Returning to Galcayo, central Somalia

For now, the town seems stable and the people are hopeful that their situation will improve. We also noticed one big change: it is far easier for people to move from one side of town to the other than before."

While news headlines speak of the new uncertain situation in Somalia after the Transitional Federal Government (TFG) and the Ethiopian troops took over, Médecins Sans Frontières (MSF) is sending its international staff back into the country. On January 4, 2007, an MSF team of three went back into the small town of Galcayo, in central Somalia. Assistant Head of Mission Reshma Adatia reports on the current situation in Galcayo.

"The fighting between the TFG and Ethiopian troops and the Islamic Courts took place in three villages just outside Galcayo. The villages' inhabitants fled to the town, the majority of them before the fighting began, and it seems there were very few civilian casualties. For now, the town seems stable and the people are hopeful that their situation will improve. We also noticed one big change: it is far easier for people to move from one side of town to the other than before."

The line inside

"For years, Galcayo was all but literally torn in two," said Reshma. "Two different clans each controlled a different part of town. Though there were no really detectable checkpoints, everybody knew where 'the line' was and people could not freely travel between the north and south.

"The difference between the two parts is still clearly visible. In the northern part, there are far more businesses including mobile phone and satellite TV companies, hotels and a big market place. But in the south, you don't see nearly as much of that. Though the line was not visible to the eye, it was inside people."

No health infrastructure

"What the people of Galcayo need most, is what the whole country needs: stability and security, freedom of movement, continued health and social services. Our hospital and therapeutic feeding centre in Galcayo are the only medical facilities in about a 700-kilometre radius. The main health problems are malnutrition, tuberculosis and diarrhoeal diseases. Maternal health is also a huge concern. Somalia has virtually no health infrastructure and the only free health care is provided by organisations such as MSF."

Commitment and pride

"Because of the insecurity, we were not able to get back to our project for over three months. During this time, our Somali doctor, nurses and other staff members - with support from our medical coordinator who stayed in Nairobi - continued the work. They are very committed to providing health care to their people and take great pride in their work.

"On an average day, they would treat 150 outpatients; take care of 20 patients in the hospital, 40 in the therapeutic feeding centre and around 15 children in the paediatric ward. During the fighting MSF staff also treated people affected by the violence. In Galcayo South in particular, 19 people injured came to the hospital.

"It's not easy to provide care in an environment that's constantly changing, particularly from a security perspective. But we have shown it's possible, and I hope other organisations will follow suit."


"Somalia has been without an effective central government since the fall of Siad Barre in 1991. Since then, continuous clan fighting and shifting alliances has made the country one of the most difficult in the world in terms of providing humanitarian assistance. It has also left Somalia with some of the worst health indicators on the planet.

"According to the World Health Organization, one quarter of Somali children die before their fifth birthday and those who survive have a life expectancy of just 44 years. On every 100,000 deliveries in Somalia, 1,100 women die while giving birth.

The Islamic Courts, who by September last year controlled most major towns in the country, provided a degree of stability in areas of Somalia which had been completely inaccessible to international aid workers for more than a decade. However, now the context has changed: with the backing of Ethiopian troops, forces loyal to the interim administration defeated the Islamic Courts at the end of 2006.