Security incidents amidst large-scale humanitarian care by MSF in Somalia during first six months of 2009

MSF - Farhiyo Hussein Mohamed, nurse, consulting a child in the OPD in Mogadishu. January 2009

Intense fighting among various armed groups claimed the lives of hundreds of civilians and displaced thousands more in Somalia in the first half of 2009. In addition, prolonged drought and food shortages worsened the already desperate situation of many of the countrys rural communities. The gap between critical needs in Somalia - particularly in and around Mogadishu - and the level of humanitarian response continued to grow, mainly due to aid agencies extremely limited capacity to deliver assistance in this highly insecure and volatile environment.

In the first six months of 2009, MSF teams working in Somalia experienced numerous security incidents. In April two staff members were abducted in Huddur, Bakool region and held for ten days before being released. Following the abduction MSF felt that it could no longer safely provide quality medical care to the people living in Bakool region and decided to close its largest health centre in south and central Somalia as well as four other health posts in Labaatan Jerow, El-Garas, El-Barde and Radbure.

In June an MSF employee died in an explosion in Belet Weyne, Hiraan region, which killed 30 other people. Constant shelling, explosions and open combat among armed groups posed an enormous challenge to MSFs efforts to provide free, quality healthcare to people living in the capital, Mogadishu. In July 2009, for the first time in 17 years MSF had to suspend activities in its paediatric hospital and three other health clinics in northern Mogadishu as staff were forced to flee for their own safety.

Despite the challenges, MSF remains the main provider of free medical services in all of central and southern Somalia. At the end of June, 2009, 1,509 Somali staff, supported by 90 staff in Nairobi, were working to provide primary health care, malnutrition treatment, health care and support to displaced people, surgery, water and relief supply distributions in nine regions of the country.

MSF - Fadumo Harai Mohamud, Nurse, at work in Mogadishu OPD.

Between January and June 2009, MSF teams provided 376,114 outpatient consultations, including 163,909 for children under five. Over 22,000 women received ante-natal care consultations and 13,312 people were admitted as inpatients to MSF supported hospitals and health clinics. 3,373 surgeries were performed, 1,975 of which were for injuries caused by violence. Medical teams treated 255 people suffering from the deadly neglected disease kala azar, 1,423 people for malaria and started 664 people on tuberculosis treatment. 18,825 people suffering from malnutrition were provided with food and medical care and over 125,000 children were vaccinated, including 41,990 for measles.

MSF staff also responded to emergencies. In early 2009, renewed fighting in Guri El and Dhusa Mareb prompted thousands of civilians to flee their homes. MSF expanded its regular project in the area and started outreach activities to supply the displaced with water and medical consultations through mobile clinics. MSF responded to outbreaks of cholera, treating 869 people in Jilib and Marere in the Lower Juba region and 61 patients in Jowhar and Mahaday, Middle Shabelle region.

Following an increase in the number of measles cases reported in March, 2009, MSF started a mass vaccination campaign in Belet Weyne, Hiraan region. 26,463 children between six months and 15 years old were vaccinated. In August MSF will start another measles vaccination campaign, targeting 12,000 children under the age of five in the Lower Shabelle region.

MSF - Mohamud Macalim Abdulle Vaccinating a child during a nutritional survey.

Present in Somalia since 1991, MSF runs projects in:

Banadir Region: Northern Mogadishu Area - In northern Mogadishu MSF has run one of the few public health facilities in the citys 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. In July 2009 MSF was forced to suspend activities in the hospital and outpatient clinics due to heavy fighting in the area.

Daynile Area - The MSF project in Daynile hospital, located nine kilometres north of the city, provides life-saving emergency surgery and care for war wounded. Following extensive rehabilitation, the facility now comprises 59 beds, and is equipped with two operating theatres, 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.

Bakool Region:

Until MSF closed its programmes in Bakool region at the end of June 2009, the organisation was operating a 293-bed health centre in the regional capital, Huddur, serving a population of approximately 250,000 people. MSF was running an outpatient department with a maternal and child health component, inpatient department consisting of adult and paediatric wards, kala azar wards, tuberculosis wards, outpatient facility and a therapeutic feeding centre. MSF was also running four health posts, three in the Bakool region and one in neighbouring Bay region.

MSF - Nacimo Barre Mohamud, pharmacist, at work in the OPD in Mogadishu. January 2009.

Bay Region:

In Dinsor MSF runs a 65-bed inpatient department (IPD), which serves the population of the entire districts approximately 110,000 people. The IPD provides medical care for adults and children, treatment for tuberculosis and kala azar; as well as therapeutic feeding for severely malnourished children with associated pathologies. The outpatient department provides curative and preventive care and it includes an ambulatory feeding centre for severely malnourished children without medical complications.

Galgaduud Region:

In Guri Els 80-bed Istarlin hospital, MSF provides outpatient services for adults and children and inpatient services including a paediatric ward; gynaecology ward; maternity ward and delivery room; operation theatre 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.

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, medical care for adults, paediatric care, treatment of severe malnutrition, and is prepared to respond to medical emergencies in the region. Emergency and observation rooms are also in place.

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

Marere – MSF provides outpatient services for adults and children and inpatient care for children, medical and maternity cases. Medical staff provide delivery services, including emergency obstetric care, therapeutic and supplementary feeding, surgery (mainly obstetric), outpatient curative and preventative services and tuberculosis treatment. In nearby Jilib MSF was forced to suspend its nutritional activities in August due to insecurity. This suspension leaves over 300 malnourished children without crucial medical care.

Jamaame - MSF provides outpatient services for adults and children and inpatient care for children, medical and obstetric cases, including treatment for severe malnutrition; nutritional screening and ambulatory care, and systematic surveillance for nutritional emergencies and outbreaks of epidemic diseases.

Middle Shabelle Region:

MSF provides basic health care through a network of four health centres in the rural districts of Jowhar, Mahaday and Balcad. The health centres provide outpatient preventive and curative services; mother and child care; and an extended programme 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 programme including a stabilisation centre and ambulatory care.

Lower Shabelle Region:

In Hawa Abdi, MSF supports a private clinic and runs an outpatient department, paediatric inpatient department, cholera and diarrhoea treatment centre, nutrition programme, water trucking and distribution of blankets and other non-food items. In Afgooye MSF supports the activities of the hospital and runs an outpatient department as well as an ambulatory feeding programme.

Mudug Region:

MSF provides outpatient curative and preventive services, including maternal care and vaccination, and inpatient care. Medical staff provide paediatric care; maternity care, 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.