Efforts underway at the UN to integrate humanitarian assistance into the international military campaign against opponents of Somalia’s government will further threaten the safe delivery of independent and impartial aid to Somalis.
This document gives an overview of MSF activities related to the humanitarian crisis in Somalia and neighboring Kenya and Ethiopia. The data presented, though provisional, account for MSF’s medical activities and financial income and expenditures in this region, while the narrative illustrates how MSF as a medical aid organization responded to this evolving crisis.
In this year-end issue of Alert we highlight 2011's pictures of the year, share MSF nurse Mary Jo Frawley's remembrance of her time in Haiti, and explore MSF's history of negotiation in the new book Humanitarian Negotiations Revealed.
The current emergency unfolding in and around Somalia is being portrayed by many aid organizations and the media in one-dimensional terms, such as “famine in the Horn of Africa” or “worst drought in 60 years.” But only blaming natural causes ignores the complex geopolitical realities exacerbating the situation and suggests that the solution lies in merely finding funds and shipping enough food to the Horn of Africa.
Throughout the summer, waves of Somalis set out on desperate, arduous journeys, braving desert heat, hunger, and bandits to seek relief from a catastrophe remarkable even by the standards of this long-troubled country.
In this issue of Alert, we share news and images of our response to the ongoing crisis in Somalia, where MSF has spent the summer trying to expand its services to meet the latest emergency to befall the country’s people.
MSF and VII Photo have launched a four-city tour of "Starved for Attention," a free interactive, multimedia exhibit in which some of the world's top photojournalists highlight the global crisis of malnutrition.
An overview of MSF's work in Somalia, which began in 1979 and has continued without interruption since 1991, with a particular focus on nutrition, emergency response to conflict, mother and child healthcare, and treatment of infectious diseases.
The hospital in Galcaayo North, which is partly supported by MSF, has treated 60 wounded, most of them civilians, while another 20 wounded were treated at an MSF-run hospital in the southern part of the city.
MSF urges all parties in Somalia, neighboring countries, and the international community to improve assistance to the Somali population in the region and remove hurdles preventing the expansion of independent aid in Somalia.
Dr. Gedi Mohamed, director of the general hospital at Dagahaley refugee camp, in northeastern Kenya, describes what brought him to Dadaab and how MSF is coping with the severely overcrowded conditions.
Even a quick glance at Doctors Without Borders/Médecins San Frontières (MSF) updates from Somalia over the past two years shows that the country’s conflict remains as relentless as ever. February 25, 2009: “121 wounded in 24 hours”; June 2, 2009: “218 treated over two weeks”; January 20, 2010: “111 wounded in 3-day period”: February 3, 2010: 89 treated, including 66 women and children, in Mogadishu.
On June 5, MSF opened new TB departments in two of its health centers in the Middle Shabelle region of Somalia. The departments will provide free quality TB services, including testing, treatment, and health education to the communities living in the surrounding areas of Mahaday and Gololey.
Following recent clashes in Somalia’s Galgaduud region, MSF is treating wounded patients in Istarlin hospital in Guri-el. The 80-bed hospital has been working to near full capacity in most departments, including treating patients for malnutrition, whooping cough and measles.
Nairobi/New York, February 3, 2010—As fierce fighting once again grips Somalia’s capital, Mogadishu, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) admitted 89 people suffering from blast injuries to its hospital in the Daynile area of the city between January 29 and February 2. Of these, 66 were women and children.
Nairobi, 19 January 2010 - As ongoing fighting in the Hiraan and Galgaduud regions of Somalia takes an ever greater toll on civilians, Doctors Without Borders/Médecins Sans Frontières (MSF) has continued to support two hospitals in Guri El and Belet Weyne.
“This is the highest number of malnourished children MSF has ever treated in the area. What’s more, we are concerned that not everyone is able to reach us. What we see in our program may just be a fraction of a wider crisis," says MSF’s head of mission for Somalia.
Medical needs in Somalia are vast, and frequently made worse by violence and drought. The graduates of Benadir University offer a rare hope for the Somali people—the possibility of lifesaving medical care. This year MSF supported and recruited a number of the university's first graduates.
In the central Somali city of Galkayo, Dr. Abdullahi Adan Mohamoud is working for Doctors Without Borders/Médecins Sans Frontières (MSF) to provide health care to a vulnerable population trapped in a conflict-ridden and divided city. In this interview, he explains about the medical work needs in Galkayo and about working as a surgeon in Somalia.
