MSF's work in Somalia began in 1979 and continued without interruption from 1991 until 2013.
Somalia 2011 © Sven Torfinn
MSF first worked in Somalia in 1979 and was present in the country with few interruptions between 1991 and 2013. MSF has worked in several locations: Baidoa, Dinsor, Huddur, Jamaame, Jowhar, Kismayo, Marere and the capital Mogadishu in the south; Galcayo and Guri El in the north; and Belet Weyne in central Somalia.
In August 2013, MSF announced the closure of all its projects in Somalia. The announcement followed the release of two MSF workers who had been kidnapped in Kenya’s Dadaab refugee camp and held in Somalia for 21 months, as well as the murder of two MSF staff in Mogadishu and the release of their convicted killer after only three months in prison. These were the final blows in an accumulation of disastrous events; a total of 16 MSF staff were killed in Somalia since 1991.
In a country with almost limitless need, MSF teams had addressed many different kinds of crises in Somalia, focusing in particular on nutrition, emergency care for people wounded in conflict, mother and child healthcare, and treatment of infectious diseases, such as cholera, measles, kala azar, and tuberculosis (TB).
“Our decision to leave has been among the most painful in MSF’s history,” wrote Dr. Unni Karunakara, MSF’s international president, noting that in 2012 and the first half of 2013, MSF was treating almost 2,000 people in Somalia every day. “Many will struggle to find the care that they need from now on. For an organization of doctors, that is a heavy responsibility.”
Security has always been the major concern for teams working in Somalia, to the extent that MSF had to take the exceptional measure of utilizing armed guards for protection. Starting a project anywhere in Somalia takes a great deal of time, patience, energy, and negotiation. Even after the project is established, the prevailing security risks have always limited the access teams have had to communities—as have the periodic, unlawful moves by those involved in the conflict to prevent medical personnel and would-be patients from reaching each other. These constraints played a large role both in determining the size and type of operations MSF could maintain and in the organization's ability to respond to emergencies.
Security constraints have, in fact, been a major factor in every instance in which MSF closed one of its projects in Somalia. Projects were closed because deteriorating security conditions and changes in the political landscape made it impossible to ensure an acceptable humanitarian space in which to develop activities. Movement was too limited, access to vulnerable populations was too irregular, and MSF workers faced too much pressure. Some projects stalled before they were implemented as well, usually due to failures in negotiations with local actors that either did not accept the conditions requested by MSF or made demands that MSF could not accept.
“But security is not the reason we left,” wrote Dr. Karunakara, “nor is the presence of criminal elements. What dashed our last bit of hope of working in the country was that the very parties with whom we had been negotiating minimum levels of security tolerated and accepted attacks against humanitarian workers. In some cases, they were actively supporting the criminal acts against our staff. In many other cases, these parties sustained an atmosphere that allowed attacks to take place. Nobody has stood up to say that it is unacceptable to threaten, abduct or kill doctors, nurses and other staff who simply try to bring health care to people who would otherwise have none.”
Here is a timeline of MSF in Somalia:
1979 to 1991
MSF begins work in Somalia by assisting Ethiopian refugees, later expanding its activities and experiencing its first security incidents.
1981 © MSF
MSF begins providing assistance to refugees coming from the Ogaden region in eastern Ethiopia to the central Hiraan and southwestern Gedo regions in Somalia. MSF closes its mission in Somalia in mid-1982.
1986 © Didier Lefevre / imagesandco.com
MSF treats Ethiopian refugees around the city of Hargeisa, the capital of Somaliland, a semi-autonomous region in the north. On January 24, 1987, ten international MSF staff members are kidnapped in Tug Wajale, near Hargeisa, and held for two weeks before being released.
1989 © E. Reisser
MSF begins supporting a 120-bed hospital in Boroma but has to shut the project after four months because the roads from Djibouti are closed and there is no available air transport, meaning all transport links had been severed.
1990 © MSF
While other international organizations are evacuating due to the deteriorating security situation, MSF arrives in Mogadishu in December for an exploratory mission.
1991 to 1995
The security situation worsens dramatically after the fall of Siad Barre’s regime. The United Nations Operation in Somalia (UNOSOM) and the US-led United Task Force (UNITAF) are deployed for humanitarian missions and peacekeeping. Meanwhile, widespread famine prompts MSF to open feeding centers.
1991 © Carl Cordonnier/Daily Life
MSF teams arrive in Mogadishu in January, just as most other actors are leaving due to insecurity. War surgery programs start in several locations controlled either by governmental troops or United Somali Congress (USC) rebels: Digfer, SOS Kinder Garden, Medina, Benadir, Martini and Military Hospitals.
