Somalia

Latest Operational Update: March 2009

Field Staff: 1,452

Reason for Intervention

Armed Conflict
Endemic/Epidemic Disease
Natural Disaster

For many years Somalis have endured violence, displacement, malnutrition, and lack of access to adequate health care. 2008 was no different. In fact a range of factors including ongoing and often indiscriminate violence; the collapse of the local economy and the ability to transport and deliver food aid; drought; inflation and high international food prices and a drastic reduction in humanitarian aid exacerbated people’s already appalling living conditions. Over the course of the year, the gap between critical needs in Somalia, particularly in and around Mogadishu, and the level of humanitarian response grew even larger, mainly due to aid agencies’ extremely limited capacity to deliver assistance in this highly insecure and volatile environment.

MSF experienced the impact of this insecurity first hand, losing four colleagues in 2008 and having to close three projects in Kismayo, Mogadishu, and Bosasso. In April 2008, intense fighting across the country and specific threats against foreign aid workers forced MSF to evacuate all of its international staff from Somalia. The media attention from this evacuation has led to an assumption by some that MSF’s operations have ceased. Nothing could be further from the truth. In fact, in sheer numbers medical activities increased in 2008.

As of February 2009 MSF’s projects continue to be run by dedicated Somali staff, supported by international staff based in Nairobi who visit whenever security allows. The commitment, hard work and bravery of these Somali staff meant that MSF was able to continue providing health care to hundreds of thousands of Somalis throughout 2008.

MSF remains the main provider of free medical services in all of central and southern Somalia with 1,452 Somali staff, supported by 104 staff in Nairobi, providing primary health care, malnutrition treatment, health care and support to displaced people, surgery, water and relief supply distributions in nine regions of the country.

In 2008 MSF teams provided 727,428 outpatient consultations, including 267,168 for children under five. Over 55,000 women received ante-natal care consultations and more than 24,000 people were admitted as inpatients to MSF supported hospitals and health clinics. Some 3,878 surgeries were performed, 1,249 of which were for injuries caused by violence. Medical teams treated 1,036 people suffering from the deadly neglected disease kala azar, more than 4,000 people for malaria and started 1,556 people on TB treatment. Nearly 35,000 people suffering from malnutrition were provided with food and medical care and 82,174 vaccinations were given.

Present in Somalia since 1991, MSF continues to run projects in:

Bakool Region:

MSF operates a 293-bed health center in the regional capital, Huddur, serving a population of approximately 250,000 people. MSF runs an outpatient department with a maternal and child health component, inpatient department consisting of adult and pediatric wards, kala azar wards, tuberculosis (TB) wards, outpatient facility and a therapeutic feeding center. MSF also runs four health posts, three in the Bakool region and one in neighboring Bay region. In 2008, MSF admitted 3,662 patients to the Huddur health center. Some 933 people received treatment for kala azar and 113 were treated for TB; 371 deliveries were done, while 570 children were treated for severe malnutrition. Some 52,000 outpatient consultations were done in the health center and the four health posts altogether, while thousands of children were vaccinated for preventable diseases.

Banadir Region:

Yaqshid Area -In northern Mogadishu MSF has run one of the few public health facilities in the city’s Yaqshid area since 1994. In 2007, MSF opened three more outpatient clinics for children in the Karan, Abdul Aziz (Lido) and Balcad areas, as well as a 50-bed inpatient clinic for children in Abdul Aziz. Throughout 2008, the four outpatient clinics provided 180,314 outpatient and 9,489 ante and post-natal care consultations. Early in the year MSF teams started a nutritional program for severely malnourished children with 1,800 patients admitted and treated in 2008. Teams also began providing dressing care for war-wounded patients who had undergone surgery. A total of 1,416 patients who had been operated on for war related injuries were provided with dressings.

Daynile Area - The MSF project in Daynile hospital, located nine kilometers north of the city, provides life-saving emergency surgery and care for those wounded in combat, regardless of clan affiliation. Following extensive rehabilitation, the facility now comprises 59 beds, and is equipped with two operating theaters, an emergency room and triage area and an intensive care unit. MSF also supports the general functioning of the hospital financially and through the supply of medical provisions. In 2008, staff treated a total of 5,250 patients in the emergency room, including 3,093 people wounded in the conflict. More than 50 per cent of patients treated were women and children under the age of 14. In the emergency room, 1,348 patients were admitted to the surgical department and 611 required emergency surgery.

Bay Region - In Dinsor MSF runs a 65-bed inpatient department (IPD), which serves the population of the entire district’s approximately 110,000 people. The inpatient department provides trauma care; life-saving surgical activities including caesarean sections; treatment for TB and kala azar; and therapeutic feeding for severely malnourished children. In 2008, MSF admitted 1,856 people to the IPD. The outpatient department provides treatment for respiratory tract infections; hypertension; diabetes; skin diseases, sexually transmitted diseases; urinary tract infections; diarrhea, and malaria. Almost 2,500 ante-natal care consultations were provided in the OPD throughout the year and 509 deliveries were assisted.

