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Somalia: Extreme Needs, Extreme Choices
Somalia 2011 © Peter Casaer
Among the terms used to describe the situation in Somalia – hopeless, chaotic, miserable, disastrous – many talk of ‘donor fatigue’, another way of saying that people are tired of hearing and caring about this part of the world. However, Somalia requires that the world overcomes its short attention span; because this is a place where so many people are stripped of their humanity.
In south-central Somalia, civilians and combatants fall to wounds from bullets and bombs, and conflict has displaced hundreds of thousands of people from their homes. Malnutrition is rampant due to drought and displacement, and simple, curable diseases such as measles go untreated in the absence of any healthcare system.
How Somalia finds itself in such a situation is complex and contentious. Environmental conditions have frequently been cited as a factor, especially in the past year, when poor rainfall caused a drought, and thousands of lives were lost. While weather patterns played a role, they were not the root cause of the 2011 emergency. Had they been, malnutrition and mortality rates would have been similar in the population of the wider region, where rains had been similarly poor. They were not.
Twenty years of conflict
The main difference in south-central Somalia is 20 years of factionalized, fragmented civil war, in which not only Somalis, but also external parties, have sought to influence the situation.
In Somalia, simple vaccination campaigns for measles, tetanus or diphtheria take place only exceptionally, prevented by insecurity or because local authorities are hostile to such interventions, on cultural or ideological grounds. Many of the children who died in MSF’s nutrition centres in Mogadishu were infected with measles.
A persistent state of war has contributed to the development of a culture of impunity and lawlessness. Kidnapping and piracy have become industries, and humanitarians are not exempt. At the time of writing, two MSF colleagues are still held captive, having been abducted from the Dadaab refugee camp in Kenya, close to the border with Somalia, in October 2011. In December, a long-time employee of MSF shot and killed two MSF colleagues in a pre-meditated act inside the MSF compound in Mogadishu.
Between a rock and a hard place
Despite these obstacles, MSF remains one of the few organizations that have been able to work across Somalia continuously over the past 20 years, and believes it has brought valuable assistance to the population. But at what cost?
Operational security in Somalia, and especially in Mogadishu, is first and foremost a balancing act, which requires juggling the allocation of the benefits and resources that a relief operation brings – such as salaries, car rental fees and procurement of local supplies – among all the clans and political, military and business interests. On top of this fragile management of local power structures, Mogadishu is also the centre of a broader conflict in Somalia, involving other powers. This, too, requires clear lines of communication with all warring parties to ensure that their military strategies do not target medical facilities.
Negotiation, communication and juggling the distribution of resources, then, are key to security. They are just as important as armed protection – the iconic image of security in Somalia.
Of course, the medical crisis in Somalia and the emergency response it requires do not occur in a political vacuum. But the current portrayal of the situation carries two dangerous oversimplifications: the first is that Al-Shabaab is solely to blame for the conflict and underlying humanitarian crisis; the second is that the response to the crisis can only occur in areas under the control of the African Union Mission in Somalia (AMISOM), the Ethiopian army, the Kenyan army or the Transitional Federal Government (TFG) and pro-TFG forces.
In such a complex and highly volatile environment, the last thing humanitarian organisations need is for politicians to suggest that aid personnel are working on their behalf. As soon as humanitarian assistance is perceived to be part of the political agenda of any side, the painstaking efforts made to reach an agreement on security risk being brought to naught. Indeed, many aid efforts in Somalia are restricted today precisely because states involved in the conflict have successfully portrayed humanitarian assistance as a part of their military policy.
To be perceived as an ‘implementing partner’ of one of the many parties involved in military action, or of their sponsors, because of warring parties’ rhetoric, risks the closure of aid programs. And it is the Somali people who will pay the price, as they will not get the assistance they desperately need.
It was only after a visit to Mogadishu in July that MSF decided to expand emergency assistance programs in 2011. From a distance, expanding operations, and taking the risk of being seen as an agency supporting AMISOM and the TFG in creating a ‘safe haven’ for displaced Somalis was considered a significant political risk, and the large number of relief organizations present seemed to be able to cover people’s needs. Once in the city, however, the team saw that the medical and living conditions of the new arrivals were so bad that the enormous needs outweighed the political risk.
Since that brief period of world attention in the middle of 2011, the need for humanitarian assistance has not vanished. The people in Mogadishu, and much of the rest of Somalia, are experiencing one of the worst humanitarian crises in the world.
Complex choices remain before us. We have said a sad, final farewell to two of our workers, and our thoughts are with two others that are held against their will (at the time of writing). Somalia is still a place where we must make extreme choices if we are to provide aid for people in extreme need.
In 2011, MSF was working in 11 regions of Somalia. In many places, MSF hospital programs represented the only specialist healthcare available. MSF provided treatment for malnutrition, measles and cholera. In total, MSF treated 864,000 patients in Somalia, nearly double the assistance provided in the previous year. For more information on activities in Somalia in 2011, click here.