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In Burao, Somaliland, MSF treats measles in patients the vaccine never reached

29 Jun 26 | 30 Jun 26

In Burao, Somaliland, MSF treats measles in patients the vaccine never reached

Deeqo Abdi Hassan comes from October Village, on the edge of Burao, the same village as Ubah Farhan. The two women did not arrive together, but they arrived with the same story. Deeqo brought a child from a household of five. The child had not been vaccinated against measles. No health worker had ever come to explain why it mattered, and she had never sat through a health session about it. She had not heard of MSF before she reached the hospital. A mother and child health centre stands near her home. The clinic was close; the vaccine was not. The service that should have reached her child, and the message that should have come with it, never arrived. Two households in one village, both with a child sick enough to need a hospital bed, neither reached by the routine immunisation that should have been ordinary. This is what a gap in vaccination looks like when it is measured not in percentages but in families: not refusal, not distance, simply a service that did not come. In October Village, it did not come twice. Caption
Deeqo Abdi Hassan comes from October Village, on the edge of Burao, the same village as Ubah Farhan. The two women did not arrive together, but they arrived with the same story. Deeqo brought a child from a household of five. The child had not been vaccinated against measles. No health worker had ever come to explain why it mattered, and she had never sat through a health session about it. She had not heard of MSF before she reached the hospital. A mother and child health centre stands near her home. The clinic was close; the vaccine was not. The service that should have reached her child, and the message that should have come with it, never arrived. Two households in one village, both with a child sick enough to need a hospital bed, neither reached by the routine immunisation that should have been ordinary. This is what a gap in vaccination looks like when it is measured not in percentages but in families: not refusal, not distance, simply a service that did not come. In October Village, it did not come twice.
© Abdurahman Mukhtar/MSF

When the number and severity of measles cases outpaced what Burao Regional Hospital could manage alone, MSF returned to Somaliland for the first time since June 2023. Across Burao and the wider Togdheer region of eastern Somaliland, measles has spread sharply since the start of 2026. By mid-June, Ministry of Health surveillance had recorded more than 1,600 cases and eight deaths across Somaliland, with Togdheer alone accounting for over 1,400 cases and six deaths. The real figure is almost certainly higher: only 150 of Somaliland's 325 public health facilities report centrally, and cases in communities and private clinics go largely uncounted.

"These cases were beyond the capacity of the Ministry of Health to handle, and there were no other actors able to respond," says Dr Fuad Dahir, MSF project coordinator. 

Since 15 May, MSF has treated more than 350 patients, 316 admitted to Burao Regional Hospital and more than 30 seen at primary health centres. Alongside Ministry of Health staff, MSF teams provide free care, manage severe cases, reinforce infection prevention and control, support nutrition, train local health workers including from neighbouring Sheikh hospital, and strengthen disease surveillance. 

Caption
© Abdurahman Mukhtar/MSF

The reasons measles took hold here are structural. Routine vaccination coverage across Togdheer region is estimated, according to Ministry of Health data, at best 40 percent. This outbreak is also revealing a significant vaccination gap beyond early childhood: 65 per cent of cases treated by MSF are in patients aged five and above, a sign that vaccination coverage has been insufficient across age groups for years, leaving older children and adults equally exposed. Many nomadic and rural communities are rarely reached by immunisation. Some families carry misconceptions about the vaccine or turn to traditional remedies. Surveillance is weak, distances to care are long, and cost keeps families home. In a health system already stretched thin, these gaps together allow a highly contagious disease to move quickly, and largely unseen.

Ubah Farhan carried her baby into Burao Regional Hospital in a hired taxi. He had a rash, a dried mouth and throat, and a fever that would not break. She had paid for the taxi herself. What she did not have to pay for, this time, was the treatment. "I was worried, 100 per cent, about the fees," she says.

Her baby has never been vaccinated. When she asked, she was told he was not yet old enough. A health centre and a pharmacy are present near her home in October Village, and still the disease reached him first. Samira Abdi Hassan travelled from Naqdhabiijo, a rural village in Togdheer, with twenty-two family members, not one of them vaccinated. She knew the vaccine existed. "Yes, we know," she says. "But it has not reached us." Deeqo Abdi Hassan came from Ubah's own village with an unvaccinated child and had never once been offered a health session on measles. Two households in one village. Two children sick enough for a hospital bed. 

Caption
© Abdurahman Mukhtar/MSF

By the time families reach the isolation unit, the illness has usually advanced. "The cases here arrive seriously ill," says Dr Issa Jama, MSF Medical Activity Manager at Burao Regional Hospital, describing children with severe pneumonia, dehydration, and other complications. When MSF arrived, isolation capacity and infection control were limited; both have since been reinforced and the isolation ward expanded. 

Cost has long kept families away, or kept them home too long. Before MSF's response, families were routinely charged around USD 30 for medicines and admission. A fee waiver was meant to protect those who could not pay, but in practice many families still feared the cost and delayed coming, or did not come at all. "Families bring children earlier when the care is free," Dr Issa says. "In measles, time matters."

Reactive vaccination campaigns help during an outbreak, but they cannot do the work of a functioning routine system. "The better the coverage reaches the cities, the nomadic families, and the rural areas, the less often outbreaks like this return," says Dr Fuad. MSF is calling on health authorities and their partners, including UN agencies and donors, to expand routine vaccination, strengthen surveillance, and invest in clinical preparedness across Somaliland. 

The funding picture is deteriorating rapidly. According to UN financial tracking, the Humanitarian Response Plan for Somalia, which includes Somaliland, was 57 per cent funded in 2024. It fell to 29 per cent in 2025, and by late May 2026 stood at just 18 per cent overall, with the health sector at 11 per cent. For a system already at its limits, each cut reduces the capacity to prevent outbreaks, detect them early, and treat them in time.

Ubah's baby is recovering, still in the ward. The treatment was free. The conditions that made him vulnerable have not changed.