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MSF in Somalia - TimelineSeptember 6, 2011
Somalia 2011 © Sven Torfinn MSF first worked in Somalia in 1979 and has been present in the country with few interruptions since 1991, when a civil war erupted following the downfall of the country's dictator, Siad Barre. MSF has worked in several locations: Baidoa, Dinsor, Huddur, Jamaame, Jowhar, Kismayo, Marere, and the capital, Mogadishu, in the south; Galcayo and Guri El in the north-central area; and Belet Weyne in central Somalia. Teams have addressed a host of different crises in their many projects, focusing in particular on nutrition, emergency care for people wounded in conflict, mother and child healthcare, and treatment of infectious diseases, including cholera, measles, kala azar, and tuberculosis (TB). Security is and has always been the major concern for teams working in Somalia. It remains the only place where MSF employs armed guards for its protection. Starting a project anywhere in Somalia takes a great deal of time, patience, energy, and negotiation. Even after the project is established, though, the prevailing security risks still limit the access teams have to various populations—as do the periodic and unlawful moves by those involved in the conflict to prevent medical personnel and would-be patients from reaching each other. These constraints play a large role both in determining the size and type of operations MSF can maintain and in the organization's ability to respond to emergencies. Security constraints have, in fact, been a major factor in every instance in which MSF closed one of its projects in Somalia. When MSF suspended nutrition projects that were established during a 1992 famine, for instance, it was partly because that particular nutritional emergency had abated. But it was also determined that the risks for the teams were too high given what they would be able to accomplish. Likewise, several other projects were closed because deteriorating security conditions and changes in the political landscape made it impossible to ensure an acceptable humanitarian space in which to develop activities. Movement was too limited, access to vulnerable populations was too irregular, and MSF workers faced too much pressure. Some projects stalled before they were implemented as well, usually due to failures in negotiations with local actors that either did not accept the conditions requested by MSF or made demands that MSF could not accept. 1979 to 1991MSF begins work in Somalia by assisting Ethiopian refugees, later expanding its activities and experiencing its first security incidents. 
1981 © MSF 1979-82MSF begins providing assistance to refugees coming from the Ogaden region in eastern Ethiopia to the central Hiraan and southwestern Gedo regions in Somalia. MSF closes its mission in Somalia in mid-1982. 
1986 © Didier Lefevre / imagesandco.com 1985-87MSF treats Ethiopian refugees around the city of Hargeisa, the capital of Somaliland, a semi-autonomous region in the north. On January 24, 1987, ten international MSF staff members are kidnapped in Tug Wajale, near Hargeisa, and held for two weeks before being released. 
1989 © E. Reisser 1989MSF begins supporting a 120-bed hospital in Boroma but has to shut the project after four months because the roads from Djibouti are closed and there is no available air transport, meaning all transport links had been severed. 
1990 © MSF 1990While other international organizations are evacuating due to the deteriorating security situation, MSF arrives in Mogadishu in December for an exploratory mission. 1991 to 1995The security situation worsens dramatically after the fall of Siad Barre’s regime. The United Nations Operation in Somalia (UNOSOM) and the US-led United Task Force (UNITAF) are deployed for humanitarian missions and peacekeeping. Meanwhile, widespread famine prompts MSF to open feeding centers. 
1991 © Carl Cordonnier/Daily Life 1991
MSF teams arrive in Mogadishu in January, just as most other actors are leaving due to insecurity. War surgery programs start in several locations controlled either by governmental troops or United Somali Congress (USC) rebels: Digfer, SOS Kinder Garden, Medina, Benadir, Martini and Military Hospitals. Following numerous interruptions of activities due to security incidents, including the killing of a MSF driver in July 1991, MSF starts hiring private armed guards. 
1992 © John Reardon 1992MSF launches a large media campaign in May—including a press conference in Paris—to call attention to famine in Somalia. Nutritional programs open throughout the country (in Barbera, Kismayo, Jowhar, Gilib, Merca, Brava, Huddur, Wajid, Baidoa, and elsewhere) and treat thousands of malnourished children. MSF's office in Barbera in the northwest and an MSF house in Kismayo in the south are both looted. In March, United Nations Security Council resolution 751 establishes an observer mission in Somalia (UNOSOM). In August, MSF holds a press conference in Nairobi opposing U.N. peacekeeping operations in Somalia. MSF states that the operations blur the line between military and humanitarian objectives. 