Located in the bone-dry central Somalia, the city of Galkayo is divided in half by warring militias and separatist regional governments that continuously clash in armed confrontations. Since MSF was forced to evacuate its international staff in 2008 due to insecurity, MSF’s Somali staff has carried on the work of providing medical care to people trapped in a conflict with nowhere else to turn.
Intense fighting among various armed groups claimed the lives of hundreds of civilians and displaced thousands more in Somalia in the first half of 2009. The town of Jamaame, in a remote area of southern Somalia’s Lower Juba region, is one area where MSF has been able to provide ongoing medical services.
In December 2008, 20 Somali students overcame huge odds and graduated from medical school in Mogadishu—the first batch to do so for almost two decades in the failed Horn of Africa state. Dr. Hafsa Abdurrahman Mohamed, 26, was one of those receiving a diploma from the capital’s Benadir University. This is her story.
Intense fighting among various armed groups claimed the lives of hundreds of civilians and displaced thousands more in Somalia in the first half of 2009. In addition, prolonged drought and food shortages worsened the already desperate situation of many of the country’s rural communities.
"So in August we tried one more time. We had been at sea for four days and four nights when our boat broke down. There were about 50 people on board. We were rescued by a Maltese ship and brought to Malta."
MSF has resumed work in Ta’kandja detention center for migrants and asylum-seekers in Malta after authorities committed to enable the provision of effective medical care and to ensure adequate living conditions for detainees. About 60 percent of patients MSF has treated there are from Somalia.
Nairobi/New York, July 7, 2009—The resumption of fighting in Mogadishu, Somalia’s capital, has forced the majority of people living in the Yaqshid, Karan, and Abdul Azziz districts in the north of the city to flee, according to the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF).
Since April, an outbreak of measles has been sweeping through the town of Guri El and nearby areas in the Galgaduud region of South and Central Somalia. So far, MSF has treated 403 patients for measles-related complications in the area.
In the early evening of Wednesday, June 24, 2009, a private vehicle rented by Doctors Without Borders/Médecins Sans Frontières (MSF) was attacked in North Galcayo, Somalia as it returned from referring a patient from one MSF facility in the south of the city to another facility in the north.
Nairobi/Brussels, June 17, 2009 — After nine years of providing health care for the population in Bakool region, Doctors Without Borders/Médecins Sans Frontières (MSF) has reached the regrettable conclusion that it does not have sufficient security to continue its work. This decision was MSF’s alone and the organization was not expelled by the authorities. MSF medical activities elsewhere in Somalia continue.
As intense violence once again rocks Mogadishu, Somalia’s capital, teams from Doctors Without Borders/Médecins Sans Frontières (MSF) continue working throughout the country to provide lifesaving medical care.
Nairobi/Geneva/New York, May 18, 2009 – More than 270,000 refugees who have fled war in Somalia are facing such alarming shortages of food, water, and adequate shelter in severely overcrowded camps in northern Kenya that many are considering returning to the Somali war zone, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said today.
The dead were among a group who had departed two days prior from the port of Bosasso, Somalia, fleeing insecurity or extreme poverty on a smuggler’s boat. They were travelling in extremely harsh conditions across the Gulf of Aden to reach Yemen.
Current TV features a documentary about the deadly risks at sea Somali refugees and Ethiopian migrants are forced to take in search of a better life in Yemen, and the Doctors Without Borders medical teams helping those who survive.
Some 533 people survived the dangerous journey from northern Somalia across the Gulf of Aden to Yemen on smugglers’ boats during one week in December 2008. At least 28 passengers did not survive the trip. Desperate to escape the violence and hopelessness of Somalia, these passengers routinely arrive on Yemen’s southern coast after a two- to three-day journey. The risks they have taken to get there are huge: smugglers pack more than 100 people onto boats made for 30; and passengers arrive with reports of brutal treatment.
On Tuesday, February 24, scores of civilians were injured in a new surge in fighting in multiple locations in Somalia’s capital, Mogadishu. MSF medical teams have so far treated 121 casualties in Daynile Hospital, by far the largest influx of wounded people since MSF opened its surgical program in Daynile, located on the outskirts of Mogadishu, in September 2007.
Nairobi, January 13, 2009 — A new surge in fighting in the Galgaduud region of central Somalia has led to many casualties and forced thousands to flee. Following heavy fighting between two groups last Sunday, Somali medical teams of the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) have treated 46 casualties at Istarlin hospital in Guri El. This brings the total of wounded treated there since fighting broke out in the area more than two weeks ago to 86.
Already struggling to survive with little or no access to even basic health-care services, Somalis experienced some of the worst violence in over a decade in 2008, with people in the central and southern parts of the country living under increasingly deteriorating humanitarian conditions.
