Source: UNCF, 25 Jan 2008
Somalia: A polio survivor dedicates her life to helping children get vaccinated
By Christine Kapka
HARGEISA, Somalia, 25 January 2007 – When she was seven-years-old, Nora woke up feeling as if she had a cold. By the following morning, she was plagued with crippling pain and unable to walk. Now, as an adult, Nora must live with the devastating effects of contracting polio. “I can remember getting ill,” she recounts of her childhood. “The next morning I woke up and I couldn’t walk or do much of anything. I then spent the next four months in hospital.”
Nora, who has limited mobility and can only move about with the aid of crutches, has now dedicated her life to helping others. She meets with families face to face, and motivates them to vaccinate their children against polio.
‘People are shocked’
“It really works,” said Nora. “When they hear what I have to say and what I’ve been through and see the effects of polio for themselves, almost all of the people who initially refuse the vaccination change their minds.”
Nora works for the ‘HAN Association’, a non-governmental organization which is working to educate households who have yet to vaccinate their children against polio.
The UNICEF-supported programme trains polio survivors to visit families in their homes, where they can dispel unfounded rumours and explain the repercussions of refusing vaccinations.
“This is probably one of our more successful programmes,” said Special Polio Coordinator for The HAN Association, Housam Latif. “When staff from HAN pay a visit to an individual or a family who has refused the polio vaccination, people are shocked at the sight of what polio can do to the body.”
Guaranteeing the health of children
The joint venture between WHO and UNICEF to eradicate polio is yielding fruits. In 2007, approximately 1.7 million children under five were vaccinated against polio.
However, polio campaigns need to be implemented several times each year, due to both the persistence of the virus and the low immunity of children, who are often suffering from malnutrition. “It’s a tiring process for both health workers and the community, but the goal of a polio-free country is necessary to guarantee the health of children,” Mr. Latif said.
Mr. Latif noted that last year, 85 per cent of non-vaccinated children became immunized against polio due to the programme. “That’s the best part about our programme, knowing that these children won’t be crippled because of this disease. They will be safe,” Nora says.
African Union Unveils Road Map for Peace in Somalia
By Peter Heinlein, Mogadishu, 24 January 2008
The African Union's top security official has presented Somalia's leaders a four-point plan for creating stability in the war-ravaged country. From the Somali capital, Mogadishu, VOA's Peter Heinlein reports the plan's ultimate goal is to entice the United Nations to take over peacekeeping duties from beleaguered Ethiopian and African Union troops.
During a four-hour visit to Mogadishu Wednesday, AU Peace and Security Commissioner Said Djinnit said Somalia is becoming Africa's biggest security challenge. He described his stopover as a symbolic show of support for Prime Minister Nur Hassan Hussein, just days after the prime minister moved his government back to the embattled capital from the more secure city of Baidoa.
But as if to underscore the continuing tensions, suspected Islamic insurgents fired four mortar rounds within a few hundred meters of Mogadishu's airport runway while Djinnit's plane was on the ground. Several other rounds landed just outside the prime minister's residence shortly after Djinnit left.
The commissioner's visit also came days before an African Union summit, at which the issue of Somalia's security will be high on the agenda.
Djinnit said he outlined to Mr. Hussain a proposal to initiate a road map that would be developed by Somali leaders in partnership with the international community.
Its four components would include strengthening the fractured nation's political process through reconciliation, greater international involvement in peacekeeping operations, creating a safe environment for humanitarian aid deliveries, and building the capacity of federal government institutions to face the immense challenges ahead.
The commissioner expressed frustration at what he called the lack of international support for efforts to bring a stable peace to Somalia. He told reporters his eventual goal, and biggest concern, is persuading the U.N. Security Council to re-establish the peacekeeping mission it abandoned in the face of uncontrolled violence 13 years ago.
"It is the issue at the heart of our concerns," said Said Djinnit. "We believe Somalia has been abandoned for so long , and the Security Council remains the principal body in charge of the maintenance of international peace and security, and Somalia is becoming the biggest challenge for security in Africa. And therefore the Security Council cannot but assume its responsibility vis a vis Somalia."