Following numerous interruptions of activities due to security incidents, including the killing of a MSF driver in July 1991, MSF starts hiring private armed guards.
1992 © John Reardon
MSF launches a large media campaign in May—including a press conference in Paris—to call attention to famine in Somalia. Nutritional programs open throughout the country (in Barbera, Kismayo, Jowhar, Gilib, Merca, Brava, Huddur, Wajid, Baidoa, and elsewhere) and treat thousands of malnourished children.
MSF's office in Barbera in the northwest and an MSF house in Kismayo in the south are both looted.
In March, United Nations Security Council resolution 751 establishes an observer mission in Somalia (UNOSOM).
In August, MSF holds a press conference in Nairobi opposing U.N. peacekeeping operations in Somalia. MSF states that the operations blur the line between military and humanitarian objectives.
1992 © John Reardon
It is an extremely volatile and tense situation for MSF teams on the ground during this time; there are burglaries, a guard is shot, and threats are made against international staff. In November, MSF suspends surgical activities at Medina Hospital in Mogadishu due to a conflict with the personnel. In December, the UN authorizes the deployment of a US-led international task force (UNITAF) to restore order and safeguard relief supplies. Operation “Restore Hope” begins.
1993 © Stephane Van Praet/MSF
In January, an MSF car is caught in an ambush and shot at in Mogadishu.
The U.N.’s Unified Task Force (UNITAF) troops attack International Action Contre La Faim/Action Against Hunger’s (AICF) compound in Mogadishu on January 17, killing one Somali worker and wounding eight. Six MSF international volunteers were present in the house. MSF issues a press release condemning the attack on the compounds and presents a formal complaint to the U.N. Security Council.
1993 © Carl Cordonnier/Daily Life
In February, an MSF feeding center and a health post are looted in Kismayo in the south while MSF cars are ambushed several times between Baidoa and Mogadishu. In March, an Australian UNITAF soldier kills an MSF guard while on duty in Baidoa. In April, MSF programs in Baidoa close down.
In March, UNSC resolution 814 authorizes the establishment of a large civilian and military peace support operation (UNOSOM II) to oversee the reconstruction of Somalia.
In March and April, MSF carries out several evaluations which lead to the closure of nutritional projects. The famine emergency is considered to be over and enough food is available. On June 6, MSF decides to close its programs in the capital city.
In early October, 18 American soldiers and hundreds of Somalis fighters are killed during the “battle of Mogadishu” following a failed operation to capture rebel clan leader Mohamad Aidid. The US subsequently withdraws from Somalia.
A large cholera outbreak hits Somalia. MSF opens treatment centers and starts primary health care and vaccination campaigns in Mogadishu.The US mission formally ends in March.
1995 to 2006
After the departure of UNOSOM in March 1995, international attention turns away from Somalia. The Somali population is forgotten, even as it is forced to contend with sporadic combat between warlords. The Islamic Courts Union (ICU) progressively gains influence and power with the support of Eritrea. The majority of international NGOs withdraw from the country. MSF decides to return but humanitarian work becomes increasingly difficult.
Following the kidnapping of an aid worker in Mogadishu, most international staff withdraw from the capital. The last of the UN forces leave the country in March.
In February and March, local MSF staff responds to cholera outbreaks in Kismayo and Mogadishu. From July onwards, MSF expands its activities in Kismayo Hospital.
1996 © Petterik Wiggers
In January, MSF launches medical and nutritional interventions in a 40-bed hospital in the southern city of Bardere and resumes its cholera interventions in Mogadishu and Kismayo.
The security situation remains very volatile. In November, an MSF anaesthetist is killed in Kismayo due to a dispute between clans.
From October to January 1997, a measles outbreak hits Mogadishu, and MSF conducts a vaccination campaign.
1992 © Petterik Wiggers
In January, MSF begins supporting Galcayo Hospital in central Somalia, (which becomes the Puntland state of Somalia in August 1998). MSF's cholera treatment center in Mogadishu reopens, but an MSF logistician working in the capital is killed in May.
In April, MSF starts working in Baidoa Hospital, supporting post-operative and nutrition activities and providing medical supplies. But on June 20, Dr. Ricardo Marques of MSF is murdered in Baidoa Hospital. MSF subsequently ends all activities in Baidoa and Bardere.
In December, MSF provides medical support in the Jamaame and Marere areas in Juba Valley following heavy floods. The operation finishes the following March.
