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MSF in Somalia, 2006
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“We do over 40,000 consultations per year in two hospitals but this barely scratches the surface. People come from up to 700 km away to get medical care, because there is nothing else available to them. Across great swathes of the country there is literally no possibility of access to medical treatment.”
MSF head of mission,
In February 2006, the new government of Somalia met for the first time. Even agreeing on a regular location to convene proved arduous. With the old capital Mogadishu imploding into all-out war in April, the temporary solution for the transitional federal government was a converted food warehouse in the southern town of Baidoa.
Following a fourteen-year period without a functioning government, Somalia's new political leaders are faced with the job of rehabilitating a country ripped apart by rival warlords and with some of the worst health indicators in the world. Complicating their task is the rise of the Islamic Courts, which took control of large swathes of south and central Somalia by July 2006.
The country has virtually no health infrastructure. People rely on the occasional private pharmacy or clinic for care, but these are out of financial reach for most. The only free healthcare is provided by organizations such as MSF. Yet with unpredictable and regular outbreaks of violence, international agencies are scarce in south and central Somalia, and MSF also temporarily evacuates its missions on a regular basis. MSF operates projects in seven locations across south and central Somalia, including the capital Mogadishu. A clinic in the Yaqshid quarter stands as one the few public health facilities in the north of the city, absorbing many patients from the neighbouring districts.
The number of consultations here are far beyond what a single facility can adequately absorb. In 2005, 109,000 outpatient and 7,900 ante and post-natal care consultations were provided at this clinic. Direct beneficiaries are the 150,000 people of Yaqshid North district, although the catchment population is close to a quarter of a million people. In addition to seeing high numbers of people with medical concerns such as respiratory infections and intestinal parasites, MSF is the only organization in the area treating epilepsy, asthma and other chronic health conditions.
In Middle Shabelle, MSF attends to primary healthcare in two districts — Jowhar and Mahady — through six outpatient dispensaries, seeing many patients with respiratory infections and skin diseases. In 2006, MSF ran a measles vaccination campaign in these districts, reaching 36,340 children aged 6 months to 15 years. In Yaqshid North area, 54,897 children were vaccinated.
The situation in Somalia worsened in 2005/2006 with a severe drought that decimated livestock and left many southern parts of the country with dwindling reserves of food and water. In early 2006, the MSF-run hospital in the town of Dinsor bolstered its team to provide mobile outreach activities, whilst the therapeutic feeding center treated more than 600 children for severe malnutrition between January and June, a figure almost ten times higher than the previous year. Even in a ‘normal’ year, malnutrition is a chronic problem in many parts of Somalia. MSF projects in Galkayo, Marare, Bakool, Galgaduud and Dinsor contain nutritional components that treat children year round.
Whilst news of the drought reached the public in 2006, most gaps in healthcare go unnoticed. Diseases such as kala azar and tuberculosis are rampant in the country — in Bakool alone there were 543 admissions for kala azar in the first half of 2006, most of these children under age five.
MSF opened new projects in the towns of Dhusa Mareb and Guri El in the Galgaduud region in early 2006. In Dhusa Mareb, the regional capital of Galgaduud, the town's hospital had not functioned since the last government collapsed in 1991. In the Istarlin Hospital in Guri El town, all but the most rudimentary medicines and equipment were unavailable and the few remaining staff were unpaid and lacked training. With MSF support, the two hospitals were already treating a combined total of nearly 3,000 patients per month by mid-2006. Patients present at the clinic for injuries resulting from car accidents and gunshots and trauma as an indirect result of violent conflict, including injuries sustained by children playing with grenades.
MSF has worked in Somalia since 1991.