Massive forced civilian displacements, violence, and unmet medical needs in the Democratic Republic of Congo, Somalia, Iraq, Sudan, and Pakistan, along with neglected medical emergencies in Myanmar and Zimbabwe, are some of the worst humanitarian and medical emergencies in the world, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) reported today in its annual list of the “Top Ten” humanitarian crises.
Human smugglers from northern Somalia forced 114 people from a small fishing boat near the village of Al Qashaah on the southern coast of Yemen early on the morning of December 5. The passengers were Somali refugees fleeing war, destitution, and disease. Among them were ten children, including babies.
Since early Monday, December 1, of a presumed 420 people who have arrived on Yemen’s shores after traveling through the Gulf of Aden from Somalia, Doctors Without Borders/Médecins Sans Frontières (MSF) has assisted 361.
Some of the world’s leading photojournalists worked alongside our medical teams throughout 2008, documenting our work and following the lives of our patients and their communities. At the same time, some of our own staff captured unforgettable moments that we are pleased to include in this Year in Pictures issue of Alert, which brings together some of the most moving and telling photographs of the crises to which we responded in 2008.
Every year, thousands of Somalis and Ethiopians risk their lives crossing the Gulf of Aden to Yemen. Hoping to escape the conflict and extreme poverty in their own countries, these desperate passengers are regularly abused and sometimes killed by the brutal smugglers they pay to get them across.
November, 1, 2008, Awhar, Yemen --A team from Doctors Without Borders/Médecins Sans Frontières (MSF) assisting refugees in the south of Yemen found 39 dead bodies on the shore between Friday, October 31 and Sunday, November 2.
Nairobi/Geneva/New York, October 2, 2008 — The recent escalation in fighting in one of Mogadishu’s most populated residential areas has resulted in a surge of wounded civilians and has once again displaced thousands of people. The international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) is treating some of the wounded and is providing basic relief supplies to newly displaced people.
Since Friday, September 19, amid intensifying violence in Somalia’s capital, Mogadishu, there has been a sharp increase in the number of admissions of war wounded civilians to the MSF hospital in Daynile, located just outside the capital.
Geneva/Nairobi, June 26, 2008 — The people of Somalia are currently facing a massive humanitarian crisis with unmet critical medical needs. In May alone, Médecins Sans Frontières (MSF) teams working in the Mogadishu suburbs of Hawa Abdi and Afgooye treated more than 2,500 children suffering from acute malnutrition with admissions to MSF nutritional programs doubling in April and doubling again in May.
Press Teleconference: Nicolas de Torrente, executive director of MSF-USA, Benoit Leduc, MSF operations manager for Somalia, and Dr. Greg Elder, MSF deputy operations manager, discuss the catastrophic humanitarian situation in Somalia.
Nairobi/Barcelona, May 7, 2008 – Due to the kidnapping of two of its humanitarian workers last December, the international medical organization Doctors Without Borders/Médecins Sans Frontières (MSF) decided to close on the 15th of April all its remaining medical and nutritional operations for the internally displaced people (IDP) living at the outskirts of Bossaso.
Between January 2008 and April 2008, the independent medical humanitarian organization MSF has treated more than 850 victims of conflict in Mogadishu, a majority of whom are civilians, at Dayniile hospital, located nine kilometers outside the capital. Among the 850 people, 455 were admitted for gunshots wounds and 231 for blast wounds consistent with explosive devices.
New York/Nairobi, Kenya, April 3, 2008—Following the killing of three staff members on January 28, the medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) has decided to close its project in the southern city of Kismayo, Somalia. Although activities in Kismayo will end, MSF remains committed to providing medical care to the Somali people, therefore projects in other locations in Somalia will continue to operate.
International staff with the independent medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) have resumed their humanitarian work in several locations in Somalia. Following the brutal killings of three MSF aid workers on January 28 in the southern city of Kismayo, MSF suspended its international staff presence in the country. Programs continued to be run thanks to the dedication of MSF Somali staff members.
On March 18, a Somali national staff from the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) died at the hospital following severe injuries sustained during an attack on an MSF car the week before. Along with other cars travelling the same route, an MSF vehicle was attacked on March 12. At 1:00 PM local time several armed men opened fire on the vehicles, seriously wounding the MSF Somali staff member, who worked as a security guard. Three other MSF Somali colleagues were slightly injured in the incident.
A car belonging to the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) was attacked on March 12 near the town of Balcad in Somalia. At 1 p.m. local time, several armed men opened fire on the vehicle, seriously wounding one of the MSF staff members, a security guard, who was taken to hospital where he is now recovering from a femur fracture. Three other employees were slightly injured in the incident.
