While the capital, Port-au-Prince, bore the brunt of the damage, subsequent challenges and setbacks—including an ongoing cholera outbreak—have left few untouched by the quake’s ripple effects.

The damage isn’t just physical. Aid workers say mental-health needs skyrocketed in the months after the earthquake, but the Haitian government was not equipped to meet the demand, with fewer than 20 practicing psychiatrists working in state-run facilities at the time. The suddenly overwhelming need for emergency and primary care siphoned even more resources away from mental-health care.

In April, Italian photographer Fabio Bucciarelli spent 10 days photographing the patients of one of the country’s two state-run mental hospitals, Défilé de Beudet in Croix-des-Bouquets, outside Port-au-Prince. His pictures show the bleak conditions some of the country’s most vulnerable citizens face every day. “When you imagine a hospital, you think of white walls with clean beds,” says Bucciarelli. Instead, Haiti’s only hospital dedicated to helping the chronically mentally ill “looks like a prison.”

The 150-bed facility is home to about 250 men and women, Bucciarelli estimates, many of whom suffer from severe psychiatric disorders. Patients sleep on concrete slabs in barred cells, which Bucciarelli refers to as cages. In the week and a half he spent at the hospital, Bucciarelli saw only one doctor but never witnessed him, or any of the nursing staff, interact with the patients. In that same period of time, Bucciarelli saw only a single patient receive any visitors. The director general of Haiti’s Ministry of Public Health told Time in an e-mail that the government intends to increase funding for mental-health care but did not provide further details.

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