Mogadishuand Kismayo are both again hit by waves of cholera. MSF opens a cholera treatment center in northern Mogadishu and treats 3.000 people. The center is robbed in April and the teams there are threatened. All international teams evacuate until September. Several evacuations also occur in Kismayo and Galcayo due to insecurity.
1999 © Petterik Wiggers
MSF extends its coverage in Galcayo Hospital to include maternal care. In October, the entire team is forced to evacuate after armed men rob the compound. Two months later, MSF returns and responds to a cholera outbreak.
Kismayo is extremely unstable due to fighting between clans and the ICU, making it impossible to keep international staff there on a permanent basis. Somali staff takes responsibility for MSF's activities in Kismayo, with international staff making “hit and run" visits to support their efforts.
MSF reopens its cholera treatment center in Mogadishu and treats patients from January to July. That month, two international aid workers are taken hostage in the southern part of the capital following an attack on their compound. In August, clan leaders and senior figures meet in Djibouti and elect Abdulkassim Salat Hassan president of Somalia. The aid workers are released in September. MSF evacuates all of its teams in the capital until November.
In April, an MSF midwife is threatened with a gun in MSF’s Galcayo Hospital maternity ward. In Kismayo, a UNICEF plane is shot at.
In June, MSF launches a medical and nutritional project in Huddur, in the southwestern Bakool region. After two months, in response to the situation on the ground, it becomes a visceral leshmaniasis (kala azar) treatment program.
2001 © Andrea Vallerani
In March, the MSF compound in northern Mogadishu comes under heavy fire in an armed attack. MSF halts its cholera interventions in the area. MSF also closes its project in Kismayo later in the year due to recurrent security incidents.
MSF treats 27,000 children as part of its measles vaccination campaign in the Bakool region.
1996 © Petterik Wiggers
Fighting in southern Somalia forces 10,000 people to flee to Kenya. In October, MSF clinics in Aden Yabal, in the south-central Middle Shabelle region, are attacked. One person is killed; three are injured.
MSF teams reopen programs in Mogadishu.
In December, after an MSF guard is killed during an attack on another organization’s compound in Marere, MSF evacuates its team from the area.
2004 © Pep Bonet/Noor
In January, MSF teams respond to a measles outbreak near Dinsor, a town in the southwest where MSF also runs a 35-bed health center.
In November, a transitional federal government (TFG) is inaugurated, though its members are still exiled in Kenya. Abdullahi Yusuf Ahmed is elected president and recognized by most of the international community.
2005 © Alexander Glyadyelov
Members of the Somali central government begin returning home from exile in Kenya. The ICU controls most of southern Somalia and is still gaining ground.
2006 © Stefan Pleger
In February, the transitional parliament meets in Somalia—in Baidoa—for the first time since it was appointed in 2004.
Following heavy fighting against the US-backed Alliance for the Restoration of Peace and Counterterrorism (ARPCT), which is largely composed of warlords and businessmen, the ICU takes control of Mogadishu and parts of the south with Sheikh Sharif Ahmed as its leader.
MSF runs a measles vaccination campaign in Mogadishu, vaccinating 26,240 children between the ages of six months and 15 years. In the Yaqshid North area, the teams vaccinate 54,897 children.
2006 © Jehad Nga
MSF opens two new projects supporting hospitals in Dhusa Mareb and Guri El, in the central Galgaduud region.
The African Union and the UN adopt a resolution in support of an Intergovernmental Authority on Development (IGAD) peacekeeping mission for Somalia (IGASOM) to be deployed in October. The Council of Somali Islamist Courts (CSIC, formerly the ICU) opposes the intervention of a regional peacekeeping body.
In December, a US-backed Ethiopian military intervention defeats the CSIC, which capitulates on December 27 and abandons Mogadishu, then Kismayo.
2007 to 2011
The UN-supported Transitional Federal Government, which officially rules Somalia, is at near constant war with the Islamist militant organization known as Al-Shabaab. MSF expands operations throughout the country but obstacles again arise quickly.
2007 © Marcus Bleasdale
President Abdullahi Yusuf Ahmed enters Mogadishu for the first time since taking office in 2004. A group of CSIC fighters launch a guerrilla organization called the Harakat al-Shabaab Mujahedeen, better known as Al-Shabaab, a jihadist movement that soon develops close ties with Al Qaeda. A UNSC resolution authorizes an African Union peacekeeping mission for Somalia (AMISOM). Once more, heavy fighting breaks out in Mogadishu and hundreds of thousands Somalis flee the capital.
