As MSF returns to Somali flood area, all now depends on security and access

In November 2006, southern Somalia was hit by flooding and thousands of people fled their homes.

In December 2006, the developments of the Somali Transitional Federal Government (TFG) and Ethiopia in the country forces Médecins Sans Frontières (MSF) to make the extremely difficult decision to evacuate its international staff from Marere. National staff members continue to work.

Finally, in January 18, 2007, an MSF international team of four returns to Marere.

In a matter of weeks, perhaps months, we hope to start running mobile clinics in the area. Everything depends on two factors now: security and access.

What's the current state of the flooded area?

"When we left, the water was flooded up to the trees in some places. Flying in to our small airstrip near the project site, I could see the fields again, and that the shelters people had made from sticks, thatch and plastic sheeting were dismantled. It's stopped raining.

"It's hot but it's still humid. The area is quite flat and the lakes created by the floods are still there. When I went into one of the villages I saw the effect of the flooding everywhere: garbage, muddy wet earth and marks high up on their traditional square houses. The Somali people are incredibly resilient. They are cleaning up and recovering their villages."

In November, the team had to travel by boat. How are the roads now?

"Roads are passable by foot, but very difficult to travel on by car. Many of them have been washed out or run over by tractors. That makes it difficult for the population to reach us and for us to reach them. Depending on the security status in the area, we can make short trips (within 45 minutes driving) to combat cholera by distributing chlorine tablets and doing health education.

"Hopefully, that won't be necessary next week. Then we can restart our nutritional outreach activities, following up on patients in our supplementary feeding programme and actively looking for malnourished children needing treatment. In a matter of weeks, perhaps months, we hope to start running mobile clinics in the area. Everything depends on two factors now: security and access."

What kinds of patients are coming in now?

"The patients who are coming into our hospital now are mostly suffering from malaria, diarrhoea and respiratory tract infections. There is a further concern right now that highly contagious diseases may break out, in particular cholera and Rift Valley Fever - the latter being a type of haemorrhagic fever.

"We've already had six patients coming in from the border area with northern Kenya with Rift Valley Fever, of which one case was confirmed and five are awaiting test results. They had to travel for 15 hours over difficult roads to reach us, but they come because they know we are the only ones who can treat them. We are the only full medical care providers for approximately 12 hours in any direction in the Juba Valley."

What are the current MSF activities in Marere?

"Our project in Marere consists of a small hospital and a therapeutic feeding centre. We have 30 beds in our inpatient department, which is not full now, and we see about 80 to 100 outpatients per day, which is less than our normal average of 150 per day. Next to that we do vaccinations and give antenatal and post-natal care. We have about 20 children in the feeding centre now, but we expect to see more when access improves.

"Before the evacuation, we had 950 children in our supplementary feeding programme. And we are expecting a malnutrition crisis in two months time, so we are preparing for that.

"As many crops were lost in the flooding, there is a limited food supply. The people are replanting their fields as the water recedes, but the question is whether they will be able to make the harvest in time. We are also preparing for the high likelihood of a cholera outbreak, due to the contamination of water and lack of clean drinking water. We just had a bulldozer levelling a field so we can set up isolation wards there. Medical supplies are already in place."

How do the people feel about the current situation?

"People told us that it was a short, intense battle near Marere with very few civilian casualties as the population left the major towns in time. In many places the Islamic Courts retreated without a fight. Right now there is a contingent of Ethiopian troops maintaining a type of tense calm. The question is, what happens when they leave? Will there be a governing power?

"The people are hopeful, but not too hopeful. When they talk about peace, they talk about peace as temporary state, without a sense of permanence. They have been accustomed to living without a government for 16 years. What every Somali wants now is security and stability."

How does it feel to be back?

"It was very good to come back to the hospital with everybody waving and smiling. Our 130 nurse consultants, medical supervisors, lab technicians, midwives and associated staff continued services at a high quality in our absence. Our national staff are extremely dedicated and they understood the need for us to evacuate when we had too, and were very happy to see us again."