical skill that make her a talented vaccinator. Returning to her stand below a shady tree, she greets the mothers lined up with their children. As she carefully stains the finger of the first small child purple, showing that they have been vaccinated, she grins.

“I am the mother of all Somali children. I am just doing my job”.

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Health

‘You have dark skin and you are beautiful’: the long fight against skin bleaching

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Amira Adawe has just arrived at a Somali-American community radio station in Minneapolis where she hosts a weekly call-in show called Beauty-Wellness Talk. After peeling off her winter jacket, Adawe slides a pair of headphones over her crown of dark, short curls. “Hello? As-Salaam-Alaikum,” she says into the foam mouth of her studio microphone. An anonymous stream of listeners starts calling in to confide about a subject that is deeply personal and also taboo — skin bleaching.

Adawe is a Minnesota-based public health researcher and educator who works as a manager in Gov. Mark Dayton’s Children’s Cabinet. In 2011, while a graduate student and health educator with St. Paul-Ramsey County Public Health, Adawe proposed a study to investigate how Somali women use skin bleaching creams in their daily lives. Growing up in Mogadishu and Minneapolis, Adawe knew that skin lightening was widespread in her community.

“A lot of it ties to colonization,” Adawe says. “Certain skin colors were more accepted in the society. But through the years, it became so embedded in the culture to where it’s become normal. If you’re light-skinned, you’re more accepted,” she says.

She had trouble finding women who were willing to be interviewed. Adawe says there’s a stigma around admitting to skin bleaching. “Women don’t want other women talking about them. They want to pretend that this is their natural color,” she says.

Adawe suspected that the fast-acting creams contained toxic chemicals, and she was right to be suspicious. Out of 27 different creams tested by Minnesota researchers as part of Adawe’s study, 11 contained mercury levels ranging from 4.08 up to 33,000 parts per million (ppm). (The U.S. Food and Drug Administration only allows mercury in amounts of less than one part per million in most cosmetics.)

The FDA classifies skin whitening creams as both a cosmetic and a drug. According to FDA spokesperson Peter Cassell, the “use of mercury in skin-bleaching preparations and other cosmetics, with few exceptions has been prohibited in the U.S.” since 1973.

“The FDA has been aware of mercury as a potential allergen, skin irritant and neurotoxin for decades,” Cassell says.

The seven Somali women Adawe interviewed for her study reported mixing several different creams into one concoction and storing it in the refrigerator. Some slathered the cream mixture over their bodies multiple times a day, even while pregnant or breastfeeding. These findings alarmed Adawe. The possibility that children or developing babies could potentially ingest mercury through breast milk or contaminated food or water was especially concerning.

Skin bleaching products can also contain steroids, which thin the skin, as well as hydroquinone, a suspected carcinogen that is banned in some countries.

“That is a really huge public health issue. That mercury vapor alone can expose everybody in the home, even people who visit. That was really shocking to me,” Adawe says.

Despite FDA regulations, toxic skin lightening creams are accessible in the United States. The products get smuggled past borders through personal luggage and can be found in ethnic markets and also online.

A global market

Globally, skin bleaching is a multibillion-dollar business. According to a 2017 market research study by Global Industry Analysts, the market for skin lightening products is anticipated to exceed $31 billion by 2024, with the Asia-Pacific region representing the fastest-growing market.

Adawe was surprised to learn that skin bleaching is such a global phenomenon. “I was so focused in the Somali community and other African communities that I didn’t know this was happening in other places,” she says.

Seventy-seven percent of women in Nigeria use skin lighteners, more than anywhere else in the world, the World Health Organization reported in 2011. In 2004, nearly 40 percent of women surveyed in China, Malaysia, the Philippines and South Korea reported using use skin lighteners, and in India, 61 percent of the dermatological market is comprised of skin lightening products, according to the same WHO report.

As Adawe continued to sound an alarm about skin bleaching, she realized that warning people about the health risks of toxic chemicals wasn’t necessarily enough to change behaviors. So long as the belief that lighter skin is inherently preferable persisted, women would likely keep bleaching, she thought. So she decided to tackle the issue from another direction.