MSF opens a hospital program focusing on surgical care in Belet Weyne, in the Hiraan region of central Somalia. MSF also opens a primary health care clinic in Yaqdish, in Mogadishu. By May, the team has treated 1,000 patients. Additionally, teams open three new outpatient clinics for children in Balcad, Karaan, and Lido over the course of the year. In December, the Lido clinic is reinforced with an inpatient ward.
2007 © Alixandra Fazzina
In Jamaame, in the Lower Juba region, MSF sets up a 30-bed hospital with a large nutritional program and outreach activities. MSF also opens a project in Hawa Adbi, outside of Mogadishu, supporting the area’s paediatric ward, focusing on nutrition, and distributing non-food items to people displaced by the fighting. MSF also begins assisting displaced people in Afgooye, outside of the capital.
2007 © MSF
In August, an MSF driver is killed in Mogadishu.
In September, MSF starts providing emergency surgical care in a hospital in Daynile on the outskirts of Mogadishu. The same month, MSF begins an emergency surgical project in Kismayo.
The number of Somali refugees who have fled the country rises above one million.
2008 © Oscar Sanchez-Rey
In January, three MSF employees are killed in Kismayo. MSF closes its projects there. MSF evacuates all international staff from Somalia in April. A new strategy of remote management is put in place. International teams based in Nairobi manage national staff teams inside Somalia that run the day-to-day operations.
In September, MSF closes its programs in the Wardigley and Hodan areas of Mogadishu due to increased security risks for MSF patients and staff.
2009 © Jan Grarup /NOOR
Ethiopia completes its withdrawal of troops that started in December 2008. Al-Shabaab fighters overtake the town of Baidoa, which had been a key stronghold of the transitional government. Parliament elects Sheikh Sharif Sheikh Ahmed as president and extends the transitional government's mandate for another two years.
MSF provides free basic health care and nutritional care to vulnerable people in Somaliland, focusing on children under five in Hargeisa.
Teams treats more than 400 children for measles in the Guri El area, in the central Galgaduud region.
In April, two MSF international staff are abducted and held for nine days in the southwestern Bakool region. They are released unharmed.
MSF closes its health center in Huddur after nine years.
In June, a rented MSF vehicle is attacked in Galcayo. The caretaker of an MSF patient is also killed. In July, amidst heavy fighting, MSF closes its paediatric hospital and three health clinics in the Yaqshid, Karan, and Abdul Azziz areas of northern Mogadishu.
Armed men raid and loot the MSF nutritional treatment center in Jilib, in the Lower Juba Valley.
2010 © Frederic Courbet/Panos
In April, MSF conducts an “eye surgery camp” in Galcayo. The project screens 3,000 people and operates on more than 600, in some cases restoring the sight of people who had been blinded by cataracts for years. In May, MSF opens a new outpatient facility for children under the age of 12 in Galcayo. In June, MSF opens TB departments in two of its health centers in the Middle Shabelle region, in Mahaday and Gololey.
In July, the Al-Shabaab claim responsibility for twin bombings that killed 74 people in the Ugandan capital, Kampala. AMISOM's mandate is reinforced and its numbers rise to 10,000 soldiers from Uganda and Burundi.
MSF teams close their medical project in Somalia’s Hawa Abdi area, on the outskirts of Mogadishu, in early September, after three years.
2010 © Feisal Omar
In Marere, in the Lower Juba region, the provision of medical care in MSF facilities becomes more difficult after the local administration imposes a number of restrictions on operations, including a ban on receiving medical supplies by plane and a prohibition on visits from international staff.
In December, MSF employs telemedicine in Istarlin hospital in Guri El, allowing a medical specialist in Nairobi to provide direct, real-time support to doctors working in Istarlin's pediatric department.
2011 © Martina Bacigalupo / Le Monde / Agence VU
In March, following two grenade attacks on its compound, MSF temporarily suspends medical activities in the Dharkenley district in Mogadishu.
When a severe drought hits East Africa, compounding the toll already taken by conflict and the longstanding lack of development and humanitarian access, some 2.8 million Somalis, according to UN figures, find themselves in urgent need of food aid.
Many flee their home villages seeking assistance. Displacement camps in neighboring Kenya and Ethiopia are overwhelmed with the influx of new refugees. Around 150,000 newly displaced people arrive in Mogadishu. MSF scales up operations to respond to the large numbers of new arrivals and to counter and prevent outbreaks of measles and other communicable diseases.