Djinnit chided the Security Council for its recent statement saying it was "reiterating its commitment to considering the possibility of deploying" a Somalia peacekeeping operation.
"If you look to ideal situation where peace is prevailing before deploying a peacekeeping operation, you might not get that ideal situation," he said. "So we are therefore calling for flexibility on the part of the United Nations in considering the situation in Somalia and in deciding as early as possible on the deployment of the peacekeeping operation to come and take over from the African Union."
The African Union peacekeeping mission in Somalia, known as AMISOM, has an authorized strength of 8,000. But nearly a year after it was formed, less than one-quarter of the troops are in place. Officials say that is far too few to stop the raging violence in and around Mogadishu.
A larger contingent of Ethiopian army troops is backing Somali's military in its campaign against Islamic insurgents. The presence of Ethiopian soldiers, however, has become a rallying point for insurgents, fueling more violence.
Ethiopia's prime Minister Meles Zenawi has repeatedly said he wants those troops replaced by a strong international force. But with Somalia among the world's most violent and gun-infested countries, and the United Nations balking at sending a peacekeeping mission, Prime Minister Hussein told reporters it is premature to set a date when Ethiopean troops could withdraw.
"To set a time maybe today it's not so easy, but you can see the efforts of the African Union, you can see the efforts of AMISOM [African Mission in Somalia] from time to time increasing their troops, and this will definitely set a way for us to discuss when and how the Ethiopian troops will be reduced," said Hussein. "So what we will try to do is have a very well-elaborated exit strategy."
Somalia's parliament chose Prime Minister Hussein last November to replace his predecessor Ali Mohamed Gedi, who was forced out in a dispute with President Abdullahi Yusuf. A career public servant and former head of Somalia's Red Crescent Society, Hussein is widely seen as a neutral figure who might be able to bring unity to a country that has been considered virtually ungovernable since 1991, when former dictator Mohamed Siad Barre was ousted.
http://www.voanews.com/english/2008-01-24-voa1.cfm
http://www.iol.co.za/
AU envoy unharmed by mortars
Mogadishu - January 24 2008 - Five mortar shells landed near the residence of Somalia's prime minister on Wednesday during a meeting with a senior African Union envoy, and two died in fighting elsewhere in the capital, witnesses said.
AU Peace and Security Commissioner Said Djinnit had been meeting with Prime Minister Nur Hassan Hussein at the time of the attack, said AU spokesperson a-Huko Baridgye.
"We do not know the motive of the shelling, but I think it was meant to intimidate," he said, adding: "Nobody inside was worried what was happening outside."
One child died and two others were wounded in shelling later at Mogadishu airport, witnesses said.
"The children were playing outside the airport when a mortar landed nearby and killed my son and wounded two others," said Abdi Ali Yare, the father of the dead child.
A spokesperson for the AU peacekeeping contingent in Mogadishu said three mortar shells struck near the airport.
And in a separate attack in southern Mogadishu, one government soldier was killed in an ambush on troops near a dairy plant, witnesses said.
Djinnit left Mogadishu on Wednesday afternoon after one-day talks with the Somali government on the unrest in the Horn of Africa nation, and a visit to African Union peacekeepers.
"The purpose of my visit is to meet the prime minister and the cabinet members to express our support for efforts in the peace process in Somalia," Djinnit said earlier.
Burundian peacekeepers began deploying last month in Mogadishu to support a 1 600-strong AU contingent of Ugandan troops who have been in the restive capital for a year.
Burundi has said it would complete the deployment of an 800-strong battalion by the end of January and has pledged a total of 1 700 troops.
The African Union has pledged a total of 8 000 troops to Somalia but contingents have been slow to arrive, with no timetable yet for the deployment of Ghanaian and Nigerian troops.
Civilians have borne the brunt of almost daily fighting in Mogadishu between Ethiopia-backed government forces and the remnants of an Islamist militia that briefly controlled large parts of the country at the end of 2006.
The troubled Horn of Africa nation has been plagued by civil unrest since the 1991 ousting of dictator Mohamed Siad Barre, and defied numerous peace initiatives.
