Why are we there?
- Armed conflict
- Endemic/epidemic disease
- Healthcare exclusion
- Somalia: alarming malnutrition rates near Mogadishu
- Dadaab kidnapping: MSF anger and shock one year on
- Somalia: Kismayo patients forced to flee fighting
A devastating drought, protracted war, a collapsed health system and restricted access for relief organisations worsened the humanitarian crisis in Somalia in 2011.
Hundreds of thousands of Somalis fled to the capital Mogadishu, or across the border to Kenya or Ethiopia, in search of help. Weakened and malnourished, many were living in unsanitary, crowded conditions, with little access to safe water.
As victims of the conflict and drought flocked to Mogadishu, Médecins Sans Frontières (MSF) scaled up its activities, opening health facilities in 12 new locations. Staff provided a full range of health services, from basic healthcare to surgery, nutritional support, cholera and measles treatment, vaccinations and maternal care.
They also distributed relief items to both displaced and local people. At the peak of its activities, MSF was running programmes in 22 places across the country.
Given the scale of medical needs, MSF took the decision to send international staff to take up permanent posts in south-central Somalia for the first time since 2009. Tragically, on 29 December 2011, two long-serving MSF staff members, Philippe Havet and Dr Andrias Karel Keiluhu, were shot dead in their Mogadishu compound.
This forced MSF to close down two programmes, which had been serving a population of 200,000 displaced people and local residents, halving the medical assistance provided by MSF in Mogadishu.
A paediatric inpatient department and maternity ward were opened in the town of North Galkayo, Mudug region. Staff managed tuberculosis (TB) programmes in Galkayo, and in Mahadaay and Gololey in Jowhar, Middle Shabelle region.
In total, MSF treated more than 864,000 patients in Somalia, nearly double the assistance provided in 2010.
Measles and cholera
Malnourished children are more vulnerable to measles infection, which in turn aggravates malnutrition. Between May and December, MSF vaccinated 102,000 children against measles. However, in some parts of the country, permission to undertake vaccination campaigns was not granted by local authorities.
Unhygienic living conditions provide a breeding-ground for water-borne diseases like cholera. When the rainy season began in November, teams struggled to contain a cholera epidemic.
Treatment sites were set up in five districts, and in Hodan, over 100 patients per week were admitted to MSF’s 120-bed treatment centre.
Limited or no access at all for relief organisations to vast swathes of the country meant that hundreds of thousands of Somalis remained in desperate need, despite the aid that was being sent to the country.
The fighting, restrictions on supply flights and international support staff, as well as administrative hurdles, all hindered the delivery of assistance. In areas controlled by Al-Shabaab, gaining access for medical supplies and personnel to provide vital medical aid was a major challenge.
It proved extremely difficult for MSF to work beyond the gates of established health facilities. Even in existing programmes, MSF faced obstacles. Attempts to open new emergency operations in south-central Somalia failed.
One of the few exceptions was the port city of Kismayo, where MSF was granted access in December after lengthy negotiations. Within a few weeks of opening, MSF had treated 200 children for malnutrition.
High security risks
Access problems were compounded by insecurity. In March, MSF suffered two consecutive grenade attacks on its compound in Wadajir district, west of Mogadishu, in less than a week. MSF was forced to suspend activities temporarily, putting at risk the lives of 414 children enrolled in the nutrition programme.
In North and South Galkayo, MSF treated patients wounded in separate incidents, and in Daynile, nine kilometres northwest of Mogadishu, of the more than 3,500 patients admitted to the emergency room, 44 per cent had war-related injuries.
Thousands of Somalis were trapped between battle lines. In the Afgooye corridor, where close to half a million people have sought refuge, MSF supported the district hospital, covering the needs of 180 surrounding villages.
Staff conducted more that 27,000 consultations and treated over 3,300 malnourished children in Afgooye.
In October, two MSF staff members were abducted from a refugee camp in Kenya, where thousands of Somalis had fled. Insecurity in Somalia increased after the Kenyan army’s intervention that month.
In Marere, dozens of injured civilians were rushed to the MSF hospital following an aerial bombardment that hit a nearby camp for the displaced in Jilib. Five people were killed and 45 wounded, including 31 children.
Overcoming obstacles to access
MSF is increasingly using telemedicine to bring specialised care to Somalis in areas where the risk is too high to fly doctors in.
Via an audiovisual link, specialist doctors based in Kenya support medical staff in Somalia during consultations. More than 500 new patients received medical attention through this technological innovation in 2011.
Healthcare in Somaliland
In the self-declared republic of Somaliland, MSF expanded operations, providing support in Burao (Burco) general hospital, the only public health facility in the Togdheer region. Admissions have tripled and mortality rates have dropped in the maternity ward since MSF started operating there.
In Ceerigabo, MSF continued to provide full support to the district hospital, while in Somaliland’s capital Hargeisa, MSF closed its basic health services in camps in June, as the needs could be covered by the Ministry of Health and another agency working in the area.
In total, more than 4,000 children under five were seen at outpatient consultations. Staff assisted more than 2,700 births and carried out 671 surgical procedures.
At the end of 2011, MSF had 1,729 staff in Somalia. MSF has worked in the country since 1991.
Ali Ahmed*, 7 years old, and his mother, Burao hospital
“My boy was very sick and was swollen all over his body.
“He was a very healthy boy before. When it started, it started with a fever and the boy complained about his hands. I live in Talahabed. It is very far from here. It usually takes one day to get to the hospital.
“I have been here for a long time; it is too far to travel home. Where I come from there isn’t even a network to call from. I was told by the villagers that the hospital might be able to help me. I took public transportation to get to the hospital – I had to pay to get here.
"As soon as I arrived the doctors were ready to help me. They took Ali straight to surgery. They put him on medication. Slowly, slowly, after the surgery, he was improving every day. We carried him here. Now he can walk, he is beautiful.”
* The patient’s name has been changed.