MSF expands operations in Somaliland, providing support in Burao (also called Burco) general hospital, the only public health facility in the Togdheer region. Admissions triple and mortality rates drop in the maternity ward. In Ceerigabo, MSF continues full support, started in 2010, to the district hospital, while in Somaliland’s capital Hargeisa, MSF closed its basic health services in displacement camps in June, as the needs can now be covered by the Ministry of Health and another agency in the area.
Somalia 2011 © Yann Libessart/MSF
In September 2011, MSF was providing free medical care in eight regions: Bay, Hiraan, Lower and Middle Shabelle, Galgaduud, Lower Juba, Mudug and Mogadishu.
More than 1,400 Somali staff, supported by approximately 100 staff in Nairobi, were providing free primary healthcare, surgery, treatment for malnutrition, as well as support to displaced people through health care, vaccination, water supply and relief items distributions.
MSF was also providing medical care to Somali refugees in Kenya and Ethiopia. MSF does not accept any government funding for its projects in Somalia. All its funding comes from private donors.
Somalia 2011 © Peter Casaer/MSF
MSF projects in Somalia detect a steady number of measles cases—3,049 between January and September 2011. MSF is battling the outbreaks of measles and cholera in and around the town of Marere in the south, where around 5,000 Somalis fleeing conflict and drought in their villages are now seeking shelter.
MSF vaccinates more than 50,000 children against measles between July and September, mostly through outreach activities and small-scale immunizations, despite difficulties, constraints, and concerns for the safety of medical staff.
Implementing mass vaccinations, the first choice to fight outbreaks, is not easy; MSF has to undertake time-consuming negotiations with local leaders, authorities, and even armed groups who control particular areas of central and southern Somalia to allow vaccination campaigns that could save thousands of lives. Negotiations also often extend to simpler things like hiring people and vehicles.
Somalia 2011 © MSF
More than 150,000 Somalis leave the provinces of the country's central region—Bay, Bakool, Hiran, Lower and Middle Shabelle—to seek refuge in Mogadishu between July and October 2011.
This large-scale population displacement is the result of poor agricultural production, loss of livestock due to drought, increasing prices, and perpetual insecurity.
In an exodus such as this, measles is the greatest threat, particularly for children. Between early August and October, MSF vaccinates more than 40,000 children under the age of 15.
Many more children need to be vaccinated to actually get the epidemic under control, but logistical and security constraints limit what the teams can do.
Somalia 2011 © MSF
Mogadishu's population is currently estimated at more than 1 million; half of that number are thought to be displaced persons. Medical needs far exceed available health services and more people continue arriving daily.
The displaced populations are living in precarious health conditions, their immune systems already weakened by poor nutrition.
Many have never been vaccinated. Infectious diseases—including cholera, pneumonia, dengue fever and malaria—are common in the city and the rainy season, which will begin in October, could increase their spread.
In Mogadishu, MSF is managing four therapeutic feeding centers where the most serious cases are hospitalized.
Kenya © Michael Goldfarb/MSF
On October 13, an MSF team suffers an attack in Dadaab refugee camp, Kenya, on the border with Somalia.
Mohamed Hassan Borle, 31, a driver for MSF, is injured during the attack; he is hospitalized in a stable condition and is out of danger.
Two international staff, Montserrat Serra, 40, and Blanca Thiebaut, 30, both Spanish citizens working as logisticians for MSF in the Ifo 2 camp in Dadaab, are abducted.
The attack jeopardizes assistance to thousands of people in urgent need of humanitarian aid. Following the attack, MSF has to evacuate part of its team working in Dagahaley and Ifo 2, two of the three refugee camps in Dadaab. As a consequence, crucial MSF medical services have to be stopped, although life-saving activities in Dagahaley continue.
Somalia 2011 © Brigitte Rossotti/MSF
MSF is forced to suspend its measles vaccination campaign after heavy fighting erupts on October 20, 2011, in Daynile, on the outskirts of Mogadishu. The campaign had been scheduled to last three weeks and to reach 35,000 children. Measles is currently wreaking havoc in Somalia, and MSF has vaccinated more than 60,000 people between late August and October.
"Combined with malnutrition, measles is now the main killer of children in Somalia,” says Duncan McLean, head of MSF programs in Somalia. “Only vaccination can stop the spread of the epidemic.”
In addition, many people were wounded during the clashes. Daynile Hospital receives 83 patients injured by gunshots or explosions; 41 are hospitalized and 11 surgical procedures are performed.
Somalia 2011 © MSF
Dozens of people are wounded in an October 30 aerial bombardment that hit a displaced persons camp in Jilib, southern Somalia.