New York/Nairobi, February 1, 2008 – The international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) is outraged by what appears to be an organized attack resulting in the killing of our three colleagues Victor Okumu, Damien Lehalle, and Mohmed Bidhaan, as well as two other people, on Monday January 28 in Kismayo, Somalia.
Nairobi/Amsterdam, January 28, 2008 - It is with great sadness that we confirm that three staff from Doctors Without Borders/Médecins Sans Frontières (MSF) were killed this morning in the Somali town of Kismayo, not far from the hospital where MSF works.
Bossaso, Somalia/Barcelona, January 2, 2008 — Mercedes García and Pilar Bauza, a Spanish doctor and an Argentinian nurse who work for Doctors Without Borders/Médecins Sans Frontières (MSF) in Somalia, were freed today at 2:30 PM local time. MSF is relieved that the two have been liberated after one week in captivity. Mercedes and Pilar are in a good health.
Bossaso, Somalia/Barcelona, December 28, 2007 - Doctors Without Borders/Médecins Sans Frontières (MSF) demands that a medical vehicle from the organization be given access to the area where its two workers are detained to assess their health status. Mercedes García and Pilar Bauza, a Spanish doctor and an Argentinian nurse, have been in captivity for more than 48 hours in the area of Bossaso, in Puntland.
Bossaso, Somalia/Barcelona, December 26, 2007 — After confirming that two of its staff members have been taken by force this morning in Bossaso, Somalia, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) has urgently called for the immediate and safe release of its colleagues: Mercedes García, a Spanish doctor, and Pilar Bauza, an Argentinean nurse. They were taken while on their way to a MSF feeding center set up to treat malnourished children near camps for internally displaced persons (IDPs) and refugees in Bossaso, in the Puntland region of Somalia.
Afgooye, Somalia/Geneva, December 11, 2007—Increased fighting inside Somalia’s capital, Mogadishu, has led to another exodus of the population, adding to hundreds of thousands of internally displaced people (IDPs) who have already fled the conflict area since January 2007.
Nairobi, November 7, 2007 — While thousands of people flee the Somali capital Mogadishu, the medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF), is gravely concerned about the remaining population as violence intensifies in the city.
New York, NY, October 31, 2007 - In a study published today in the inaugural issue of PLoS Neglected Tropical Diseases, Doctors Without Borders/Médecins Sans Frontières (MSF) medical teams detail a dramatic increase in visceral leishmaniasis, also known as kala azar, in the Bakool region of south-central Somalia. The current conflict in Somalia and the lack of health infrastructure makes it both difficult to address the problem and to assess the true magnitude of the impact of the disease.
Nairobi, 20 August 2007 — Access to medical care and assistance for civilians and displaced persons in and around the Somali capital of Mogadishu has decreased alarmingly in the past months, according to the international medical humanitarian organization Médecins Sans Frontières (MSF). MSF is urgently calling upon all parties to the conflict to respect the need for medical staff to work unimpeded and for residents and displaced people in and around Mogadishu to have safe access to medical care.
Last May, Doctors Without Borders/Médecins Sans Frontières (MSF) opened a pediatric clinic for children under five in the Halwadag district of Mogadishu. Since then, the clinic has been extended and increasing numbers of children have been admitted for treatment. Now, however, an increase in insecurity is keeping many children from receiving care.
Geneva/New York, July 23, 2007 — Four months into the present crisis triggered by a major wave of violence in Somalia's capital city, Mogadishu, most of the 400,000 displaced people from there (398,000 according to the United Nations) have been unable to return to their homes and remain highly dependent on assistance provided by the few aid organizations present, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said today.
It is with great sadness that MSF learned of the death of Ibrahim Abdi Isse, a hospital watchman for MSF in Beledweyne, who was killed while off duty. The tragic death of Ibrahim Abdi Isse is not linked to his activities with MSF. Sources indicate that the killing was the result of a personal dispute.
On April 17, 2007 MSF launched an emergency medical response in Afgooye, Lower Shabelle Region, about 30 kilometers west of Mogadishu. Due to insecurity in the area, MSF decided to dispatch a team of senior MSF Somali staff from Nairobi and the Dinsor Health Center to evaluate the needs of thousands of displaced people who poured into the town following major fighting in Mogadishu.
On Tuesday, June 5, a car with driver, hired by the international humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) was involved in a shooting incident in Mogadishu, Somalia, which resulted in the driver of the rental car being killed, and one MSF staff member wounded.
