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MSF in Somalia, 2006/2007
Field Staff: 654
Reason for Intervention
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The political climate in Somalia in 2006/2007 was highly turbulent, with massive insecurity caused by fighting between the Union of Islamic Courts and the Transitional Federal Government and the presence of Ethiopian troops.
Conflict once again worsened the situation in a country where needs are vast, yet little medical-humanitarian assistance is delivered on the ground. Since 1991, the Somali people have been without either a functioning central government or public health services. There was a need for MSF to repeatedly speak out on the deteriorating humanitarian situation in Somalia.
Coupled with famines, droughts, floods, and repeated conflict between armed factions and foreign armies, the absence of public health services has resulted in enormous unmet basic health needs for a large majority of the estimated population of over 11.5 million. Women and children under five are particularly vulnerable. One in ten women die during childbirth and more than one in five children die before their fifth birthday.
What little medical aid exists is privately owned and costly – out of reach for most Somalis. Many suffer from easily treatable diseases that can be fatal with no healthcare, such as diarrhea and respiratory tract infections. Somalia also has one of the world’s highest prevalence rates of tuberculosis (TB). The neglected tropical disease kala azar claims the lives of thousands and there are regular outbreaks of measles, cholera and other epidemics.
MSF has provided medical care in Somalia since 1991, comprising basic and secondary health services, treatment for neglected diseases, and emergency surgery. Activities were increased and expanded over 2006/2007, with new projects opening in Jamaame, Galgadud and Belet Weyne. In the first two months of operations in Belet Weyne hospital, which opened in early 2007, MSF staff carried out 95 major surgical interventions and 33 minor surgical procedures. The volume of activities also increased dramatically in extant projects. In Huddur, for example, a large health center in the Bakool region, consultations for kala azar patients rose by 530 percent between 2004 and 2006 and outpatient consultations increased by 58 percent.
Civilians displaced from Mogadishu
Insecurity overshadows all of MSF’s work in Somalia. In early 2007, fighting in Mogadishu caused the displacement of over 300,000 people. Whilst many were taken in by family or friends, in some towns close to Mogadishu, MSF found thousands of people living out in the open with no food, water or medical care.
MSF launched an emergency response in Afgooye, a town approximately 30 kilometers west of Mogadishu, and in Balad, a town approximately two hours from Jowhar on the road to Mogadishu. In Afgooye, a team of MSF Somali staff supplied medicines to existing health structures and items such as plastic sheeting to more than 3,500 families. With the threat of a cholera outbreak looming, the provision of clean water was a priority. MSF provided 72,000 liters of clean water daily to the displaced people through water trucking distributions. In Balad, MSF distributed food and vaccinated 1,300 children against measles. A temporary outpatient clinic was set up, providing approximately 80 consultations daily. MSF also conducted a vaccination campaign in Al Ma’an, a small port location north of Mogadishu.
Although some of those who fled to Afgooye returned to Mogadishu, lack of resources and theft or destruction of homes made return impossible for many others. Throughout the fighting, MSF’s Somali staff continued to run a primary health clinic in the Yaqshid area of Mogadishu, in an environment of insecurity. The fighting destroyed many public buildings and the few functioning public hospitals were closed. Cholera was particularly worrying in the capital. In March, MSF set up a cholera treatment center (CTC) in Forlanini, south Yaqshid, which treated over 1,300 patients.
In early May, MSF was able to open another, smaller CTC in Mogadishu. As the number of patients with the disease seemed to be declining, this center has now been converted into an outpatient clinic for children under five years of age, with approximately 90 patients treated daily. With continued insecurity, it remains very difficult for people in Mogadishu to get to clinics.
Continuing to work amidst insecurity
Insecurity in the capital is not the exception. Unfortunately, MSF is sometimes forced to suspend its medical activities because of violence or threats of violence against staff and patients. International staff must be evacuated at times and the projects continue to run under the management of Somali staff, the core providers of MSF’s work in Somalia. Following fighting in late 2006, at least 250 wounded were treated in various medical facilities in Dinsor. On 27 December 2006, representatives of military forces entered an MSF medical facility, pressured the Somali medical staff employed by MSF and confiscated all inpatient confidential medical files. MSF publicly expressed its grave concern for the safety of staff and patients following this serious incident.
MSF has worked in Somalia since 1991.