Somalia: Providing medical care despite severe obstacles

Though access to local populations can be extremely difficult and evacuations due to insecurity are frequent, MSF continues to seek out civilian populations that would otherwise have no access to healthcare. Most of the projects focus on meeting urgent needs while improving access to basic care. MSF is now working in the capital, Mogadishu, as well as the regions of Bakool, Mudug, Bay, Banaadir, Lower Juba and Shabeellaha. In southern Somalia, where there is a complete lack of medical infrastructure, MSF is working to reach the 200,000 people who live in Bakool region. A primary health care center in Huddur district provides basic healthcare and treatment for diseases such as tuberculosis and kala azar. In order to reach the mainly nomadic local population, MSF has also established health posts in the districts of Tieglow and Rabdure. Currently, activities are underway to rehabilitate a health structure in El Berde district to create a new health post. This would expand MSF services to four of the five districts in the region. Since 1997, MSF has been present in Galkayo, Mudug region, home to an estimated 350,000 people. MSF is supporting pediatric and maternity services in two hospitals there, one on each side of the "green line" which divides the town between warring factions. In addition to supplying medicines and supplies, training local staff and providing direct patient care, MSF is rehabilitating both hospitals. Between October and December 2003, MSF made three interventions during repeated clan conflicts in Galgudud, 200 kilometers south of Galkayo. MSF teams traveled to both sides of the conflict, treating more than 180 wounded and replenishing stocks of emergency drugs and supplies. In Lower Juba Valley, Marere region, an area where most people are Bantu (a marginalized group in Somalia) MSF focuses on maternal and child health activities. While working to improve vaccination coverage and reproductive health, the MSF team also responds to outbreaks of communicable diseases and other urgent needs in the area. In late December 2003, a Somali MSF staff member was killed in crossfire between attackers and guards during a robbery at the compound of the Somali aid organization, AFREC. The rest of the team was evacuated. By January 2004, the remaining team members had returned and were caring for 48 children in a therapeutic feeding center. The number of admissions dropped by late February 2004, yet it is expected to increase in the coming months due to anticipated failed harvests. In the southwest part of the country, MSF runs a health center with 35 beds in Dinsor, a town in the western Bay region, close to Baidoa. The MSF clinic is the only health facility for the 100,000 people who live in this region. Much of the team's activities are related to armed conflict and therefore include surgical interventions for critical cases. In February 2004, the team responded to tribal clashes near Boale by treating the wounded and referring the most severe cases to the Dinsor health center. At the same time, MSF staff are also working to monitor and respond to epidemics, such as a measles outbreak which occurred in January 2004. Respiratory infections are among the most common illnesses in this area. MSF hopes to begin treating people with tuberculosis in the future. MSF is also working in Somalia's capital city, Mogadishu, providing basic healthcare and responding to cholera outbreaks as necessary. Cholera is endemic in Somalia and MSF prepares for the cholera season by creating chlorination teams to treat main water supplies and teach communities about prevention measures. When outbreaks occur, MSF opens cholera treatment centers. MSF also runs a primary healthcare outpatient clinic in Mogadishu. Its activities include maternal and child health care, nutritional screening and monitoring of infectious disease outbreaks. MSF also supports primary healthcare in 11 clinics in the regions of Banaadir and Shabeellaha. The choice of where and how to intervene in Somalia remains extremely difficult. Precarious food security, armed conflict, and dismal or non-existent medical structures all contribute to the problem. Today, less than one-third of the population has access to medical care. Though security concerns are ongoing, medical needs are immense, and Somalia continues to be a priority for MSF. In addition to strengthening the projects currently underway, MSF teams are monitoring the nutritional situation in Sool Plateau.