Over 130 migrants from Somalia die as boats capsize off Yemen, UN reports
22 January 2008 – More than 130 migrants from Somalia, many fleeing violence in their homeland, died over the weekend when their boats capsized off Yemen as weather and the brutality of people-smugglers continued to exact a grievous toll, the United Nations refugee agency reported today. In the first instance, smugglers ordered their 135 passengers to jump overboard, fearing capture by the Yemeni Coast Guard when they saw lights ashore. Those who resisted were beaten with sticks and stabbed. A large wave then capsized the boat, drowning 114 passengers and two smugglers, UN High Commissioner for Refugees (UNHCR) spokesman William Spindler told a news briefing in Geneva.
The following day, 10 women and six children, part of a group of 29 Somalis aboard a two-engine smuggling boat, died when strong winds capsized the vessel just off the coast. They had left Somalia four days earlier and encountered engine problems. The 13 male survivors said four children had died under their parents’ eyes from lack of food, water and exposure, while the other two drowned.
Overall, 157 people have been reported dead or missing during the first 19 days of 2008 in the perilous trip across the Gulf of Aden, which last year claimed over 1,400 people dead or missing. So far this year, 2,452 boat people have landed in Yemen, most of them from Somalia, compared with over 29,500 for the whole of 2007.
“UNHCR has been calling for increased action to save lives in the Gulf of Aden and other waters,” Mr. Spindler said, noting that over the past year the agency had stepped up its work in Yemen under a $7 million operation that includes additional staff, more assistance, provision of additional shelter for refugees and training programmes for the coast guard and other officials.
In recent weeks, two smuggling boats have been intercepted by the Yemeni Coast Guard. Patrols and crack-downs have increased in an attempt to deter the smugglers and save lives. Some boats used by the smugglers had been given to Somali fishermen by international aid agencies after the tsunami disaster in 2005.
The new arrivals said they paid $150 for their trip to Yemen. They stated they had left Somalia due to violence in the Mogadishu region, the continuing hostilities between government forces and insurgents. The survivors said an increasing number of civilians are being killed by heavy artillery.
UNHCR is expanding its presence along the remote, 300-kilometre Yemeni coastline with the opening of two additional field offices in early 2008. It is also working closely with non-governmental organizations such as Médecins Sans Frontières (MSF), which has mobile clinics that can work at arrival points along the coast.
On the Somali side, UNHCR and other partners have set up information projects to warn people of the dangers.
“We have also increased our presence and are providing assistance and the possibility to seek asylum on the Somali side of the Gulf of Aden,” Mr. Spindler said. “But many of those fleeing say conditions in their homeland are so bad that they are willing to take the risk.”
http://www.un.org/
SOMALIA: Anti-government activities spreading, warns AU
Thousands have been displaced by fighting between government troops and insurgents. The African Union has warned that forces opposed to the government have expanded their insurgent activities to areas that were previously peaceful
NAIROBI, 21 January 2008 (IRIN) - Forces opposed to the Somali government have expanded their insurgent activities to areas that were previously peaceful and could be planning attacks in the Middle and Lower Juba regions, the African Union (AU) has warned.
"Their strategy seems to be to further weaken the TFG [Transitional Federal Government] by destabilising as many areas as possible, fully aware that the government does not, at the moment, have the capacity to deploy significant numbers of troops in all the regions," according to a report by AU Commission Chairman Alpha Konare on 18 January.
"In the Middle and Lower Juba regions, the al-Shabaab [military wing of the deposed Union of Islamic Courts] are reported to be training new recruits and planning attacks, taking advantage of the instability created by clashes between clans, especially over revenue collected from the Kismayo port."
Armed elements, it added, were also reported to be using the Lower Shabelle region to ferry arms. "Recently, the TFG forces in the area were attacked and forced to withdraw to Bardoogle. In the Bay region, there have also been stepped-up attacks on TFG and Ethiopian positions."
Prevailing insecurity has resulted in civilian casualties, massive displacements and constrained the delivery of assistance to needy people.
More than 240,000 people left Mogadishu since end-October, according to the UN, while the total number of civilians who fled the city in 2007 is estimated at 600,000.
