Somalia: The vicious cycle of measles and malnutrition

Measles. It starts with a fever, runny nose and a cough. Then a rash. For children who are not immunised, this often spells disaster.

In Somalia, tens of thousands of vulnerable children are at risk when the disease sweeps through overcrowded displacement camps where malnutrition levels are high and immunity low.

Measles and malnutrition

“Measles is an airborne infection and conditions in overcrowded camps create the ‘perfect storm’ for outbreaks," says MSF nutritionist Dr Susan Shepherd.

"Malnourished children under five are the most susceptible. They get caught in a vicious circle where measles and malnutrition wear down their weakened body's defences, which can push them over the edge with complications like pneumonia and diarrhoea.

"The first priority in such emergencies is to vaccinate against measles and to rapidly treat all the cases you can identify."

Nutrition crisis and infections

MSF projects around Somalia detected a steady number of measles cases – 3,049 cases since January – and then there was marked increase before the onset of the nutrition crisis.

Between May and September a total of 2,132 cases were reported – 70 percent of the year’s caseload in just four months.

In Hodan district, where MSF operates one of three ITFCs in Mogadishu, over 50 percent of the severely malnourished children have measles too. These children are isolated to prevent the spread of disease.

Treatment and immunisation

Teams in Marere, southern Somalia, have also witnessed measles outbreaks. And all MSF projects in Mogadishu have reported cases – whether in therapeutic feeding programmes or outpatient services.

It is vital that measles patients get treatment quickly after being identified by MSF outreach teams. The treatment aims to prevent complications such as respiratory infections.

Somalia’s legacy of war, conflict, lack of development and a collapsed health system means that level of routine immunisation coverage is extremely low – the World Health Organisation puts it about 30 percent.

This is a particular concern as MSF facilities are treating measles in older children and adults, when outreach teams find them.

Stopping measles

MSF has already vaccinated over 50,000 children against measles since July this year – despite constraints and concerns for the safety of medical staff – mostly through outreach activities and small-scale immunisations.

Implementing mass vaccinations, the first choice to fight outbreaks, is not easy in an insecure environment like Somalia.

Several vaccination teams are needed. A typical team can consist of up to 10 people, who need to be recruited, trained, equipped and deployed.

Creating space for action

Setting this up in Somalia today is complicated. It involves time-consuming negotiations with local leaders, authorities and even armed groups who control certain parts of central and southern Somalia, to allow vaccination campaigns which could save thousands of lives.

But it doesn’t end there. Negotiations also often have to extend to simpler things like hiring people and vehicles in a one of the most difficult places in the world.

MSF inside Somalia

MSF runs 13 medical-nutritional programmes in Somalia.

Around 5,500 malnourished children are receiving therapeutic feeding.

Nearly 500 children with medical complications on top of severe malnutrition are being nursed back to health in eight intensive therapeutic feeding centres (ITFC).

MSF has worked continuously in Somalia since 1991 and currently provides free medical care in eight regions.

Over 1,400 Somali staff, supported by approximately 100 staff in Nairobi, provide free primary healthcare, surgery, treatment for malnutrition, as well as support to displaced people through health care, water supply and relief items distributions in nine locations in South- and Central-Somalia.

MSF is also providing medical care to Somali refugees in Kenya and Ethiopia.