COVID-19 in Somalia: Health and nutrition services under threat
On my recent visit to Somalia, just before COVID-19, I visited one of Save the Children's health and nutrition mobile clinics. After hours driving along bumpy and dusty roads, we arrived at Gabiley village, some 40 kilometers west of Hargeisa town in Somaliland. Incredibly remote. Here I found a team of health workers setting up their temporary clinic under a tree, that didn't seem to provide much of a shade under the scorching Somali sun.
On one side of the tree, the team had set up a reception area, where children and their mothers are received, registered and screened. On the other side was a waiting area turned into a classroom where mothers are educated on best nutrition practices, good hygiene and healthy behavior to avoid diseases. At the centre, two desks were set which serve as consultations area and pharmacy.
The place was already crowded with mothers and children. Most of them had to wake up early, walk for long distanced to get here. To most, this is the only place to get health services —their only hope.
"We do not have a hospital in our village. This is the only service we can access," says Aisha who brought her 3-year-old daughter for review. "Two weeks ago, my child had very high fever. She was not eating well until she became so weak. I could not take her to the hospital. I had no money for transport. I had to wait for this clinic because it's free. The doctor told me that she was malnourished. I got the help I needed. Now she is feeling much better. I have brought her to be checked again."
Aisha and her baby are among the lucky ones who were able to access health services on time and avoided a tragedy. Many more people, particularly women and children, in Somalia cannot access health services due a number of challenges including the long distances they have to travel to reach a public health centre that may not be well equipped to provide the services they need.
"Somalia still face significant challenges in providing equitable access to health and nutrition services," Dr. Mohamed Magan, Save the Children's Health Program Manager for Southern States in Somalia, explained to me. "We have very few public health centers or hospitals so people have to travel a long way. Most are privately owned and charge outrageous fees that most people, particularly women and children, cannot afford."
As a result people opt for home remedies which end up doing more harm to children. "On top of that, the health seeking behavior of Somalis is very low. This has resulted in low uptake of immunization and delivery at the health facilities," Dr. Magan adds.
In addition, the rapid spread of COVID-19 in Somalia has increased pressure on the already weak healthcare system. The country's resources and health capacities are currently dedicated to responding to coronavirus, including containment measures, and this will further compound risks to children. Children face increased exposure to infection of COVID-19 when accessing facilities, and this can discourage attendance and disrupt routine health services, such as immunizations, causing a rise in other common childhood illness and preventable deaths.
Women walk in rural Somalia where health services are very limited.
The frontline health workers, who are key in saving lives, are overstretched and threated by spread of COVID-19. For instance in one regional hospital in southern Somalia, four doctors, including two who were trained by Save the Children to conduct caesarean sections, are now infected with COVID-19. They are now safely in isolation. This has significantly reduced the capacity of the hospital to address most urgent maternal health complications, leaving women and children more exposed to risks. If this trend continues to other hospitals and health facilities, the price will be too high, especially for women and children.
Somalia has some of the worst health indicators in the world, with women and children most affected. The country has one of the world's highest rates of under-five mortality (122 per 1000 live births) and the sixth highest lifetime maternal death risk (732 deaths per 100,000 live births) in the world.
The population is faced with a chronic nutrition crisis, with malnutrition rates increasing and remaining stubbornly high due to a combination of factors, including food security, high morbidity, low immunization, lack of Vitamin A supplementation, as well as poor care practices.
The most recent analysis indicates that 1 in 7 children in Somalia are acutely malnourished; and 1 in 25 is severely malnourished. The situation is worse in southern regions of Somalia where 1 in 4 children are acutely malnourished, and 1 in 17 severely malnourished.
Over the past years, climate-related shocks have increased in frequency and intensity, exacerbating humanitarian needs and undermining resilience at the household and community levels.
Currently, an estimated 5.6 million are facing acute food insecurity in Somalia - including 2.7 million people who are expected to face 'crisis' level or worse (IPC Phase 3 or higher) outcomes between April and June. These numbers are expected to increase further between July and September, when a further 800,000 people could be food insecure.
In Somalia, Save the Children is working very closely with the Federal Government's Ministry of Health and the Federal Member states to expand health service, including delivering specific maternal and child nutrition services. Currently we are supporting 101 mobile health clinics across the country, as well as providing resources, strengthening systems and building the capacity of health professionals to ensure services reach the most vulnerable populations in the country.
However the gaps remain large and COVID-19 has the potential to erode all the efforts and progress made so far. It's vital that we act now to develop and support a comprehensive package to rescue Somalia health services before the coronavirus pandemic undoes decades of work.