MSF treats the wounded in the town of in Marere, in Lower Juba Region. At least three people are reported dead and 52 injured, mostly women and children.
Ethiopia 2011 © MSF
Refugee camps in Ethiopia are home to roughly 130,000 refugees from Somalia, the majority of whom have fled an ongoing food crisis and conflict. By November 2011, the number of people crossing the border into Ethiopia has increased to approximately 300 per day, up from 90 per day in September and October.
“At the moment, the capacity to receive more people and provide the necessary food, nutritional care, medical care, drinking water, sanitation and more, is grossly insufficient,” said Wojciech Asztabski, MSF project coordinator in Dollo Ado, Ethiopia.
Since May 2011, MSF has dramatically scaled up its medical programs to help bring mortality rates under the emergency threshold of one death per 10,000 people per day, but the organization warns that the emergency is far from over.
Somalia 2011 © Yann Libessart/MSF
In less than six months, MSF provided intensive medical care to more than 10,000 severely malnourished children who were brought to projects in northern Kenya, including in Dadaab refugee camp; in eastern Ethiopia, at refugee camps in Malkadida, Kobe, Bokolmayo, Hilleweyn, Dolo Ado; and across much of south-central Somalia itself, in Marere, Beletwayne, Dinsor, Daynile, Mogadishu, Jowhar, Guriel, and Galcayo. As of November 2011, MSF also enrolled a total of 54,000 severely malnourished children in outpatient feeding programs in more than 30 locations in these three countries. At the same time, MSF teams have been battling the deadly combination of measles and acute malnutrition, which affects children in particular.
Somalia 2011 © Yann Libessart/MSF
On December 29, MSF confirms that two of its staff members were killed this morning as a result of a shooting at the MSF compound in Mogadishu, Somalia.
One of the aid workers died during the shooting; the other was transferred to a hospital and died following surgery this evening. Philippe Havet, a 53-year-old from Belgium, was an experienced emergency coordinator who had been working with MSF since 2000 in many countries, including Angola, the Democratic Republic of Congo, Indonesia, Lebanon, Sierra Leone, South Africa, and Somalia.
Andrias Karel Keiluhu, better known as "Kace," was a 44-year-old medical doctor who had worked with MSF since 1998 in his native Indonesia, as well as in Ethiopia, Thailand, and Somalia.
MSF is forced to end all activities in the Hodan district of the capital, including the closure of two separate 120-bed medical facilities for the treatment of malnutrition, measles, and cholera.
The closure of activities in the Hodan district reduces by half the assistance MSF is providing in Mogadishu. The facilities were MSF’s largest in the city. For now, MSF projects will continue to provide medical care in other districts of the city, as well as in 10 other locations in Somalia.
Kenya 20122© Brendan Bannon
In February 2012, life in the Dadaab refugee camps of northeastern Kenya, which collectively form the largest refugee camp in the world, is becoming more difficult every day and hundreds of thousands of refugees are facing a humanitarian emergency.
In the wake of the 2011 kidnapping of two MSF staff and amid a climate of worsening security, MSF has suspended all "non-lifesaving activities". Official registration and medical screening of new arrivals has been stopped. Today, for many refugees, services have not been restored. There is an urgent need to ensure that protection and assistance is provided.
The relocation of families to the newly opened camps of Ifo 2 West and Ifo 2 East continues, but work to ensure sufficient services has been slow to restart. Today, a limited number of people remain on the outskirts of the camps in so-called "self-settled areas" where living conditions are still extremely poor.
Kenya 20122© Brendan Bannon
In March 2012, measles is sweeping unchecked through parts of southern Somalia. The disease is highly contagious and unvaccinated children are at great risk, especially if they are also malnourished.
"Over the last weeks, we diagnosed and treated over 300 patients for measles—mainly children—in the towns of Haramka and Marere in Lower Juba Valley," says Silvia Colona, MSF's project coordinator for southern Somalia. "We also set up a measles treatment unit in the city of Kismayo last week, and it filled up immediately with critically ill children."
Somaliland 2012© Hamza Mohamed/MSF
In Somaliland, MSF helps ensure better access to health care and improves water and sanitation systems in detention centers in Hargeisa, Mandheera and Burao (also called Burco), and continues to work with the Ministry of Health at Burao General Hospital.
Somalia 2012© MSF
On March 30, 2012, Daynile Hospital in Somalia’s capital, Mogadishu, is hit with mortars. The shelling strikes the hospital’s emergency room and a portion of the surgical ward, causing significant damage. MSF has worked in the hospital since 2006.