Radio outreach

Adawe launched her radio show, Beauty-Wellness Talk, in November 2017. It’s a platform where the Somali community can talk openly about skin lightening without fear of being outed or stigmatized. From the beginning, Adawe made it clear that listeners could call in anonymously.

On a recent wintry Saturday afternoon, Adawe’s in-studio radio guest is Hibat Sharif, an educator and outreach worker with St. Paul-Ramsey County Public Health. They’re discussing how parents can build healthy self-esteem in their children, especially girls.

“We’re African, we’re Somali, we have dark skin,” says Sharif in a mix of Somali and English. “Our skin is melanated. It provides us with a lot of benefits. Why are we telling our girls: You’d look so much better if you were lighter? It’s important not to put those toxic stereotypes in your child’s head.”

Sharif cautions listeners about words that reinforce harmful stereotypes, such as cadey, a Somali expression of endearment.

Questioning word choices

“That word is really heavy,” explains Salma Ali, 19, a Somali-American college student who grew up in the Twin Cities area. Her friend, Yusra Abdi, also 19, agrees.

“It means whitey. Like white girl,” Abdi says. “You will never hear anybody say madoowey, which is ‘darky.’ If anything, that would be an insult in the Somali language.”

Colorism is personal for both Abdi and Ali, who describe themselves as dark-skinned. “Growing up, if somebody in my family was mad at me, they’d call me koor madow, which means, ‘Hey darker-skinned,’ ” explains Ali. “And it was an insult,” she adds.

Family members pressured Ali and Abdi to use lightening creams. When Abdi was in middle school, her mother gave her a lightening gel to help with acne scars. After about a month, she noticed her complexion had lightened and her acne marks had worsened. She decided to stop.

“When women use these products, it comes from a very deeply ingrained place of insecurity,” Ali says. “It’s because of what society pushes on us to believe. Across all cultures, darker-skinned people have self-esteem issues.”

Both Ali and Abdi say that they’ve seen Somali women obfuscate their use of skin lightening products by describing the practice as cleaning their skin or helping it to glow.

“I’ve had my aunts come up to me telling me, ‘Salma you’re not ugly, it’s just that your skin is just a little dirty. You need to clean it up. I got some products from China. I’mma hook you up.’ I’m like, ‘How is my skin dirty? I’m taking care of myself.’ But because of the fact that I have darker skin, I’m seen as ugly. And that’s just part of the way we’ve all been socialized.”

Changing attitudes

Adawe wants to disrupt that socialization, but changing ingrained behaviors and perceptions takes time. She sees medical providers as key partners in actualizing systemic change. Over the past six and a half years, Adawe says she and her colleagues have trained more than 100 clinic systems, with a focus on pediatric care.

She advises doctors and nurses not to ask patients about skin bleaching directly, but instead to probe slowly and with sensitivity about the different lotions women use. Nurses who conduct home visits with pregnant women can play an especially important role since they build a relationship with mothers over time and can see if skin lightening products are being kept in the home.

On a Thursday afternoon in mid-February, Sharif, the outreach worker, stands in front of a class of Somali, Hmong, Nepalese and Karen adult students and their translators. The students are all new arrivals to the United States. The class hums with a staccato melody of different languages.

“The No. 1 thing you can do is to stop using these products,” Sharif tells the students in English and Somali. “The biggest takeaway from this presentation is that every shade is beautiful,” she says.

A Somali man in the class says it’s been ingrained in him to gravitate toward lighter-skinned women.

Sharif laughs and says, “The change needs to start with you. It really does.”

She asks him if he has dark-skinned daughters, and the man says he does.

“What does that say to your daughter?” Sharif says when reflecting on the exchange after class. “Do you want a guy to treat your daughter that way where he tells her she’s not beautiful because she’s dark?”

“You have dark skin and you are beautiful”

Salma Ali says she had low self-esteem when she was younger. It’s something she thinks a lot of darker-skinned young women experience. Things shifted in high school when she started reading books by black women writers and found inspiration in seeing black women actors play strong leading roles on television.