In March and April 2007, heavy fighting in Mogadishu, Somalia, resulted in a large number of civilian casualties and thousands of people fleeing the capital. The following stories, gathered by MSF, come from people displaced from Mogadishu who arrived at MSF's hospital in South Galcayo in May.
People have been fleeing Mogadishu since the start of the clashes, but the last month has seen a real increase of people arriving in the Hiraan, Galgadud and Bay regions and also in Afgooye. We think that there are about 10 to 12,000 families who have fled to Afgooye from Mogadishu, with an average of 6 people per family. They're mostly women and children, there are very few men.
New York, April 24, 2007 – In the last weeks, tens of thousands of displaced Somalis have fled Mogadishu following a resurgence of violence affecting the capital city of Somalia, already home to many displaced people. This recent spell of violence has put on roads entire columns of people attempting to move to safer areas of the country such as Lower Shabelle region, Hiiraan region, Galguduud region, and Bay region.
New York, 11 April 2007 – Since cholera was confirmed in Mogadishu on March19, 2007, the international humanitarian medical aid organization Doctors Without Borders/Médecins Sans Frontières (MSF) has treated more than 800 patients. However the recent worsening violence is making it increasingly difficult for patients to access MSF's cholera treatment center (CTC), which opened two weeks ago. The fighting is also preventing MSF national staff from reaching other areas of the city.
On January 17, 2007, David Michalski, MSF head of mission in Somalia, delivered the following speech at the "Securing Somalia's Future: Options for Diplomacy, Assistance, and Security Engagement," conference on Somalia hosted by the Center for Strategic International Studies, the Council on Foreign Relations, and the Woodrow Wilson Center in Washington, DC.
Nairobi/Geneva, December 28, 2006—MSF is gravely concerned for the safety of our staff and patients following a serious incident occurring in an MSF medical facility in Dinsor (Bay region, Somalia) on December 27. After taking control of Dinsor, representatives of military forces entered the MSF medical facility, pressured the Somali medical staff employed by MSF, and confiscated all inpatient confidential medical files.
Heavy rains in the last few weeks have caused flooding of the Juba and Shebelle rivers in southern Somalia, bringing devastation to much of the riverside areas, and highly increasing the needs in one of the most densely populated regions in the country.
Nairobi, November 22, 2006 - Heavy rains over the last few weeks have caused flooding of the Juba and Shebelle rivers in southern Somalia, bringing devastation to much of the surrounding areas and aggravating humanitarian needs in one of the most densely populated regions in the country. Thousands of families have seen their homes destroyed and thousands more are displaced, including hundreds of families trapped in pockets of higher ground.
MSF took over responsibility for Istarlin Hospital in the town of Guri El in early 2006. Since then, 21 percent of the admissions to the hospital have been violence-related. Many of its beds are occupied by patients with disturbingly similar stories.
Anab Mohamud Mohamed is a Somali pharmacist who has been working with MSF in Somalia since 1997. In late June, and thanks to a special visa (Somalia is stateless and its citizens do not have valid passports to leave the country), she visited MSF's office in Barcelona where she shared her views about the situation in Somalia.
Since 1991, Somalia has been a state with no government. Fourteen years of conflict have left the country with enormous humanitarian needs and a high level of everyday violence. MSF was running health care projects in the capital, Mogadishu, as well as northern Somalia when war broke out, having begun working in the country in 1986.
Roda Musa lies on a bed, cradling her arm. Her flowing, colorful clothes are a stark contrast to the white plaster that covers her from hand to shoulder. She looks to be in her early twenties, but her face lines with anger when she explains why she has found herself surrounded by other Somali women in the trauma ward of the MSF-run Galkayo hospital in the north of the town.
It's like it's never going to end. Hundreds of women are walking single file into the huge compound, lining up at its remote end. They're all carrying children and they're all hoping for food. It's a scene that repeats itself every month in the tiny village of Istorte in Somalia's Bakool region. The women and children are here for the nutritional screening, hoping that they will qualify for extra food rations.
What started as a disagreement over prices in the market degenerated into a deadly battle because the two men involved were from rival clans. Some 18 people were killed and more than 37 injured in the resulting gunfight.
The continuing insecurity in many areas and a lack of international attention has resulted in a dearth of meaningful emergency assistance, leaving many desperate segments of society abandoned and all but forgotten. This is an interview with Colin McIlreavy, MSF head of mission in Somalia for the past year.
Doctors Without Borders is approved by the Internal Revenue Service as a 501 (C) (3) tax-exempt organization, and all donations are tax deductible to the extent provided by law. Doctors Without Borders Federal Identification Number (EIN) is 13-3433452.