Somalia 1997-1998

Complete dependence on health care assistance Ordinary Somalis continue to wait for their leaders to negotiate peace, if not for the whole country, at least for Mogadishu. The only public health care available depends on NGOs and UN agencies. MSF continues to work in Kismayo hospital, the only functioning hospital with surgical facilities for a target population of 250,000. Programmes cover paediatrics, orthopaedics, surgery, TB and therapeutic feeding as well as out-patient consultations and training for medical staff. The team also provided consultations in an IDP camp outside Kismayo until its nomadic occupants moved on in March 1998. Although it is hoped to reach a sufficient level of hospital administration and medical management to run the hospital with only minimal input from international staff, there is a major lack of human resources. Many qualified Somali doctors and surgeons remain as refugees rather than return to this unstable country. Logistics, maintenance and financial administration have, however, been successfully handed over to local staff. MSF is present in the north of Mogadishu, the divided capital, supporting a health centre offering out-patient consultations, mother-and-child health care and health education. MSF is in charge of the year-round chlorination of Mogadishu's main wells in Yashid district. In Jowhar, an MSF team focuses on primary health care. Activities include EPI, mother-and-child health, out-patient consultations, health education and epidemiological monitoring. In Aden Yabal, MSF runs a mother-and-child clinic, an out-patient dispensary, an emergency ward and a district network of health posts. A new approach aimed at avoid the exploitation and extortion so often associated with Somalia is being tried out in Galkayo, Northeast region. This involves keeping the number of MSF local staff to a minimum and insisting that they remain the employees of the regional administration, rather than MSF. Instead of paying salaries, MSF supports the rehabilitated hospital, which re-opened in February 1998, with drugs, essential equipment, and training in diagnosis, treatment protocols and hospital management. A specialist provided training in cholera prevention and treatment prior to the start of the cholera season at the end of 1997. Floods and cholera MSF began an emergency intervention in November 1997 in response to floods that rendered some southern parts of the country inaccessible except by air. Teams provided consultations in Kismayo IDP camp and in small dispensaries in Jamame, Marere and Harquesa, three flooded villages in the Jubba valley. A cholera treatment centre set up in January 1998 in Mogadishu North had treated 2,169 cases by April. MSF also intervened when the cholera epidemic hit Middle Shabelle. The team took charge of epidemiological monitoring, and referrals to Jowhar hospital as well as setting up oral rehydration points in the district. The Kismayo team provided urgently required medical material for cholera treatment in Ras Chiambone village, 14 hours by boat from Kismayo. In the same area, MSF reacted to a suspected measles outbreak in March by establishing data collection points and intensifying the routine immunisation programme. A mass immunisation against measles was carried out in Jowhar district in May and June.