1992 © John Reardon It is an extremely volatile and tense situation for MSF teams on the ground during this time; there are burglaries, a guard is shot, and threats are made against international staff. In November, MSF suspends surgical activities at Medina Hospital in Mogadishu due to a conflict with the personnel. In December, the UN authorizes the deployment of a US-led international task force (UNITAF) to restore order and safeguard relief supplies. Operation “Restore Hope” begins.
1993 © Stephane Van Praet/MSF 1993In January, an MSF car is caught in an ambush and shot at in Mogadishu. The U.N.’s Unified Task Force (UNITAF) troops attack International Action Contre La Faim/Action Against Hunger’s (AICF) compound in Mogadishu on January 17, killing one Somali worker and wounding eight. Six MSF international volunteers were present in the house. MSF issues a press release condemning the attack on the compounds and presents a formal complaint to the U.N. Security Council. 
1993 © Carl Cordonnier/Daily Life In February, an MSF feeding center and a health post are looted in Kismayo in the south while MSF cars are ambushed several times between Baidoa and Mogadishu. In March, an Australian UNITAF soldier kills an MSF guard while on duty in Baidoa. In April, MSF programs in Baidoa close down. In March, UNSC resolution 814 authorizes the establishment of a large civilian and military peace support operation (UNOSOM II) to oversee the reconstruction of Somalia. In March and April, MSF carries out several evaluations which lead to the closure of nutritional projects. The famine emergency is considered to be over and enough food is available. On June 6, MSF decides to close its programs in the capital city. In early October, 18 American soldiers and hundreds of Somalis fighters are killed during the “battle of Mogadishu” following a failed operation to capture rebel clan leader Mohamad Aidid. The US subsequently withdraws from Somalia. 1994A large cholera outbreak hits Somalia. MSF opens treatment centers and starts primary health care and vaccination campaigns in Mogadishu. The US mission formally ends in March.1995 to 2006After the departure of UNOSOM in March 1995, international attention turns away from Somalia. The Somali population is forgotten, even as it is forced to contend with sporadic combat between warlords. The Islamic Courts Union (ICU) progressively gains influence and power with the support of Eritrea. The majority of international NGOs withdraw from the country. MSF decides to return but humanitarian work becomes increasingly difficult. 1995Following the kidnapping of an aid worker in Mogadishu, most international staff withdraw from the capital. The last of the UN forces leave the country in March. In February and March, local MSF staff responds to cholera outbreaks in Kismayo and Mogadishu. From July onwards, MSF expands its activities in Kismayo Hospital. 
1996 © Petterik Wiggers 1996In January, MSF launches medical and nutritional interventions in a 40-bed hospital in the southern city of Bardere and resumes its cholera interventions in Mogadishu and Kismayo. The security situation remains very volatile. In November, an MSF anaesthetist is killed in Kismayo due to a dispute between clans. From October to January 1997, a measles outbreak hits Mogadishu, and MSF conducts a vaccination campaign. 
1992 © Petterik Wiggers 1997In January, MSF begins supporting Galcayo Hospital in central Somalia, (which becomes the Puntland state of Somalia in August 1998). MSF's cholera treatment center in Mogadishu reopens, but an MSF logistician working in the capital is killed in May. In April, MSF starts working in Baidoa Hospital, supporting post-operative and nutrition activities and providing medical supplies. But on June 20, Dr. Ricardo Marques of MSF is murdered in Baidoa Hospital. MSF subsequently ends all activities in Baidoa and Bardere. In December, MSF provides medical support in the Jamaame and Marere areas in Juba Valley following heavy floods. The operation finishes the following March. 1998Mogadishuand Kismayo are both again hit by waves of cholera. MSF opens a cholera treatment center in northern Mogadishu and treats 3.000 people. The center is robbed in April and the teams there are threatened. All international teams evacuate until September. Several evacuations also occur in Kismayo and Galcayo due to insecurity. 