Social media helped Ali and Abdi to find affirming messages about black beauty as well. Both of them are fans of black women beauty vloggers like Jackie Aina and Alyssa Forever whose YouTube channels attract millions of views. They credit Rihanna for leading the way with releasing a makeup line with many different shades for darker-skinned women.

“It can really change the way you think about yourself and the way you see the world,” says Ali about social media. “I really do have hope for this next generation of darker-skinned women who want to be represented. Who want to be uplifted and celebrated for our skin. You have dark skin and you are beautiful. I really want that to be a cultural norm,” she says.

Adawe says that after working on this issue for nearly seven years, she’s starting to see hints of change. More people are talking, disagreeing and questioning colorism out in the open. “All of that didn’t exist before,” she says. “All of that helps.”

Adawe is now writing a curriculum for teachers. Her next step is to take the conversation into the schools.

“This is going to need systemic change,” says Ali, who is studying sociology with a focus in health care and a minor in public health and neuroscience at the University of Minnesota. “I feel like it’s something that’s so within us that it’s going to take a while. It’s going to take some work.”

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Crime

Somalia’s first forensic lab targets rape impunity

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AFP — Garowe – The new freezers at Somalia’s only forensic laboratory can store thousands of DNA samples, although for now there are just five.

The big hope is that they could be the start of a revolution in how the troubled Horn of Africa country tackles its widespread sexual violence – provided some daunting hurdles are overcome.

The first sample arrived at the start of the year taken on a cotton swab from the underwear of a woman, a rape victim from the village of Galdogob.

It was wrapped in paper and driven 250km to the Puntland Forensic Centre in Garowe, capital of semi-autonomous Puntland, slipped into a protective glass tube and placed in one of the three ultra-low temperature fridges.

If DNA ID can be teased from the sample, this would be a crucial step in convicting the woman’s rapist.

No longer would it be a case of he-said-she-said, in which the survivor is less often believed than the accused. Two decades of conflict and turmoil have made Somalia a place where lawlessness and sexual violence are rampant.

“Now, people who have been raped hide because they don’t have evidence,” said Abdifatah Abdikadir Ahmed, who heads the Garowe police investigations department.

But with the lab, he said, “it’s a scientific investigation. There are biological acts you can zero in on.”

Challenges

Not yet, however.

Abdirashid Mohamed Shire, who runs the lab, has a team of four technicians ready but is awaiting the arrival of the final pieces of equipment.

Their work to provide the evidence that might convict or exonerate is yet to begin.

And the pressure is on. The freezers mean the DNA samples can be safely stored for years but Somali law allows a rape suspect to be held for a maximum of 60 days. Shire needs the analysis and identification machines urgently so that, as he put it, “justice will be timely served”.

The laboratory, partly funded by Sweden, was launched last year after the Puntland state government enacted a Sexual Offences Act in 2016, which criminalised sexual offences and imposed tough penalties.

But technology alone will not solve Somalia’s many judicial weaknesses.

The DNA sample from Galdogob, for example, was stored in unclear and unrefrigerated conditions for five days before being sent to the lab, meaning a defence counsel could potentially argue the DNA evidence had been tampered with.

Human rights lawyers worry the new lab might backfire for this reason.

“A lot of thought needs to be given to how the chain of custody can be preserved in these kinds of cases,” said Antonia Mulvey of Legal Action Worldwide, a Kenya-based non-profit organisation.

More fundamental still is the failure of Somalia’s police to take sexual assault cases – and their jobs – seriously.

Corruption is rife, with a legal advisor to Puntland’s justice ministry saying officers “meddle” in cases, undermining them for personal gain.

“My concern is that the corrupted system could not make a sure success of the lab,” the advisor said, requesting anonymity to speak candidly. “Investing in the lab is good, but we need to think about the preconditions.”

The UN Population Fund (UNFPA) which helped pay for the lab is trying to address this by running training programmes for dozens of the Garowe police on sample collection, gender violence investigations and documentation.

But, the legal advisor cautioned that donors can only do so much.

“The issue is more complicated than training police. It relates to the political commitment of the government. UNFPA can train police but who will pay those you train? Are they given power to do the work?”

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