An indepth interview on MSF's decision to withdraw completely from Somalia. An MSF General Director, Arjan Hehenkamp, speaks to Somali journalist Hamza Mohamed.
Why were we there?
- Armed conflict
- Endemic/epidemic disease
- Healthcare exclusion
- Dadaab: MSF forced to close health posts and evacuate staff amid escalating insecurity
- MSF President: Why MSF decided to leave Somalia
- Somalia: MSF forced to close all medical programmes
This is an extract from our latest Activity Report, looking back on our work in the previous year.
In August, Médecins Sans Frontières/Doctors Without Borders (MSF) closed all of its projects in Somalia after 22 years of continuous operations.
Leaving Somalia was an extremely difficult decision to make. A series of violent attacks on MSF personnel took place with the tacit acceptance – or active complicity – of armed groups and civilian authorities.
The minimal conditions necessary for operations were not respected, and hence MSF ceased supporting health facilities in Somalia by mid-September 2013, handing them over to government entities and humanitarian organisations where possible.
Conflict, disease, natural disasters
Although the humanitarian situation has improved since the nutritional crisis of 2011, the ongoing conflict in the south-central regions, together with natural disasters and seasonal outbreaks of disease, put huge strains on the weak healthcare system.
In many parts of Somalia, access to healthcare is extremely limited and mortality rates for pregnant women and young children are among the highest in the world.
Hundreds of thousands of Somalis remain displaced inside the country and in refugee camps across Somalia’s borders, living a precarious existence exposed to many forms of violence and extortion.
In and around Mogadishu
Nine kilometres northwest of Mogadishu, in Dayniile, MSF supported a 60-bed hospital with an emergency room, operating theatre, intensive care unit, paediatric unit, feeding centre and maternity facilities.
The team performed 646 surgical procedures and over 8,272 consultations in 2013.
MSF’s 40-bed hospital in the Jaziira district of Mogadishu, which mostly catered to displaced populations, carried out some 25,700 consultations and 2,200 hospital admissions this year, and treated over 330 severely malnourished children.
To improve access to quality basic and specialist healthcare for children, MSF ran the only paediatric hospital in Mogadishu, in Hamar Weyne.
The hospital had isolation wards for children suffering from measles or acute watery diarrhoea and a nutrition centre that treated 3,800 children between January and August.
MSF also ran health clinics for displaced populations and residents in the Wadajir, Dharkenley and Yaaqshiid districts.
These focused on maternal and child health and were able to respond to sudden outbreaks of disease such as cholera, treat peaks of malnutrition through feeding programmes, and participate in mass vaccinations against polio, which had made a resurgence in the country.
Over 100,000 consultations were carried out at these health facilities prior to MSF’s departure. All drugs and supplies from these clinics were donated to other aid organisations in Mogadishu, and the Dharkenley clinic has continued operations.
MSF began supporting Dinsor hospital in Bay region in 2002. It is the main referral hospital for the entire region, and is especially active in providing maternity services and treating malnutrition, tuberculosis (TB) and kala azar (visceral leishmaniasis).
In 2013, the team at the 60-bed hospital performed 16,208 outpatient consultations, around 1,458 antenatal consultations, and treated more than 680 malnourished children.
Lower Shabelle region
The Afgooye district hospital serves displaced people and residents of the Afgooye Corridor with an outpatient and 30-bed inpatient department, emergency room, maternity facility and an outpatient feeding programme.
Between January and September, the hospital conducted 11,408 medical consultations, admitted 738 patients to its wards and assisted the delivery of 953 babies. The Qatar Red Crescent Society assumed support of the hospital following MSF’s withdrawal.
Middle Shabelle region
MSF provided outpatient care, maternal and child health services, vaccinations and nutritional support at the Jowhar maternity hospital and health centres in Kulmis, Bulo Sheik, Gololey, Balcad and Mahaday.
The Mahaday and Gololey facilities also treated TB. Mahaday clinic closed in March 2013 due to insecurity and the other clinics were handed over to the International Medical Corps (IMC) in September.
More than 60,000 consultations were performed, 1,040 deliveries assisted, and 8,447 women and children received vaccinations.
MSF ran projects in two referral hospitals in the divided city of Galkayo. In the Ministry of Health’s referral hospital in Galkayo North, MSF offered paediatric outpatient and inpatient care, maternity services, feeding programmes and TB treatment.
MSF teams carried out 33,824 consultations in 2013. In addition, MSF ran a satellite programme for TB treatment in Burtinle in Nugal region.
In the hospital in Galkayo South, MSF provided surgery and paediatric care, maternity services, nutrition programmes, TB treatment and immunisations.
Two mobile clinics also provided primary healthcare in Galmudug region. Some 44,071 people received assistance through the hospital and the clinics between January and September.
Management of the hospital was passed to the Mudug Development Organisation, which now works in partnership with two international medical organisations to continue these vital services.
MSF’s hospital in the small rural town of Marere served as the referral hospital for the whole of Middle and Lower Juba and Gedo regions, providing basic and specialist healthcare, TB treatment, nutritional services and emergency obstetric care to a huge catchment population.
In addition, mobile teams covered the towns of Ketoy and Osman Moto and delivered basic healthcare to children under 12 and nutritional care to malnourished children under five.
A small fixed clinic in Jilib had facilities to treat malnutrition, measles and cholera. Over 68,000 medical interventions were carried out through this programme between January and August.
In the port city of Kismayo, MSF ran an inpatient nutrition programme for children under five, with special wards for those suffering from measles and cholera.
This facility opened during the nutritional crisis of 2011 and saw a steady stream of children thereafter: 5,183 received treatment between January and September 2013.
The International Committee of the Red Cross opened a similar structure at Kismayo hospital in October to compensate for MSF’s withdrawal.
MSF had been supporting the inpatient, maternity and surgical facilities of the 160-bed Burao hospital in the Togdheer region of Somaliland since 2011. Prior to its withdrawal, MSF conducted 775 surgical interventions, admitted 1,602 people to the inpatient department and assisted in the birth of 720 babies.
MSF also intervened in three prisons in Somaliland, carrying out medical consultations, improving water and sanitation facilities and distributing relief supplies.
At the end of August 2013, MSF had 1,188 staff in Somalia. MSF worked in the country from 1991 to 2013.
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