1999 © Petterik Wiggers 1999MSF extends its coverage in Galcayo Hospital to include maternal care. In October, the entire team is forced to evacuate after armed men rob the compound. Two months later, MSF returns and responds to a cholera outbreak. Kismayo is extremely unstable due to fighting between clans and the ICU, making it impossible to keep international staff there on a permanent basis. Somali staff takes responsibility for MSF's activities in Kismayo, with international staff making “hit and run" visits to support their efforts. 2000MSF reopens its cholera treatment center in Mogadishu and treats patients from January to July. That month, two international aid workers are taken hostage in the southern part of the capital following an attack on their compound. In August, clan leaders and senior figures meet in Djibouti and elect Abdulkassim Salat Hassan president of Somalia. The aid workers are released in September. MSF evacuates all of its teams in the capital until November. In April, an MSF midwife is threatened with a gun in MSF’s Galcayo Hospital maternity ward. In Kismayo, a UNICEF plane is shot at. In June, MSF launches a medical and nutritional project in Huddur, in the southwestern Bakool region. After two months, in response to the situation on the ground, it becomes a visceral leshmaniasis (kala azar) treatment program. 
2001 © Andrea Vallerani 2001In March, the MSF compound in northern Mogadishu comes under heavy fire in an armed attack. MSF halts its cholera interventions in the area. MSF also closes its project in Kismayo later in the year due to recurrent security incidents. MSF treats 27,000 children as part of its measles vaccination campaign in the Bakool region. 
1996 © Petterik Wiggers 2002Fighting in southern Somalia forces 10,000 people to flee to Kenya. In October, MSF clinics in Aden Yabal, in the south-central Middle Shabelle region, are attacked. One person is killed; three are injured. MSF teams reopen programs in Mogadishu. 2003In December, after an MSF guard is killed during an attack on another organization’s compound in Marere, MSF evacuates its team from the area. 
2004 © Pep Bonet/Noor 2004In January, MSF teams respond to a measles outbreak near Dinsor, a town in the southwest where MSF also runs a 35-bed health center. In November, a transitional federal government (TFG) is inaugurated, though its members are still exiled in Kenya. Abdullahi Yusuf Ahmed is elected president and recognized by most of the international community.
2005 © Alexander Glyadyelov 2005Members of the Somali central government begin returning home from exile in Kenya. The ICU controls most of southern Somalia and is still gaining ground. 
2006 © Stefan Pleger 2006In February, the transitional parliament meets in Somalia—in Baidoa—for the first time since it was appointed in 2004. Following heavy fighting against the US-backed Alliance for the Restoration of Peace and Counterterrorism (ARPCT), which is largely composed of warlords and businessmen, the ICU takes control of Mogadishu and parts of the south with Sheikh Sharif Ahmed as its leader. MSF runs a measles vaccination campaign in Mogadishu, vaccinating 26,240 children between the ages of six months and 15 years. In the Yaqshid North area, the teams vaccinate 54,897 children. 
2006 © Jehad Nga MSF opens two new projects supporting hospitals in Dhusa Mareb and Guri El, in the central Galgaduud region. The African Union and the UN adopt a resolution in support of an Intergovernmental Authority on Development (IGAD) peacekeeping mission for Somalia (IGASOM) to be deployed in October. The Council of Somali Islamist Courts (CSIC, formerly the ICU) opposes the intervention of a regional peacekeeping body. In December, a US-backed Ethiopian military intervention defeats the CSIC, which capitulates on December 27 and abandons Mogadishu, then Kismayo. 2007 to 2011The UN-supported Transitional Federal Government, which officially rules Somalia, is at near constant war with the Islamist militant organization known as Al-Shabaab. MSF expands operations throughout the country but obstacles again arise quickly. 
2007 © Marcus Bleasdale 2007President Abdullahi Yusuf Ahmed enters Mogadishu for the first time since taking office in 2004. A group of CSIC fighters launch a guerrilla organization called the Harakat al-Shabaab Mujahedeen, better known as Al-Shabaab, a jihadist movement that soon develops close ties with Al Qaeda. A UNSC resolution authorizes an African Union peacekeeping mission for Somalia (AMISOM). Once more, heavy fighting breaks out in Mogadishu and hundreds of thousands Somalis flee the capital. MSF opens a hospital program focusing on surgical care in Belet Weyne, in the Hiraan region of central Somalia. MSF also opens a primary health care clinic in Yaqdish, in Mogadishu. By May, the team has treated 1,000 patients. Additionally, teams open three new outpatient clinics for children in Balcad, Karaan, and Lido over the course of the year. In December, the Lido clinic is reinforced with an inpatient ward. 