"While most of the [displaced] went to the Lower Shabelle region, especially Afgoye, large numbers of people fled even further to Bay, Mudug and Hiiraan regions," the AU said. "These movements of population constitute an additional burden for host communities that are already facing an acute humanitarian situation, compounded by the disruption of the livestock and agricultural markets in Mogadishu.
"It should also be noted that the fighting in the Sool region between Puntland and Somaliland forces has also led to large-scale displacement. About 30,000 displaced people are reported to be vulnerable and in need of assistance."
Prevailing insecurity has resulted in civilian casualties, massive displacements and constrained the delivery of assistance to needy people
Incidents targeting humanitarian organisations and workers continue to be reported while ad hoc roadblocks, including on the Mogadishu-Afgoye road, hinder relief efforts.
"Despite exemptions granted by the TFG, humanitarian workers indicate that they are often requested to pay taxes at these roadblocks, whose number reached 336 in November," the report said. "As a result, the cost of transportation has increased, while the delivery of much needed humanitarian assistance is being further delayed."
The report also highlighted incidents involving the African Union mission (AMISOM), including a mortar attack on 8 October at Kilometre 4; a grenade attack on 24 October and another attack on 19 December.
AMISOM has about 1,600 Ugandan peacekeeping troops deployed in Mogadishu, while Burundi has started deploying 800 - out of an AU force that is supposed to number 8,000 men.
"While the TFG and Ethiopian forces have continued to make sustained efforts to improve security in the country, the overall situation remains precarious," the AU said. "In Mogadishu, there is an average of five to six incidents per day."
More than 15 years after the onset of the civil war and nearly four years after the Inter-governmental Authority on Development-sponsored Reconciliation Conference in Kenya, progress towards lasting peace and reconciliation in Somalia had remained extremely limited, the AU stated.
"Somalia continues to be plagued by persistent violence and insecurity, the absence of effective governance structures capable of performing their functions, including delivering basic social services, an acute humanitarian crisis, and economic collapse," the AU said.
Somalia: UN reports continuing tensions in north after clashes
21 January 2008 –
http://www.un.org/. Tensions remain high in Somalia’s disputed northern Sool region after violent clashes last week between troops from the self-declared autonomous Puntland and Somaliland provinces, according to United Nations humanitarian workers in the fractured Horn of Africa country.
While there is no confirmation of internal displacement of civilians due to the latest fighting, the UN High Commissioner for Refugees has registered some 1,240 people from Sool in Yemen since the start of this year.
UNHCR also reports that some 20,000 have been newly displaced from Mogadishu, Somalia’s battle-wracked capital, in recent weeks due to ongoing violence.
Meanwhile, the UN World Food Programme has resumed distribution for some 200,000 internally displaced persons (IDPs) at camps along the Afgooye-Mogadishu road. With some 7,400 children attending classes in 30 makeshift schools, UN humanitarian agencies are concerned that the constant movement of families on the run from the violence has left 4,000 remaining on waiting lists. The agencies have appealed for additional emergency educational structures in the Afgooye area.
The Somalia Health Cluster Bulletin 28 October 2007
The Somalia Health Cluster Bulletin aims to provide an overview of the health activities conducted by the health cluster partners active in Somalia. It compiles health information received from the different organizations working in Somalia, but does not include Somaliland and Puntland.
Highlights
* Due to rapid control measures, no more cases were reported from two affected districts in Bay region, two weeks after a cholera outbreak was declared by the Minister of Health of the Transitional Federal Government.
* WHO prepositioned one additional cholera kit to Banadir hospital, where 387 patients were treated for dehydration with IV fluids in September.
* Measles outbreak reported in Kismayo and West Jamame (Lower Juba); 45 clinically diagnosed measles cases with no related death, revealing low routine vaccination coverage. Related outbreak reported in Hagadera, a Somali refugee camp in Kenya, with 87 measles cases; 41% originated from Lower Juba.
Situation Overview
* The World Food Programme (WFP) temporarily suspended all food distributions in Somalia’s capital after its head of office was abducted inside the UN compound by Somali government troops. The WFP officer was freed after several days.