There are no casualties among the hospital’s 19 patients or the staff; everyone sought shelter from the shelling in the internal medicine department.
MSF calls on parties to the conflict in Somalia to respect the neutrality of Daynile Hospital, along with that of all medical facilities in the country, and to respect the safety of patients and hospital staff.
Somalia 2008 © Oscar Sanchez-Rey
MSF teams in Somalia’s Middle Shabelle region have been responding to a cholera outbreak that was first detected in late March. After the first cholera case was confirmed, MSF opened a cholera treatment center in the town of Balcad. In addition to treating patients, MSF teams are also chlorinating water sources and distributing water-purifying tablets to affected communities.
Ethiopia 2012© Michael Tsegaye
MSF in May 2012 hands over its project in Hiloweyn camp, one of the five refugee camps near the border between Ethiopia and Somalia, to ARRA, an Ethiopian refugee agency. The number of refugees crossing the border has decreased significantly since August 2011—the height of the humanitarian crisis—when MSF opened the project. However, MSF continues to run stabilization centers for severely malnourished children with medical complications in all five camps.
Somalia 2011 © Peter Casaer/MSF
Also in May, due to worsening security conditions, MSF makes the difficult decision to close its basic health care programs in Dhusa Mareb and Hinder. The 108-bed hospital in Belet Weyne, Hiraan region, is to be closed at the end of the year, and activities in Guri El Hospital, Galguduud region, are to be handed back to the community in January 2013.
Somalia 2011 © Peter Casaer/MSF
MSF had expanded its medical services in Galcayo North to include maternity and obstetric care in December 2011; in June 2012, the number of deliveries spikes to about 200 per month, with many mothers traveling from great distances. Somalia's maternal mortality rates are among the highest in the world, and the trials faced by many women giving birth here are immense.
Kenya 2011© Lynsey Addario/VII
Kenya’s Dadaab holds the shameful title of the largest refugee camp in the world. Its five camps—Dagahaley, Hagadera, Ifo, Kambios, and Ifo 2—are home to 465,611 registered refugees in June 2012, as well as thousands who are not yet registered. Envisaged as a temporary solution to house refugees from Somalia’s civil war, the refugee camps are now 20 years old, and have become a permanent home for the majority of those who have sought shelter there.
Most refugees there have already suffered violence, hunger, and terrible loss in Somalia. They have made the dangerous journey to Kenya in search of safety, shelter, and assistance, only to discover that the camps no longer offer refuge.
Somalia 2011© Peter Casaer/MSF
In July 2012, MSF is responding to increasing cases of acute watery diarrhea among children and adults in the city of Kismayo in southern Somalia. Acute watery diarrhea is highly infectious and can be deadly if not treated in time. Kismayo’s dense population means that a widespread outbreak could easily occur if urgent prevention measures are not taken.
The most effective way to prevent such outbreaks is chlorination of drinking water sources and adherence to basic hygienic measures. Unfortunately, the use of chlorine is not allowed in the Kismayo area, so MSF community health workers are advising people to strain water through clean cotton fabric and boil it before drinking it, in addition to regularly washing their hands with soap.
A temporary cholera treatment center has been set up in one of MSF’s existing facilities in Kismayo, but the 20-bed ward has already been overloaded by the 36 patients currently under treatment.
Kenya 2011© LynseyAddario/VII
Drastic measures to improve the protection and assistance to refugees in Dadaab camp, Kenya, must be implemented now, MSF says in October, especially with the emergence of cholera and an outbreak of hepatitis E in the camp.
“We are seriously questioning the overall level of assistance provided to the refugees,” says Bruno Jochum, MSF general director. “With security conditions worsening, basic services and the provision of aid have been significantly reduced, so it is no surprise that refugees are yet again facing disease outbreaks.”
Since 2011, international funding for the camps has been cut by more than 40 percent, while the refugee population has continued to grow. With the rainy season about to begin, there is an alarming lack of shelter and sanitation infrastructure. The temporary assistance being provided is clearly not enough, and it is only a matter of time before a new major humanitarian crisis again hits the camps.
Kenya 2011© Lynsey Addario/VII
One year after the abduction from Dadaab refugee camp of Blanca Thiebaut and Montserrat Serra, two MSF employees, MSF restates its anger and shock. They were abducted on October 13, 2011, from Dadaab’s Ifo 2 refugee camp, in northeastern Kenya, by armed men while working on the construction of a hospital. MSF demands their immediate release.