2007 © Alixandra Fazzina In Jamaame, in the Lower Juba region, MSF sets up a 30-bed hospital with a large nutritional program and outreach activities. MSF also opens a project in Hawa Adbi, outside of Mogadishu, supporting the area’s paediatric ward, focusing on nutrition, and distributing non-food items to people displaced by the fighting. MSF also begins assisting displaced people in Afgooye, outside of the capital. 
2007 © MSF In August, an MSF driver is killed in Mogadishu. In September, MSF starts providing emergency surgical care in a hospital in Daynile on the outskirts of Mogadishu. The same month, MSF begins an emergency surgical project in Kismayo. The number of Somali refugees who have fled the country rises above one million. 
2008 © Oscar Sanchez-Rey 2008In January, three MSF employees are killed in Kismayo. MSF closes its projects there. MSF evacuates all international staff from Somalia in April. A new strategy of remote management is put in place. International teams based in Nairobi manage national staff teams inside Somalia that run the day-to-day operations. In September, MSF closes its programs in the Wardigley and Hodan areas of Mogadishu due to increased security risks for MSF patients and staff. 
2009 © Jan Grarup /NOOR 2009Ethiopiacompletes its withdrawal of troops that started in December 2008. Al-Shabaab fighters overtake the town of Baidoa, which had been a key stronghold of the transitional government. Parliament elects Sheikh Sharif Sheikh Ahmed as president and extends the transitional government's mandate for another two years. MSF treats more than 400 children for measles in the Guri El area, in the central Galgaduud region. In April, two MSF international staff are abducted and held for nine days in the southwestern Bakool region. They are released unharmed. MSF closes its health center in Huddur after nine years. In June, a rented MSF vehicle is attacked in Galcayo. The caretaker of an MSF patient is also killed. In July, amidst heavy fighting, MSF closes its paediatric hospital and three health clinics in the Yaqshid, Karan, and Abdul Azziz areas of northern Mogadishu. Armed men raid and loot the MSF nutritional treatment center in Jilib, in the Lower Juba Valley. 
2010 © Frederic Courbet/Panos 2010In April, MSF conducts an “eye surgery camp” in Galcayo. The project screens 3,000 people and operates on more than 600, in some cases restoring the sight of people who had been blinded by cataracts for years. In May, MSF opens a new outpatient facility for children under the age of 12 in Galcayo. In June, MSF opens TB departments in two of its health centers in the Middle Shabelle region, in Mahaday and Gololey. In July, the Al-Shabaab claim responsibility for twin bombings that killed 74 people in the Ugandan capital, Kampala. AMISOM's mandate is reinforced and its numbers rise to 10,000 soldiers from Uganda and Burundi. MSF teams close their medical project in Somalia’s Hawa Abdi area, on the outskirts of Mogadishu, in early September, after three years. 
2010 © Feisal Omar In Marere, in the Lower Juba region, the provision of medical care in MSF facilities becomes more difficult after the local administration imposes a number of restrictions on operations, including a ban on receiving medical supplies by plane and a prohibition on visits from international staff.
In December, MSF employs telemedicine in Istarlin hospital in Guri El, allowing a medical specialist in Nairobi to provide direct, real-time support to doctors working in Istarlin's pediatric department.
2011 © Martina Bacigalupo / Le Monde / Agence VU 2011In March, following two grenade attacks on its compound, MSF temporarily suspends medical activities in the Dharkenley district in Mogadishu. When a severe drought hits East Africa, compounding the toll already taken by conflict and the longstanding lack of development and humanitarian access, some 2.8 million Somalis, according to UN figures, find themselves in urgent need of food aid. Many flee their home villages seeking assistance. Displacement camps in neighboring Kenya and Ethiopia are overwhelmed with the influx of new refugees. Around 150,000 newly displaced people arrive in Mogadishu. MSF scales up operations to respond to the large numbers of new arrivals and to counter and prevent outbreaks of measles and other communicable diseases. 
Somalia 2011 © Yann Libessart/MSF As of September 2011, MSF provides free medical care in eight regions: Bay, Hiraan, Lower and Middle Shabelle, Galgaduud, Lower Juba, Mudug and Mogadishu. Over 1,400 Somali staff, supported by approximately 100 staff in Nairobi, provide free primary healthcare, surgery, treatment for malnutrition, as well as support to displaced people through health care, vaccination, water supply and relief items distributions. MSF is also providing medical care to Somali refugees in Kenya and Ethiopia. MSF does not accept any government funding for its project in Somalia. All its funding comes from private donors.
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