Introduction

Somalia’s last president, Siad Barre, was ousted in 1991. For 15 years, the Somali people have been without a functioning central government and public health services.

Médecins Sans Frontières (MSF) has been providing medical care in Somalia since 1986.

The absence of public health services, coupled with famines, droughts, floods and repeated fighting among a host of armed factions has resulted in enormous unmet basic health needs throughout the country.

Somali health standards are among the worst in the world*. Women and children under five are particularly vulnerable. One in 16 women dies during childbirth. More than one in 10 children die at birth. Of those who survive, a quarter will perish before their fifth birthday.

What little medical aid there is, is privatised and costly – out of reach for the vast majority of Somalis.

In the two northern regions of Somaliland and Puntland, there have been efforts to implement civilian administrations. These two regions are safer than the rest of the country. Consequently, there are more humanitarian actors here than in other parts of the country. Most of the international medical aid is channelled to these regions, especially Somaliland, the more stable of the two.

MSF focuses its medical humanitarian efforts on the rest of the country, where there are few international aid actors, and where the needs of the population are extreme.

A large majority of Somalia’s estimated population of over 10 million has no access to basic health services whatsoever. Somalia has one of the world’s highest prevalence rates of tuberculosis (TB). The fatal and neglected tropical disease kala azar is killing thousands and there are regular outbreaks of measles and other epidemics.

Some 350,000 people are estimated to have been internally displaced and 300,000 have sought refuge abroad.

Every year, many people are injured by gunshots. Large numbers of children under five are malnourished, women’s health is poor and the marginalised Bantu ethnic group is heavily discriminated against.

Natural disasters like floods in the Lower Juba and Shabelle valleys make the human catastrophe worse. They cause high rates of chronic malnutrition and preventable diseases. South and central Somalia is also prone to drought. Due to insufficient rainfall, the last two harvests of 2005 in the regions of Bay, Bokool and Gedo have largely failed.

MSF has close contact with the Somali people in the areas where the organisation works. This allows MSF’s medical teams to operate in places that would otherwise be inaccessible because they are extremely unsafe.

MSF’s presence shows that it is possible to provide basic health services in Somalia. Even so, MSF is often forced to suspend its medical activities due to violence or threats of violence against staff and patients.

MSF provides access to basic health services for the general population, treats neglected diseases, performs surgery on victims of violence, and provides healthcare to marginalised groups where it is safe enough to do so. At the same time, the organisation tries to break the international media’s silence on Somalia.

In 2004/2005, 46 expatriate and 534 local staff worked for MSF in Somalia. MSF is now providing healthcare in seven out of 10 regions in central and southern Somalia, covering basic medical needs for some 1.2 million people. However, many areas are inaccessible due to insecurity.

This document provides a closer look at MSF’s efforts to alleviate the desperate medical situation Somalis continue to endure; a dramatic situation that receives little attention from the international media.