Somalia: Providing care amid chaos

With no state and thus no state medical services, Somalia is a country in desperate need of this type of assistance. With significant numbers of international and national staff on the ground, MSF tries to fill some of the huge gaps.

Unsurprisingly, Somalia has some of the worst health indicators in the world. More than one in ten children dies at birth and of those who survive, a quarter will perish before their fifth birthdays. Malnutrition is one of the many scourges of Somalia.

Mass poverty and dry rainy seasons also contribute to the problems. On a national level, there is no authority to take up the challenge of feeding Somalia's people, nor of providing them with health care. The effects are obvious: the average life expectancy for a Somali is only 47 years.

Violence is so widespread and the country's clan structure is so complex that few aid agencies choose to work there. But with no state and thus no state medical services, Somalia is a country in desperate need of this type of assistance. With significant numbers of international and national staff on the ground, MSF tries to fill some of the huge gaps.

Its projects involve primary health care across the worst affected areas in south and central Somalia, and include treatment for those with tuberculosis (TB) or kala azar, therapeutic feeding of malnourished children, pediatric care and even surgery.

In the Bakool region, which borders Ethiopia, MSF operates a health center in the regional capital of Xuddur and three health posts in surrounding villages. Through inpatient and outpatient facilities, MSF offers vital services that would otherwise be out of reach for the 200,000 impoverished inhabitants of the region.

The team gives primary health care, and treats people with TB and kala azar. Severely malnourished children are also treated in the health center.
The city of Galkayo in the northwestern Mudug region is divided between two warring factions (see box).

MSF supports two hospitals in the city, in each of the areas controlled by the two factions. The organization provides inpatient and outpatient care, therapeutic feeding, surgery, TB treatment, maternal health care, and pediatric and emergency services.

In Mogadishu, MSF runs a primary health care clinic, providing outpatient services and maternal and child health care. The organization also does epidemiological surveillance and intervenes when needed.

In the Middle Shabelle region in the west of the country, MSF provides basic health care and epidemiological surveillance in the districts of Jowhar, Mahaday and Aden Yabal. MSF's activities include running 10 outpatient dispensaries, 6 maternal and child care health dispensaries, 1 emergency room and 5 mobile immunization teams.

In the Lower Juba Valley in the Marere region in northeastern Somalia, MSF provides inpatient care for pediatric, medical and maternity cases; therapeutic and supplementary feeding; and outpatient services for the rural population, including the marginalized Bantu ethnic group.

MSF also runs a health center in Dinsor in the Bay region in central Somalia. In addition to providing outpatient health care and immunizations, it runs an inpatient department with 40 beds, provides emergency surgery, gives antenatal health care, and has opened a laboratory to support its TB work.

The staff also treats malnourished children and patients with TB and kala azar. In addition, MSF maintains an emergency-response system in cases of epidemics or clashes.

MSF has worked in Somalia since 1991.

INTERNATIONAL STAFF 46
NATIONAL STAFF 534