A child peeks through a hole in a partition in Jamaame hospital.
MSF Activities in Somalia
MSF is the main provider of free medical services in all of central and southern Somalia. At the end of June, 1,407 Somali staff, supported by 94 international staff in Nairobi, were working to provide primary health care, treatment for malnutrition, health services and support to displaced people, surgery, water, and relief supplies in nine regions of the country.
In March, MSF vaccinated 26,463 children against measles in Belet Weyne. Early this year, MSF treated 869 people in Jilib and Marere in the Lower Juba region, and 61 north of Mogadishu, for cholera and responded with mobile medical clinics and water distribution when people were displaced by an outbreak of violence in the Guri El area.
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 gap between the country’s critical needs and the level of humanitarian response continues to widen, mainly due to aid agencies’ extremely limited capacity to deliver assistance in a highly insecure and volatile environment. In spite of a series of attacks, abductions and other security incidents, Doctors Without Borders/Médecins Sans Frontières (MSF) manages to maintain a presence in half of Somalia’s 18 regions.
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. Starting as a temporary response to severe flooding in March 2007, the Jamaame project has evolved into a primary and secondary healthcare program with a small hospital serving some 60,000 people from the town and surrounding areas, including the nearby city of Kismayo.
“It’s a relatively isolated area and that provides us some security,” says Javier Roldan, MSF’s Jamaame project coordinator based in Nairobi. “But it is still dangerous to work, with many different armed groups in the area and very few other aid workers. We can be quite vulnerable.”
As the largest health care provider in the area and one of the few nongovernmental organizations in Lower Juba, MSF serves outpatients and inpatients who travel great distances to receive treatment. Priorities include nutritional care for the region’s malnourished children and maternity care—an essential service given Somalia’s extremely high maternal mortality rates. During the first seven months of 2009, MSF saw some 30,000 outpatients for a variety of health issues and more than 600 children in the nutrition program. More than 1,100 inpatients were admitted to Jamaame hospital during this same period.
A woman walks with a baby through an inpatient ward.
Unlike most MSF programs that are run by teams made up of both international and national staff, day-to-day operations in Jamaame fall to locally hired staff whose dedication endures despite considerable risks to their safety. Kidnappings and killings of foreign and local aid workers—including the killing of three MSF staff in Kismayo in 2008, and the kidnapping of two MSF staff in Bakool in April of this year—have forced MSF international staff to support the project from a base in Nairobi and to make only short visits to the project when security allows.
“Neutrality and impartiality have been essential to our work in Somalia,” says Roldan. “We show through our principles that we don’t take any part in the politics of the country. This allows us to take a step farther than some others.”
“The most important thing is for the community to see what we’re doing and what we’re providing for them,” says Benoit Leduc, operations manager for Somalia. “The respect we gain is our main form of security.”
Basic services, from health care to education, have been lacking for nearly two decades in Somalia. Violence has surged in several parts of the country in recent years and huge numbers of people have been displaced. According to the United Nations, 200,000 have fled the capital, Mogadishu, in just the last few months; there are now more than 1.3 million internally displaced Somalis and 3.2 million in need of humanitarian assistance.
Health workers are among those who have fled the violence, and drugs and other medical supplies have dried up. One of the main challenges for MSF is to recruit doctors and nurses in the absence of a functioning educational system. “We call it a lost generation because a whole generation has not had access to basic things like education and have known nothing other than war,” says Roldan.
There was a ray of hope this year with the graduation of 20 doctors from a university in Mogadishu—the first batch of new physicians in two decades. There is a desperate need for such skills throughout the country, and the Lower Juba region is no exception. MSF’s team in Jamaame is fortunate to have found three qualified Somali doctors. The nearest hospital in the region is run by a nurse.
In Jamaame, MSF has also trained community health staff to relieve doctors and nurses of some of their tasks. When and if security allows, MSF would like to improve obstetric care and increase epidemiological monitoring. For now, these plans are on hold. Still, Roldan says the locals appreciate what MSF provides: “The hospital is always full and these people have no other place to go,” he says.