* The Transitional Federal government (TFG) endorsed the recommendations of the recently concluded National Reconciliation Congress (NRC), such as democratic elections before 2009 and an appeal to all clans for a cease-fire and disarmament
* Tension is high in Buurgaabo area in Badade district 350 southwest of Kismayo after another incident of fighting. More than ten people have been killed so far in continuous fighting.
* The general security situation in other parts of the country is calm.
Health Response to the Humanitarian Crisis
1. Assessment and monitoring
* WHO assessed the possibility of establishing an international operational base in Merka, to ensure appropriate response to the emerging health needs of the IDP settlements on the road from Mogadishu to Afgoye. Per half November, an international WHO officer will be based in Merka.
Cholera cases in Mogadishu
Between 1 and 30 September 444 cases of suspected cholera, including 13 deaths were reported in Mogadishu (Case Fatality Rate 2.93%)
IDPs in Afgoye
According to the UN Office for the Coordination of Humanitarian Affairs (OCHA), an estimated 110,000 displaced people settled on the road from Afgoye (Lower Shabelle) to Mogadishu. Another 100,000 IDPs fled to Galgadud. WHO Representative Dr Fouad Mojallid opens the Logistics Support System (LSS) training event conducted in Nairobi from 17 to 19 October. 29 Somali WHO warehouse managers and representatives of key health agencies attended the training.
2. Health coordination
* After an intensive course in the Logistics Support System (LSS) from 17 to 19 October in Nairobi, Kenya, where 29 warehouse managers, pharmacists and logisticians from WHO warehouses in Somalia and key health partners were trained in the software programme, WHO has successfully installed LSS in all its warehouses in Somalia.
Inventories of the warehouses can now be shared with each other and with the central level in Nairobi. The UN-based software program has been implemented to ensure efficient and transparent management of all supplies in the WHO warehouses.
* The third health cluster meeting was held in Baidoa on 2 October. About seven health partners (both local and international organizations) and Ministry of Health officials attended, including the Minister herself, Her Excellency Dr Qamar Aden Ali.
3. Communicable diseases and Environmental health Acute Watery Diarrhoea (AWD)
* Rapid control measures into confirmed cholera cases in Berdale and Burhakaba districts in Bay region have had the desired effect: no further cases were reported since 15 October 2007.
Stool samples from Towsilow village were tested positive for Vibrio cholera serotype inaba, by the AMREF public health laboratory in Nairobi, weeks after samples taken from the neighbouring village of Toosweyne (Berdale district, 80 km from Baidoa) had also been tested positive for cholera.
In total between 30 August and 10 October 2007, up to 109 cases including 17 related deaths were reported from Towsilow, Folfayle, Buloxawo and Toosweyne villages. The local NGO Community Care Centre (CCC) has been treating patients in its Cholera Treatment Centre (CTC) in Toosweyne village.
Bay regional hospital and WHO provided 120 litres of Ringer lactate and 500 sachets of Oral Rehydration Sachets (ORS) to Towsilow village, as well as Doxicycline, other supplies and 4 sets of Cary Blair transport media for collection of stool samples.
Cholera patients in Towsilow village
* In Lower and Middle Juba between 6 and 25 October, 553 cases of suspected cholera were reported with no related death: 71% of the total cases (396) were children under five years old.
Joint mission between Ministry of Health, Bay regional hospital, WHO, UNICEF and Community Care Centre (CCC) checking on the water quality in Towsilow village
* To respond to an increased number of rumours of cholera cases in Mogadishu, a taskforce meeting was conducted between WHO, UNICEF, ACF and other NGOs. As samples taken from patients in Banadir hospital had been tested positive for Vibrio cholera inaba, the cholera plan for Mogadishu was reactivated.
* World Vision set up a CTC and provided cholera supplies and chlorine to Warabaale village (Bay region), after 41 cases of suspected cholera including 7 related were reported at the end of September. Two stool samples were sent to AMREF in Nairobi; one was confirmed with Vibrio cholera inaba.
