Somalia : a population caught between epidemics, malnutrition and conflict

Even for the long-suffering Somali population, the events of the past year have been challenging. The conflict that began two decades ago continues, and its consequences are exacerbated by drought, one of the worst on record in the country. Thousands of people have been forced to flee Somalia, and are seeking humanitarian aid in refugee camps in Kenya and Ethiopia. A measles epidemic is spreading. The lack of infrastructure and services is worsening the population’s vulnerability. In recent weeks, civilians have endured new military offensives launched in southern Somalia and the capital Mogadishu.

It is in this context that Médecins Sans Frontières (MSF) has, in less than six months, provided intensive medical care to more than 10,000 severely malnourished children who were brought to the facilities. MSF has projects in northern Kenya (mainly Dadaab), in eastern Ethiopia (in 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. MSF has also enrolled a total of 54,000 children in outpatient feeding programmes for the severely malnourished 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. A large proportion of the population has not been vaccinated - against measles or any other disease - because years of instability, lack of effective government and a functional state have caused the health care system to collapse. Measles, if untreated, can be highly fatal for children.

MSF teams have vaccinated more than 150,000 people in and around Somalia for measles, and have treated more than 5,000 patients for the disease this year. Much more needs to be done, however. The vaccination effort needs to be scaled up in Mogadishu, where waves of people continue to arrive, seeking assistance. In certain parts of the country, access has been greatly limited by the presence of armed groups. Medical teams have not been able to reach the population there, not even to assess their situation and mass measles vaccination campaigns have been blocked.

The arrival of the rainy season may further worsen conditions for children and adults living in makeshift camps in Mogadishu and elsewhere. In the capital, the proportion of children suffering from waterborne diseases - including diarrhoea, which also contributes to malnutrition - is now on the rise. MSF is preparing to deal with possible cholera outbreaks whose effects on hundreds of thousands of already malnourished people living in crowded conditions could be devastating.

All of this is occurring against a backdrop of insecurity and fighting, for which the Somali people continue to pay the price. On October 30, MSF treated 52 wounded people - including 31 children - in the southern town of Jilib, after an attack caused civilian casualties among the displaced. Ten days earlier, MSF teams in Daynille, on the outskirts of Mogadishu, treated 83 patients for gunshot and blast wounds, and was forced to suspend the measles vaccination campaign it had there. However, thousands of people displaced by conflict and drought continue to arrive in Mogadishu.

Since years, Somalis cross the border to seek refuge in neighbouring Kenya with an historical peak in June 2011 when more than 40,000 people were settling there every month. Present in the camp since 2009, MSF is offering a comprehensive package of health care to the population of Dagahaley camp. In Ifo camp, activities had to come to a halt after the kidnapping of two of MSF staff on October 13th. In Dagahaley, the insecurity forced MSF to reduce temporarily the activities which are increasing now.
The fighting in southern Somalia and along the Kenyan border and heavy rainstorms and floods have slowed to a trickle the number of people presenting themselves to authorities at the Dadaab camp. Meanwhile, the numbers of people fleeing into Ethiopia is increasing.

During these last six months, the organisation’s emergency efforts have proved difficult to translate into concrete actions for the Somali people, because of the lack of security both in the country and at the borders, and also due to ongoing restrictions imposed on MSF operations in certain parts of Somalia. Despite this, MSF was still able to scale up its activities and open new projects, in addition to the nine medical facilities that had already been running in south-central Somalia, making it the main provider of free healthcare in the region.