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
- MSF President: Why MSF decided to leave Somalia
- Somalia: MSF forced to close all medical programmes
- Somalia: Kidnapped MSF staff released after 644 days
This is an extract from our latest Activity Report, looking back on our work in the previous year.
Despite some improvements in security during 2012, the majority of people in Somalia are still living in crisis.
Two decades of civil war have inflicted violence, displacement and loss of livelihood on the people of Somalia. Médecins Sans Frontières/Doctors Without Borders (MSF) continues to work in areas controlled by the government as well as areas held by opposition groups.
Most of the country’s healthcare infrastructure has been destroyed, leaving only one doctor in the country for every quarter of a million people.
The nutritional crisis of 2011 in south and central Somalia further damaged coping mechanisms and caused massive internal displacement as people searched for food and security.
At the beginning of the year, MSF decided to put on hold any opening of new non-emergency projects in Somalia until the safe release of its two colleagues, Blanca Thiebaut and Montserrat Serra, abducted from the Dadaab refugee camps in Kenya on 13 October 2011 and held against their will in Somalia.
Basic healthcare in the capital
Access to food, water, sanitation, health services and shelter is irregular and insufficient in Mogadishu, where an estimated 369,000 displaced people are living.
Attacks, bombs and targeted assassinations have decreased in number, but remain frequent.
Children are suffering particularly and there is an urgent need for preventive activities such as vaccinations, as well as lifesaving emergency care. MSF supports a children’s hospital in the city, running a general ward, inpatient feeding programme and isolation units for measles and acute watery diarrhoea.
Two mobile teams travelled further afield to carry out consultations, referrals and routine vaccinations. Some 6,300 children received nutritional support, 945 were admitted for inpatient treatment and 2,480 were vaccinated against measles.
On the outskirts of the city, MSF manages 60 beds in Daynile hospital. Medical services include an emergency department, surgery, intensive care and paediatric inpatient units, a nutrition programme and maternity services.
At the end of March, fighting between pro-government forces and Al-Shabaab drove MSF to close the hospital. It was reopened in September.
Three health clinics located in Mogadishu’s Wadajir, Dharkenley and Yaaqshiid districts provide medical consultations and care for pregnant women and children to help meet the increase in need as displaced people have arrived in the areas. A mobile nutrition programme also visited six camps for the displaced in Wadajir.
Teams also ran medical clinics in the city’s Rajo, Refinery and Jasiira camps and opened two more in Howlwadaag and Xadaar in March and April, respectively.
In July and August, the clinics in Rajo, Refinery and Howlwadaag were closed. A 40-bed hospital near Jasiira camp admitted 2,000 inpatients over the year.
During a cholera outbreak in Mogadishu between May and August, teams treated 350 people for the disease.
Malnutrition in the Afgooye corridor
The Afgooye corridor, linking Mogadishu and the town of Afgooye, is an increasingly dense settlement of displaced people. MSF supports the 30-bed community hospital in Afgooye, the only health facility covering the needs of 180 villages.
The hospital offers outpatient consultations, emergency services, maternity care and an outpatient feeding programme. In 2012, staff carried out consultations with 25,640 people.
In November, MSF medical staff visited 34 camps, which host some 18,000 people. The team screened 1,530 children and treated more than 400 for malnutrition. They vaccinated children against polio, diphtheria, tetanus, measles and pertussis (whooping cough), and all children under five years of age were given albendazole, to treat worms, as well as vitamin A. Staff returned in December for follow-up.
Comprehensive care in Dinsor
Mother and child programmes in Middle Shabelle
During the second half of 2012, Jowhar and Balcad were on the front line of conflict and access became a challenge for delivery of supplies and supervision visits.
MSF staff support the maternity hospital in Jowhar, and offer mother and child healthcare, including nutrition and vaccinations, through four clinics in Kulmis, Bulo Sheik, Gololey and Mahadaay. TB is also treated in Mahadaay and Gololey. MSF runs a mother and child programme at the clinic in Balcad.
Galkayo North and South
MSF has worked in the divided city of Galkayo, capital of Mudug province, for over a decade. Teams support paediatric and TB services in a clinic in Galkayo North, which is located in Puntland, a self-declared independent republic.
A new maternity ward was opened in the clinic in December. In Galkayo South, administered by the state of Galmudug, a hospital team receives patients from both sides of the regional armed conflict. Comprehensive services include emergency, maternity and paediatric care, TB treatment and surgery.
MSF continues to run essential health programmes throughout Lower Juba region. In Marere, a hospital offers outpatient services, reproductive health and emergency obstetrics, surgery and TB treatment.
Mobile teams travelled to sites where displaced people had recently settled, offering basic healthcare and treatment for malnutrition. In Jilib, a health centre housing a measles isolation unit and providing cholera treatment offers services around the clock.
MSF also runs an inpatient nutrition programme for children under five in the port town of Kismayo, the capital of the region. The team opened emergency treatment units in response to outbreaks of measles and cholera during the year.
In May, due to worsening security conditions, MSF made the difficult decision to close its basic healthcare programmes in Dhusa Mareb and Hinder. The 108-bed hospital in Belet Weyne, Hiraan region, was closed at the end of the year. Activities in Guri El hospital, Galguduud region, will be handed back to the community in January 2013.
Healthcare in Somaliland
In the self-declared republic of Somaliland, staff are ensuring better access to healthcare and improving water and sanitation systems in Hargeisa, Mandheera and Burao (Burco) prisons. Support is also given to psychiatric patients in the Berbera mental health clinic.
An MSF team works with the Ministry of Health at Burao general hospital in the Togdheer region of Somaliland, focusing on inpatient care. In 2012, emergency staff dealt with more than 10 incidents involving the arrival of numerous casualties. When flash floods affected the region, MSF made donations to health facilities in Buhoodle.
At the end of 2012, MSF had 1,990 staff in Somalia. MSF worked in the country from 1991 to 2013.