Water and sanitation
* In response to the confirmed cholera cases in 4 affected villages in Burhakaba district, UNICEF, World Vision, and the NGOs SARD and Green Hope initiated chlorination of 40 open wells, hygiene promotion, distribution of Aquatabs to patients, as well as the protection of 10 open wells and installation of hand pumps. Similarly, in Toosweyne (Berdale district) a local water committee started chlorinating the water supply system with support from the Ministry of Water and Mineral Resources (MWMR). UNICEF provided a water container of 10,000 Mt to the community. ICRC renovated 17 hand-dug wells and continued work on 18 others, drilled four boreholes and continued work on four others, and rehabilitated six rainwater catchments and continued work on two others all over Central South Somalia. Also, as a flood preparedness measure, ICRC handed out 110,000 sandbags in Lower and Middle Shabelle, Gedo and Lower and Middle Juba.
* To attend to the increasing number of IDPs on the road from Mogadishu to Afgoye, WASH cluster partners divided their tasks between the different settlements: UNICEF and the Somali Red Crescent Society (SRCS) are providing water trucking to the Faculty of Agriculture camp with an estimated population of 10,560; Oxfam/CED are providing water trucking and latrines to a population of 28,320 in Elasha camp; Islamic Relief to KM 13 (population 8340) and Lafoole College (population
17,306); and Oxfam Novib to Hawa Abdi (population 25,206).
Donkeys are an important means to transport drinking water in Somalia and can be a major contributing factor to spreading water borne diseases like cholera Measles.
* Following a rumour of an outbreak of measles in Lower Juba, WHO conducted an outbreak investigation revealing 45 clinically diagnosed measles cases reported from Kismayo and West Jamame between 2 September and 13 October 2007 with no related death. From the total, 91% (41 cases) came from Kismayo. The most common reported symptoms were skin rash (98%) conjunctivitis (87%), fever (84%) and running nose (29%). With a mean age of 3.9 year (ranging from 0.8 to 10.0 years), 52% of patients were female. Of all 45 cases, 60% (27 cases) were not vaccinated against measles. The last measles vaccination campaign in the area was conducted in 2006, targeting 808,911 children between 9 months and 15 years of age. The overall coverage in the area was 92%, representing 745,822 children.
For effective response and to prevent further spreading, WHO is organizing a rapid assessment focusing on enhanced surveillance, active case finding and proper case management.
A related measles outbreak was reported in Hagadera, a Somali refugee camp in Kenya near the Somalia border, where 87 measles cases were reported between 3 July and 13 August. The measles cases were laboratory confirmed. Of the total cases, 41% originated from Lower Juba region in Somalia. The mean age of reported cases was 14.4 (ranging from 1.0 to 30 years), with 72% males (63/87). Similarly as in Somalia, 73% of the cases (73/87) were not vaccinated against measles.
Polio
* Somalia has been polio-free for 7 months. The last wild poliovirus was reported from Hobyo district, Mudug region on 25 March 2007. The total number of confirmed polio cases for 2007 remains 8, compared to 31 cases for the same period in 2006. The next vaccination campaign is a Sub- National Immunization Days planned for 29-31 October in six regions: Togdheer, Nugal, Mudug, Galgadud, Banadir, and Hiran.
Polio National Immunization Days conducted last August in Jowhar, Middle Shabelle Leprosy
* World Concern conducted 2 training sessions for 30 health workers and hospital staff on Leprosy control in Baidoa and provided anti-leprosy drugs to WHO in Baidoa.
The NGO is planning to conduct mobile services to monitor and control Leprosy in the area.
4. Primary and Secondary Health Care Treatment of war injured
* Medical facilities in Mogadishu, such as the Keysaney and Medina hospitals supported by the International Committee of the Red Cross (ICRC) continue to treat dozens of weapon-wounded people every week, with surgeons regularly performing operations night and day. In the first three weeks of September alone, the two hospitals treated 158 wounded. In August and September, a four-member surgical team from the Qatar Red Crescent Society (QRCS), working together with ICRC and SRCS performed 86 operations in the Keysaney and Medina hospitals, significantly increasing the surgical capacity of the two hospitals.
