In the tangled corridors of Amanuel Mental Specialised Hospital, 29-year-old Wondwessen Belete's footsteps echo stories of trauma and resilience. The Hospital, in the busy vicinity of Congo Street, is a reminder of Ethiopia's troubled past and a symbol of its mental health challenges today. It is the oldest facility in the country.

Amanuel's history is intertwined with the country's turbulent past.

Initially a general hospital built on a 1.4hct plot, its purpose shifted post-1941, after the traumatic Italian occupation, addressing the mental health impacts of the Rodolfo Graziani-induced three-day massacre in Addis Abeba. Now, under the aegis of the Ministry of Health, the facility juggles a budget of 198 million Br, with an influx of over 60,000 patients annually. Close to 33 million Br is sourced from its services, having 240 beds distributed across 11 wards.

Wondwessen was one of these patients admitted after experiencing a severe episode of alcohol-induced self-harm. He partially severed his two fingers in an alcohol-fueled rage following disagreements with his sister.

"I was heaving in rage," he told Fortune.

His family refused to give him a portion of the revenues from selling his minibus, worrying that he would spend it on drinks. He recalled spending three weeks on the streets of Kolfe Qeranyo District before family members took him to a facility. He voluntarily sought refuge in the Hospital's substance abuse ward, where he stayed for 10 days. The Hospital, according to Wondwossen, provides much-needed relief from outside stresses while easing family's concerns. The once-energetic taxi driver now finds solace in strolling the compound grounds, attempting to steer clear of the afflictions that haunted him.

"I need a few sober days," Wondwossen confided, a fresh bandage on his left hand visible, which has yet to recover from the damage. "I'll relapse if I leave now."

His words resonate with the silent pleas of many like him, seeking a haven in one of the country's two public psychiatry hospitals.

Yet, Amanuel’s story is not one of unbridled success. As Gezahegn Gamo, the hospital's head of public relations, somberly puts it, "No significant expansion has occurred since its foundation.”

The 46 general practitioners and 13 psychiatrists are far from adequate in addressing the growing demand, while many arriving for inpatient treatments were returned from the doors. A recent road expansion plan by the City Administration was no good news for staffers like Gezahegn. They fear it will slice a piece from the compound.

"It [the premises] would have benefited from trees and a greener atmosphere instead," he told Fortune.

The Hospital is not alone in this languishing state; the broader mental health landscape reflects a similar picture of unmet needs and resource scarcity. The statistics paint a daunting picture, although a mere five percent of studies focus on mental health in Ethiopia. There is a glaring gap in comprehensive data, even as indicators point towards a surge in self-harm over the past two decades.

A study Getachew Mullu and Amanuel Lemu conducted in 2018 revealed approximately 21.5pc of the population struggles with common mental health issues. Yet, mental health services are conspicuous by their absence. Only a quarter of health facilities out of the 400 hospitals and 3,706 health centres provide mental health services. Urban centres like Addis Abeba might fare slightly better, but regional states such as Benishangul Gumuz and Gambela remain direly underserved.

With a health worker-to-patient ratio half the continental average and a fourth of the number recommended by the Sustainable Development Goals (SDG), Ethiopia has a long road before realising universal healthcare.

Wude Shiferaw, a focal point person on mental health at the Disease Prevention & Health Promotion Directorate of the Addis Abeba Health Bureau, disclosed that the best way to address mental health concerns is by deploying professionals at every health service provider in the city. This is part of the decentralisation strategy the Ministry of Health laid out in successive national plans.

"We're continuously training and assigning new staff at every health centre," she told Fortune.

With around 120 specialised psychiatric doctors vying to provide services for over 100 million people, a troubling fact looms as the percentage of mental health professionals stands at less than one per cent of the total workforce.

The third-year psychiatry resident from Dila University, Bezawit Mandifraw, has had a lifelong dream of working in the mental health sector, coming close to completion as she approaches her final year. While she has had experience at her University's psychiatric wing, the scale of Amanuel has reinvigorated her desire to pursue further studies.

"I want to be able to do more," she told Fortune.

Within the walls of Amanuel, Endale Mamo, one of the 372 professionals, has been a beacon of hope for many. As a psychologist and counsellor for six years, he curates the art therapy centre – a space filled with profound artworks, each echoing the turbulent journey of its creator. Endale astutely observes the unaddressed traumas manifesting as substance abuse and suicidal tendencies.

"A teenager is less likely to handle the impact of stressors," he told Fortune, pointing to the alarming university entrance results.

Addressing this underlying trauma is at the heart of a pilot project helmed by Tigist Waltenigus, co-founder of Erq Ma'ed Psychosocial Support Service. Her initiative aims to provide psychological support to students, often an overlooked demographic.

"Teenagers barely get psychological support from their schools," she said.

In a country daunted by myriad challenges, including a prolonged civil war, droughts, inflation, and regional conflicts, the burden of mental health often remains unaddressed.