Somaliland has only one mental hospital in the entire country. Many patients in the hospital suffer from post-traumatic stress syndrome from the civil war with southern Somalia, which eventually led to secession and, still after 18 years, de-facto independence. Overuse of khat, a narcotic leaf that is normally chewed throughout the day, has been said to lead to more cases schizophrenia. However, given Somaliland's unrecognized status, the state's coffers are stretched thin, with little available resources for social services such as health care. That state's total budget is roughly 50 million dollars a year for a population of 4 million, or $12.5 USD per citizen annually.