Kalakla, Sudan - Two women lay wrapped in blankets on a wooden bed as Sheikh Abdur Mahmoud shouted into their ears to scare away the demons they said were ruining their personal lives.
Mahmoud recited verses from the Koran through a plastic tube and hit the women on the legs with a whip. One screamed and wrung her hands.
"I could hold sessions with around 50 people but it is better to have less people so you can concentrate on each one," said Mahmoud, a large man wearing a white prayer cap and robe, and a beard reaching down to the top of his chest.
Islamic spiritual healers in Sudan say more people are coming to them every day seeking cures for problems ranging from marital strife and migraines to leprosy and cancer.
Officials from international health organizations say money and familiarity lie behind reliance on spiritual healers in Sudan, where about 70 percent of the population are Muslim.
The United Nations Human Development Report says there are only 16 doctors for every 100,000 people in Sudan, Africa's largest country which has been crippled by more than 20 years of war in the south and a festering conflict in western Darfur.
The violence has left the country in ruins: hospitals, schools and roads need to be rebuilt in the south while the Darfur war has driven an estimated 2 million people from their homes and killed about 180,000, according to U.N. officials.
There are shortages, too, in the capital Khartoum.
Health organization officials say there are only about 2,500 doctors, many with basic training and little experience, in the city of 5 million.
Nearly all health services must be paid for privately and medical insurance is very rare, they say.
REMOVING DEMONS
In Mahmoud's house in a suburb of Khartoum, 15 km (9 miles) from the center of the city, the women, who gave their names as Mariam and Aisha, lay in a bamboo-covered corner of the open-air compound.
"Weak, weak," Mariam said while writhing on the bed and speaking in a high-pitched voice. "I was a big demon, but now you have made me very small," she said, apparently referring to her four sessions with Mahmoud.
She later said she could not remember being hit with the whip or what she said.
"The demons come in various forms. They can be animals that attack people or diseases like leprosy and cancer and they can also cause problems in relationships between couples," Mahmoud said.
Aisha says she became possessed after her ex-husband went to a black magician to prevent her from marrying again. Mariam says a jealous colleague was responsible for creating her marital problems. Both women said they suffered headaches and vomiting.
"People do not discuss their problems any more. These days, if someone has a problem with someone else they go straight to a witch-doctor to put a curse on them," said Aisha, a secondary school teacher.
Mahmoud said many people go to "black magic" witch-doctors for help in afflicting business rivals, relatives or spouses with demons. He said his patients paid whatever they could afford for his services.
CULTURE AND ECONOMICS
A health official with an international organization, who did not want to give his name, said people turned to spiritual healers for cultural and economic reasons.
"People will have known the traditional healer for many years, trust would have been built up. The traditional healer probably lives in the same area, and is known by the community," he said, adding that doctors were usually based in town centers, meaning many people had to travel to get to them.
For many, the economic argument is the most seductive.
"Traditional healers take payment in kind, usually food or other products made by the patients. For many people in rural areas, spending on health is not a priority. They would rather spend what they have on land or something else that generates income," the health official said.
Aid officials say Sudan needs to drastically improve its health care provision. Health spending per person is about $3 in most of Sudan, increasing to $17 in conflict zones where aid organizations provide facilities.