Somalia 2011© Feisal Omar
A November 2012 MSF assessment shows that malnutrition rates are still alarming in many parts of Somalia, including the outskirts of Mogadishu.
According to this assessment, one in four children living in camps outside the Somali capital are malnourished. In response to this critical situation, an MSF team launched an emergency three-day intervention to provide urgent nutritional treatment and on-site medical care to children under the age of five.
Over three days, 1,500 children were screened for acute malnutrition and 396 were admitted to MSF’s nutritional program. The MSF team also provided emergency medical care to 162 children, referring 25 of them to the MSF pediatric hospital in Mogadishu’s Hamar Weyne District. Most were suffering from respiratory tract infections, skin diseases, and/or diarrhea. Additionally, some 380 children were immunized against measles, diphtheria, tetanus, whooping cough, and polio.
Somalia 2011© Peter Casaer/MSF
December 2012: a year has passed since our two colleagues, Philippe Havet and Andrias Karel Keiluhu (“Kace”), were brutally murdered in Mogadishu.
Following their tragic murders, MSF decided to close two large medical centers in the Somali capital. However, MSF continues to operate 10 projects throughout Somalia and provides medical and humanitarian aid to thousands of Somali refugees in camps across the border in Ethiopia and Kenya.
Kenya 2011© Michael Goldfarb
In late 2012, Kenyan authorities publicly exhort thousands of Somali refugees living in urban areas of Kenya to uproot and move to refugee camps in Dadaab. The camps, which together comprise the largest refugee settlement in the world, are already home to close to half a million people, well beyond their original capacity of 90,000. Squalid living conditions and insufficient assistance have been compounded by increasing insecurity in the camps over the last year.
Somalia 2012© Peter Casaer/MSF
In February 2013, the United Nations Security Council is deliberating the future structure of the UN’s mission in Somalia. Under discussion is the possible inclusion of humanitarian assistance within the broader political and military agenda for Somalia. Such an approach, in a country where the ability to provide relief is already severely compromised, could generate distrust of aid groups.
“As many Somalis continue to struggle to obtain the basic necessities for survival, such as food, health care, and protection from violence, humanitarian assistance must remain a priority and it must remain completely independent of any political agenda,” said Jerome Oberreit, MSF Secretary General. “The humanitarian aid system must not be co-opted as an implementing partner of counter-insurgency or stabilization efforts in Somalia.”
Yemen 2013© Ramón Pereiro/MSF
Authorities in Yemen free more than one thousand migrants from Somalia and Ethiopia between April and May 2013, many of who were forcibly held by human smugglers.
Some of the migrants had been held for months and displayed signs of torture and other physical, sexual, and emotional abuse. Many of the migrants treated by MSF were suffering from life-threatening diseases, including pneumonia, complicated malaria, and dengue. Many were victims of human trafficking, forced labor, and slavery; 62 are children and 142 are women.
Yemen is located along one of the main people smuggling routes from the Horn of Africa to the Gulf States.
On July 18, 2013, Montserrat Serra and Blanca Thiebaut are are released in Somalia.
MSF is extremely relieved to confirm the release of its two colleagues, who were abducted from the Ifo 2 refugee camp in Dadaab, Kenya, on October 13, 2011, and were subsequently held in Somalia for 21 months. “Once again, MSF strongly condemns the attack against these humanitarian aid workers, who were providing medical assistance to the most vulnerable Somali population fleeing hunger and war in their country,” said Jose Antonio Bastos, president of MSF-Spain.
Somalia 2011© MSF
After working continuously in Somalia since 1991 MSF announced on August 14, 2013, the closure of all its programs in Somalia, the result of extreme attacks on its staff in an environment where armed groups and civilian leaders increasingly support, tolerate, or condone the killing, assaulting, and abducting of humanitarian aid workers.
Over its 22-year history in Somalia, MSF has negotiated with armed actors and authorities on all sides. The exceptional humanitarian needs in the country have pushed the organization and its staff to tolerate unparalleled levels of risk—much of it borne by MSF’s Somali colleagues—and to accept serious compromises to its operational principles of independence and impartiality. “In choosing to kill, attack, and abduct humanitarian aid workers, these armed groups, and the civilian authorities who tolerate their actions, have sealed the fate of countless lives in Somalia,” said Dr. Unni Karunakara, MSF’s international president. “We are ending our programs in Somalia because the situation in the country has created an untenable imbalance between the risks and compromises our staff must make, and our ability to provide assistance to the Somali people.”
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