Galgaduud Region:

In Guri El’s 80-bed Istarlin hospital, MSF provides outpatient services for adults and children and inpatient services including a pediatric ward, gynecology ward; maternity ward and delivery room; operation theater and surgical ward; laboratory and x-ray facilities. Preventive services, such as ante-natal care and vaccination, are also offered. In addition MSF runs two health posts in Galgaduud: one in Dhusa Mareb, the regional capital, and one in Hinder, which opened in January of 2008. In 2008, 63,425 received consultations and free medication in the different outpatient departments of the hospital and health posts. Almost 4,000 patients were admitted to the hospital, of which 843 were deliveries and 622 patients were admitted for major and minor surgery. Some 700 children were treated for severe malnutrition.

Hiraan Region:

MSF runs a project within the regional 99 bed hospital in Belet Weyne offering free, secondary level health care to the 280,000 inhabitants of the region. MSF provides emergency and elective surgery; trauma care, pediatric care, treatment of severe malnutrition, and is prepared to respond to medical emergencies in the region. In 2008, 2,399 people were admitted to the hospital. Over 1,000 emergency and elective surgeries were performed. A total of 383 of these surgeries were for victims of violence.

Lower Juba Region:

MSF provides primary, secondary, and emergency care in the towns of Marere and Jamaame in the Lower Juba region.

Marere – activities include inpatient care for children, medical, and maternity cases; delivery including emergency obstetric care; therapeutic, and supplementary feeding; surgery (mainly obstetric); outpatient curative and preventative services; and TB treatment. In 2008, the MSF team in Marere provided 31,055 outpatient consultations including treatment for approximately 2,400 cases of Schistosomiasis (Bilharzia) and 600 cases of malaria. The year also saw 1,548 inpatient admissions, 1,637 admissions in the nutritional program and more than 2,700 in the supplementary feeding program in Marere and the nearby village of Jilib.

Jamaame -activities include an outpatient clinic; inpatient department for medical and obstetric cases, including complicated deliveries, and severe malnutrition; nutritional screening; ambulatory feeding program, and systematic surveillance for nutritional emergencies and outbreaks of epidemic diseases; emergency preparedness. In 2008, 1,079 patients were admitted to the inpatient department for treatment, 55 per cent of whom were under five years of age. A further 19,250 people were treated in the outpatient department (OPD), with the number of consultations doubling in the second half of the year as patients increasingly arrive at the hospital from other regions in order to receive free care. A total of 774 children under five years of age were also treated in the nutritional program over the course of the year.

Middle Shabelle:

MSF provides basic health care through a network of four health centers in the rural districts of Jowhar and Mahaday. The health centers provide outpatient preventive and curative services; mother and child care; and an extended program for immunization through mobile and fixed clinics. A maternity ward provides services for natural deliveries; caesarean sections, family planning and care for victims of sexual violence. There is also a nutritional program including a stabilization center and ambulatory care. In 2008 MSF staff provided 194,625 outpatient consultations and 35,262 ante and post-natal consultations. More than 3,200 malnourished children were admitted to the therapeutic feeding centers for malnutrition treatment and management of related medical complications with the highest peak of admissions during the months of June and July. A total of 1,520 babies were delivered in the maternity ward, of which 20 per cent were complicated.

Lower Shabelle:

In Hawa Abdi, MSF supports a private clinic and runs an outpatient department, pediatric inpatient department, cholera treatment center, nutrition program, water trucking and distribution of blankets and other non-food items. By the end of 2008, MSF had provided 78,599 outpatient consultations, more than half of which were for children under five years old. Over the course of the year MSF staff saw a huge rise in the number of children needing nutritional care in the intensive and ambulatory feeding centers in Hawa Abdi and Afgooye In total MSF treated 15,587 malnourished children under the age of five. More than two thousand of them were admitted to intensive care, while the majority were cared for as outpatients.

Mudug Region:

MSF provides outpatient curative and preventive services, including maternal care and vaccination; inpatient; paediatric; maternity including emergency obstetric care; therapeutic feeding; tuberculosis treatment; surgery for violence-related traumas; and emergency preparedness at South Galcayo Hospital. In North Galcayo Hospital, MSF provides tuberculosis treatment and therapeutic feeding. The hospital in South Galcayo provided 43,781 outpatient consultations in 2008. Over 3,000 severely malnourished children were treated, staff assisted in the delivery of 936 babies and 17,650 vaccinations were given. Almost 1,000 people suffering from TB were started on treatment.

MSF has worked in Somalia since 1991.