"Every day, I had to find a few dinars to survive. I couldn't stand it any more. I decided to commit suicide. I went to buy gas, I poured it on myself, set it on fire, and ran to the main road of the city."
Karim Hamdi, 39, remembers clearly his act of despair one evening in November 2011.
He was saved by family and neighbours. One of Mr Hamdi's brothers managed to smother the flames with a blanket and he was taken to a regional hospital by the civil defence, who arrived an hour and a half after they had been called. He was in a coma for 10 days but survived, although the injuries he suffered require expensive treatment to this day.
The father of a 9-year-old girl has always had a hard life. His entire family live in a modest, one-storey cement house in Raqqada, a southern suburb of Kairouan, a town in Tunisia's central region. One of his brothers migrated illegally to Italy four years ago and has not been heard from since. Mr Hamdi dropped out of school at the age of 13 and started working in seasonal and temporary jobs: as a bricklayer, a watermelon picker — whatever he could find in a region where work is scarce.
Mr Hamdi’s case is one of hundreds of self-immolations in Tunisia since the revolution in 2011. The death by self-immolation of Mohamed Bouazizi, a street vendor in the central town of Sidi Bouzid, on December 17, 2010 is considered a trigger for the protest movement that led to the fall of the president Zine El Abidine Ben Ali on January 14, 2011.
The phenomenon has not stopped since. Seven years after Bouazizi’s death, which moved the entire world, self-immolation has become the second most common suicide method in Tunisia, with a case every three days in 2016, according to the health ministry.
Mehdi Ben Khelil, a doctor at the forensic department of Charles Nicolle Hospital in Tunis, has published many studies on suicide in Tunisia and has been studying the self-immolation phenomenon since 2012. For him, there is no doubt the increase is linked.
“It is certain that there was a Bouazizi phenomenon. We noted a preferential increase in immolations. Before the revolution, self-immolations were the fourth suicidal mode. Now it is the second one with an increase of more than three times. It's really significant," he says.
A widely publicised suicide, such as Bouazizi's, is known to be followed by a spike in copycat acts — a phenomenon known as "the Werther effect". But Dr Ben Khelil says this is an "overly simplistic explanation" because the Werther effect is limited: "Peaks are usually observed two to four weeks after the widely publicised event, and reduce in the three to six following months." In Tunisia, the trend has not declined seven years later.
Dr Ben Khelil’s work also shows a correlation between the rise of suicides in general since the revolution and the socio-economic context. He refers to studies on suicides after major societal changes, such as the dissolution of the USSR. “With the revolution, many hopes were born. People were hoping to be heard, and their social situation would improve."
Unemployment in Tunisia remains high, reaching 15.3 per cent in the third quarter of 2017. Regional disparities persist. In 2015, the poverty rate in the governorate of Kairouan was 34.9 per cent, compared with 5.3 per cent in the region of Tunis.
In El Maksouma, another southern suburb of Kairouan, Hafedh Haddaji, 33, has recently returned from a specialist hospital in Ben Arous, near Tunis, where serious burns cases from all over Tunisia are treated. His wife Dorsaf committed suicide by immolation at the end of July.
"She was on fire, I threw myself on her, and caught her to save her. At that moment, I thought about the poverty we were living in, and I told myself that if I couldn’t save her I would rather die with her."
Already very poor, the couple found life even more difficult after the birth of their first child two years ago. Driven to desperation by their daily struggle to provide milk and diapers for their son, Mr Haddaji's wife finally decided to take her own life.
Mr Haddaji, who is still recovering from his wounds, blames the authorities. Besides odd jobs, a few rows of olive and fruit trees behind his house are small but vital source of income.
“Water does not reach the village. Some olive farmers have diverted the water supply to irrigate their fields. We demonstrated, but the authorities did nothing. They are with them.”
Even the dramatic death of Mr Haddaji’s wife did not move the authorities.
His brother Atef regrets the lack of help for people with psychological problems. “She had suicidal thoughts," he says of his late sister-in-law, "and my brother still has some, and nobody is there to help them.
"When we go to the regional hospital, it’s only if we have real, physical injuries,” he says.
“There is a lack of psychiatrists in the inland regions, so we train people in different fields who can be in touch with people at risk — in the schools or occupational physicians,” says Fatma Charfi, a child psychiatrist and coordinator of the Tunisian Technical Committee Against Suicides, which is affiliated with the health ministry.
The committee work on several aspects of suicide prevention: training "sentinels" to identify people at risk; teaching people how to care for suicidal people; creating public awareness; and setting up an epidemiological information system to better understand the phenomenon.
Mr Hamdi says he never received any psychological support or help from the authorities after attempting suicide six years ago.
"Apart from more responsibilities to undertake, with my daughter to raise, and 7,000 dinars [Dh10,300] of credit to repay to the hospital, what I did hasn’t changed anything,” he says.
“My burns still make me suffer a lot. Self-immolation is not a solution. But at the same time, there are no solutions in our cases.”