In 2009, the Somali population continued to fall victim to indiscriminate violence, while severe drought plagued parts of the country. Millions of people urgently require health care, yet the enormous gap between the needs of Somalis and the humanitarian response on the ground continues to widen. Ongoing abductions and killings of international and Somali aid workers is thwarting the efforts of humanitarian organizations to respond, and the public health-care system remains in near total collapse.
This occurred despite a new political momentum at the beginning of the year with the election of a new president Sheikh Sharif Sheikh Ahmed. In the capital, Mogadishu, fighting raged between the African Union- and UN-backed Transitional Federal Government forces and opposition groups. It remains impossible to verify the precise human toll of the conflict, but human rights groups and United Nations agencies have estimated that between 20,000 and 25,000 people have been killed from the fighting and countless others wounded since 2007, along with the displacement of more than 1.5 million people who have fled renewed, heavy fighting in Mogadishu and other parts of South Central Somalia in the last twelve months.
An MSF surgical team working in Daynile Hospital, just outside the capital, treated more than 2,400 war wounded, demonstrating the high levels of violence in the city. In February, the team treated scores of civilians injured in a dramatic upsurge in fighting, receiving 121 admissions in just one day. Forty-seven of the injured were women and children under twelve years of age.
The violence was not limited to the capital, as an MSF surgical team in the northern city of Galcayo treated more than 320 victims of violent trauma during the year. “The explosion took place after midnight and the hospital was flooded with wounded,” told MSF surgeon Dr. Maslah, “We perform all types of surgery, however war wounded patients make-up roughly half of the patients we operate on.” In early 2009, renewed fighting in Guri El and Dhusa Mareb, central Somalia, prompted thousands of civilians to flee their homes. MSF supplied water and medical care to displaced persons in the area.
The impact of such high levels of violence and insecurity stretches far beyond MSF’s surgical units, contributing to a general lack of access to basic lifesaving medical care countrywide. MSF’s ability to provide assistance was further diminished when in April two MSF staff members were abducted in Huddur in Bakool region leading to the closure of its largest health centre in south and central Somalia and four other health posts. In June an MSF employee died in an explosion in Belet Weyne, Hiraan region, which killed 30 other people. In July, the heightened insecurity forced MSF, for the first time in 17 years, to close activities in its pediatric hospital and three other health clinics in northern Mogadishu as staff were forced to flee for their own safety.
Another major challenge is the lack of qualified medical staff in Somalia, with so many health workers among those who have fled the violence and no medical universities open. In December 2008, there was a ray of hope with the graduation of 20 doctors from Benadir University in Mogadishu—the first graduating class of new physicians in two decades. This hope was short-lived with the bombing of the next graduation ceremony on December 3, 2009, killing 23 people, mostly graduates, and wounding more than 50 others.
The lack of free medical care available throughout the country exacerbates the health issues people face as a result of chronic poverty and this year’s severe drought. Although little reliable data is available at the national level, health-care indicators in Somalia are among the worst in terms of immunization, maternal mortality, malnutrition and access to basic health care services. According to the World Health Organization, women have a one in ten lifetime risk of dying during pregnancy or childbirth. One in five children under the age of five is acutely malnourished.
These statistics are borne out in malnutrition treatment centers and hospitals run on a daily basis by MSF’s committed 1,400 Somali staff who, supported by an international team based in nearby Nairobi, Kenya, provide vital access to free health care to the Somali population deprived from any other alternatives. Patients sometimes travel hundreds of miles to reach an MSF hospital or clinic, or suffer in isolation from easily preventable diseases such as measles. Between April and July, an outbreak of measles swept through the town of Guri El and nearby areas in the Galgaduud region of South and Central Somalia. MSF treated 403 patients for measles-related complications in the area, but was prevented from carrying out a mass vaccination campaign due to insecurity. In Hawa Abdi, where thousands of people fleeing Mogadishu have gathered, MSF was able to vaccinate 30,000 children for measles.
A drought and the death of important livestock precipitated a nutritional emergency in Galcayo and its surrounding areas. “I know many die in the village,” Ubah, a mother whose child was one of 1,300 severely malnourished children enrolled in the MSF nutrition program in Galcayo in early December, representing nearly half of all the cases treated in the program in 2008. “The journey is not only long, but also expensive, and many can’t afford it.”
Somalis have continued to flee by the tens of thousands to the neighboring Djibouti, Kenya and Yemen. MSF provides assistance to the refugees in these three countries as well as in Malta and until recently Italy. In Northern Kenya, in 2009, an estimated 270,000 additional Somalis settled in the surroundings of the overcrowded Dadaab refugee camps where they struggled to obtain even the most basic assistance such as food, water and sanitation.