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Somalia and Somaliland

In 2020, 2.6 million people were displaced, mainly due to conflict and floods, while 4.1 million people were considered food insecure.

We are constantly assessing whether conditions will allow our staff to continue operating safely, and our patients and health facilities to be respected and protected of violent attacks in the country located in the Horn of Africa. 

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After an absence of almost four years due to extreme attacks on staff, our aim is to ensure that people have access to medical care in areas where needs are critical and the security conditions allow us to operate. 

MSF'S work in Somalia: 2020

 In 2020, COVID-19 further complicated access to healthcare in Somalia and Somaliland. Médecins Sans Frontières (MSF) assisted with the response to the pandemic while continuing to run core activities wherever possible. The COVID-19 pandemic aggravated the overall humanitarian situation in Somalia and Somaliland, where people were already struggling with the effects of climate hazards, locust infestations and recurrent outbreaks of fighting.

Malnutrition rates among children were well above the emergency threshold in many areas, and the number of deaths during pregnancy and childbirth remained among the highest in the world. In 2020, 2.6 million people were displaced, mainly due to conflict and floods, while 4.1 million people were considered food insecure. Throughout the year, despite the restrictions imposed by the COVID-19 pandemic, we managed to maintain most of our regular activities and support to hospitals, including maternal, paediatric and emergency care, nutrition, and diagnosis and treatment of tuberculosis (TB). Some activities, such as mobile clinics, were put on hold, while others that had been planned, such as ‘eye camps’ – providing In South Africa, Médecins Sans Frontières (MSF) supported the COVID-19 response, while continuing to provide care for HIV and tuberculosis (TB) patients, victims of sexual violence and vulnerable migrants.

Malnutrtion screening in El Wak, Jubbaland. (December, 2020).

To address the secondary consequences of COVID-19, which included a sharp decline in the uptake of health services, we adapted our existing activities in novel ways. Our sexual violence project in South Africa’s platinum belt ensured that health services for victims remained accessible through the provision of phone-based counselling and transport at a time when public services had ceased. Our teams in Eshowe and Khayelitsha worked to maintain HIV and TB diagnosis and treatment through largescale distribution of oral HIV self-testing kits, and by making sure that local facilities tested for COVID-19, HIV and TB at the same time. Staff delivered antiretrovirals (ARV) and medications for other chronic diseases to patients’ homes or community pick-up points, and provided home-based care for drug-resistant TB (DR-TB) patients. screening and treatment for common eye conditions – and fistula surgery campaigns, were delayed.

In Somaliland, which has a high burden of TB, MSF supported the diagnosis and treatment of drug-resistant TB (DR-TB) at a TB hospital in Hargeisa and three regional TB centres. We supplied patients with longer medication refills to reduce the number of medical appointments for which they would need to travel, lessening the risk that patients would contract COVID-19. We adapted our medical programmes to screen COVID-19 patients and referred them to designated treatment facilities; provided training for Ministry of Health staff in several locations; and put in place hygiene, emergency preparedness and preventive measures to protect staff and patients. In addition to these activities, we launched emergency responses to assist people affected by flooding in Bardale and in Bardhere town after the Juba river burst its banks in April; a cholera outbreak in Beledweyne and in Baidoa town in May; and the aftermath of cyclone Gati, which hit the coast of Puntland in November. 

Tropical cyclone Gati hit the coast of Puntland and its main city of Bosaso with a population of almost 500,000 in northern Somalia in late November (December, 2020)

MSF's work in Somalia: 2019

Access to healthcare remained limited in parts of the country, malnutrition rates among children were well above the emergency threshold in many areas and the number of deaths during pregnancy and childbirth ranked among the highest in the world.

Throughout the year, Médecins Sans Frontières (MSF) continued rolling out new operations across Somalia and Somaliland, supporting medical activities in hospitals in towns and cities, with a focus on maternal, paediatric and emergency care, nutrition, and diagnosis and treatment of tuberculosis (TB).

We also ran mobile clinics for internally displaced people. 

Women and children 

To address the health needs of women and children, we supported the maternity ward at Bay regional hospital in Baidoa, SouthWest state, and started activities in the paediatric department. 

Kawsar Ibrahim Osman, a 25-year-old mother, holds her eight-month-old son Bilal, as he is checked by nurse Fartun Said Abdalla in the inpatient therapeutic feeding centre at the Mudug Regional Hospital in Galkayo city, Somalia.

In Baidoa, MSF carried out a fistula campaign, treating 34 women suffering from this stigmatising condition for which there are no available services in the public health system. We aim to carry out similar campaigns in other parts of the country in 2020.

We also scaled up medical care for women and children in Galkayo, a city in central Somalia divided administratively between Puntland and Galmudug states, where we first resumed operations after returning to the country in 2017. In addition, a team started assisting births and complicated pregnancies at the hospital in Las Anod, a city in Somaliland.

TB Projects

In Galkayo North, we strengthened our medical activities in Mudug regional hospital, the city’s main referral facility, and ran frequent mobile clinics in displacement settings. Our teams here worked on treating patients with TB, a highly prevalent disease that spreads easily in overcrowded living conditions. At the end of 2019, we started to support Galkayo South hospital.

In 2019, we launched a new TB project in Somaliland, supporting the treatment of the multidrug-resistant form of the disease in a dedicated hospital in Hargeisa and collaborating with TB centres in Burao, Berbera and Borama.

In addition to our regular malnutrition programmes in Galkayo and Las Anod, we frequently carried out short interventions focusing on nutritional care for malnourished children, but also providing vaccinations, eye surgery and staff training in Afmadow and Bardhere, in southern Jubaland state. 

Hirshabelle state

For the first time since 2012 and after our return to the country, we managed to launch an emergency response in a location without a regular project.

In the last two months of the year, we responded to severe flooding in central Hirshabelle state. Beledweyne town, where the banks of the Shabelle river burst, was the most affected area, with approximately 270,000 people displaced. 

In the first phase of the response, MSF trucked in safe drinking water and delivered tents and relief items such as cooking utensils and sachets of therapeutic food.

In the second phase, the teams decontaminated water wells and provided healthcare through mobile clinics in displacement sites around the city, including nutritional support to malnourished children. 

find out more in our international activity report >

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