![Kroo Bay is a slum in Sierra Leone's capital Freetown. Roughly 7,000 people live on the densely populated 50-acre area with no access to electricity, running water or sewage system. Harsh living conditions like these often lead to child neglect, violent abuse or sexual exploitation. [Olivia Acland/Al Jazeera]](https://www.aljazeera.com/mritems/Images/2019/7/21/a1801b09df8c4d5eb11ce916e23e4541_8.jpg)
Freetown, Sierra Leone – Sierra Leone witnessed a decade-long civil war and the worst Ebola outbreak ever, leaving hundreds of thousands traumatised in one of the world’s poorest countries.
The World Health Organization (WHO) estimates that 10 percent of the country’s population of seven million has mental health problems. Due to an unknown number of unreported cases, the reach of depression, psychosis or post-traumatic stress disorder (PTSD) is likely to be higher.
Psychological help for these disorders is hardly available as there are only two practising psychiatrists in the country.
With more than half the population living in extreme poverty, daily hardships and misery can turn into what scientists call “toxic stress” and trigger or amplify mental health problems.
For children growing up in adversity, this “toxic stress” can have damaging effects on learning, behaviour and health throughout their life.
Inaccessible health services and spiritual beliefs drive those in need to the shrines of 45,000 traditional healers.
For a long time, there was a lack of political will to change the situation.
But now, individuals, activists, medical professionals and NGOs are coming together to help the country come out of the dire situation.
This project has been funded by the European Journalism Center (EJC) via the Global Health Journalism Grant Programme for Germany.
![Despite the difficult conditions, people are getting on with their lives in the toughest of circumstances. [Olivia Acland/Al Jazeera]](https://www.aljazeera.com/mritems/Images/2019/7/21/1537c3fb827746c492e33720703ee22b_8.jpg)
![For children growing up in adversity, this 'toxic stress' can have damaging effects on learning, behaviour and health throughout their life. [Olivia Acland/Al Jazeera]](https://www.aljazeera.com/mritems/Images/2019/7/21/0ba26443c1424a8f9303ff075a1b7f98_8.jpg)
![A school by an NGO We Yone Child (Our Own Children) for 200 children was built with wood and corrugated iron. [Olivia Acland/Al Jazeera]](https://www.aljazeera.com/mritems/Images/2019/7/21/e160f27796604d7fa4c403f783881fdb_8.jpg)
![The school's founder, Santigie Bayo Dumbuya, was 12 when rebels forced him to fight in the civil war. After the war, going back to school helped him overcome his trauma. 'The people here don't see education as a necessity,' says Dumbuya. 'But it's the only way out.' [Olivia Acland/Al Jazeera]](https://www.aljazeera.com/mritems/Images/2019/7/21/08037101980b4e479a6043b71590b321_8.jpg)
![The Ebola outbreak hit the country in 2014. In the following 18 months, roughly 8,700 people were infected, nearly half of them died. Thousands of kids were orphaned. [Olivia Acland/Al Jazeera]](https://www.aljazeera.com/mritems/Images/2019/7/21/9a71ca0f752b46b78d8b7603ee2a101a_8.jpg)
![Health services are almost inaccessible and medication is hardly available. Patients in the country's only psychiatric hospital are still being chained. 'The situation is quite unfortunate,' says Stephen Sevalie, one of the only two psychiatrists practising in the country. 'People are not treated in the most humane way and their rights may be violated regularly. But I don't think it is deliberate. It's just that the resources are not there to address the problems.' [Olivia Acland/Al Jazeera]](https://www.aljazeera.com/mritems/Images/2019/7/21/4411cdf3114943f48e1a0a2cfb29e9e5_8.jpg)
![Inaccessible health services and spiritual beliefs drive those in need into the shrines of 45,000 traditional healers. Their role is ambivalent. In a country without comprehensive healthcare, they are the go-to people for everyday problems. [Olivia Acland/Al Jazeera]](https://www.aljazeera.com/mritems/Images/2019/7/21/2fe4a101a3a3460cabedc426f70ce13b_8.jpg)
![Healer David Conteh mixes pastes and tinctures out of powders, roots and leaves to drive away evil spirits, he says. [Olivia Acland/Al Jazeera]](https://www.aljazeera.com/mritems/Images/2019/7/21/4f39bc4e4f694a81be1fcbc982cf0b4e_8.jpg)
![Mocked as 'crazy' men, mentally ill outcasts roam the city. In the case of Ibrahim, his family brought him to healer Conteh. As Conteh explains, Ibrahim used to be a teacher until the day his girlfriend's father cursed him. [Olivia Acland/Al Jazeera]](https://www.aljazeera.com/mritems/Images/2019/7/21/4a1b9f160165416fa3ad4bc5c3da1d80_8.jpg)
![Rebecca Esliker, director and only employee at the Institute for Psychology at the University of Makeni in central Sierra Leone, criticised the healers. In her research, she speaks of a 'medical war the country is currently fighting' between modern medicine and what she calls myths and beliefs. 'They [healers] beat them [the patients] mercilessly because they say that's the way to get rid of the devil.' [Olivia Acland/Al Jazeera]](https://www.aljazeera.com/mritems/Images/2019/7/21/3dcd569d1e7c4ee693311ceb41b1d828_8.jpg)
![Mary Kargbo works in the Mental Health Department at Koidu Community Hospital. She is one of the 21 mental health nurses that were trained and sent to 14 districts to provide basic treatment. [Olivia Acland/Al Jazeera]](https://www.aljazeera.com/mritems/Images/2019/7/21/7bc444ebdf18446f94099be1cc4d15ab_8.jpg)