Treatment of war injured From 1 January 2007 up to 8 October, Medina and Keysaney hospitals in Mogadishu treated 3387 wounded persons (increase of 890 since June 2007). In the same period, ICRC airlifted 102 tonnes of surgical and medical supplies to hospitals in the
Somali capital.
Primary health care and reproductive health
* The maternity ward of Bay regional hospital in Baidoa is now run by the International Medical Corps (IMC). The NGO trained and recruited 11 health workers for the maternity ward, which will be fully rehabilitated. UNFPA will be delivering reproductive health supplies.
IMC also provides basic health services to 7 IDP camps through 2 mobile clinics in Baidoa, as part of a 3 month program. In one month, IMC treated 4000 patients including host community.
Mother and Child Health Care centre/Maternity Koshin run by IMC in Beletweyne, Hiiran region
* Health services for another 5 IDP camps in Baidoa (Hannano I and II, ADC, ONOD, and Asharow camps) are covered by World Vision mobile teams, 5 days per week.
* The Deeg-Roor Medical Organisation (DMO) is carrying out Expanded Programme of Immunization (EPI) activities through its outreach team in Awdinle and Goofgaduud villages of Baidoa. DMO also runs one MCH in Baidoa town where health workers are providing antenatal and postnatal services and EPI on a voluntary basis.
* CARITAS started providing treatment of Kala-Azar in its dispensary in Baidoa, where 120 patients are treated daily for different health problems, plus 20 IDPs.
* After conducting careful assessments in Bay, Bakool and Gedo regions, Muslim Aid UK plans to expand its health program in 2008 by opening new MCHs and TB centres.
Relevant links
* Logistics Support System (LSS) www.lssweb.net (software available in English, French, Spanish, Portuguese and very soon in Arabic)
* Important publication on treatment of Cholera: “First steps for managing an outbreak of acute diarrhea”
http://www.who.int/cholera/publications/first_steps/en/
http://www.fews.net/resources/gcontent/pdf/1000872.pdf.
Special Report: Somalia. The impact of piracy on livelihoods and food security in Somalia
Background
Increased piracy off the coast of Somalia is negatively affecting livelihoods, especially in the south where food security conditions are critical. Piracy is hampering both commercial and humanitarian shipping, which accounts for the majority of the countries imports. As a result, commodity prices are increasing (including food and fuel), income from commercial activities and related logistical operations are being undermined, and humanitarian aid deliveries are being delayed and their costs are increasing.
Somalia’s 3,300 kilometer (km) coastline is the second longest in east Africa and is host to a higher density of live marine resources than neighboring coasts. Civil unrest in Somalia and recurrent droughts have increased competition over these resources.
In recent years, the number of households reliant on fishing has doubled from one percent of the population in 2000 to two percent of the population in 2005. Many of these new fishermen are formerly destitute pastoralists who have to fishing to survive. In addition, there has been an increase in fishing by foreign vessels in Somalia’s poorly controlled waters.
Concurrently commercial traffic along Somalia’s coast has increased. In a normal year, traders import between 200,000 and 400,000 metric tons of foodstuffs--especially rice, sugar and pasta--via ocean transport. About half of the country’s cereal food requirements and most of its non-food items come via sea freight.
Piracy has been a problem for a number of years, but has become increasingly prevalent in recent years.
In 2003, the International Marine Bureau (IMB) recommended that ships stay 50 nautical miles off the Somali coast in response to increasing attacks on fishing boats. In 2004, this cautionary distance was extended to 100 nautical miles due to an increasing number of attacks close to the shore. In recent months, the cautionary distance has been increased once more to 200 nautical miles because of a further escalation in piracy affecting both commercial and humanitarian ships sailing near the Somalia coastline.
Since March 2005, 32 hijackings and attempted seizures have been recorded off the Somalia coastline. If the situation does not improve, it is conceivable that the IMB could issue a ban on the passage of vessels off the coast of Somalia.
The increase in piracy is having a direct impact on food security and livelihoods in Somalia as a result of increases in commodity prices, lost income from reduced commercial trade and port activities, and delays in humanitarian aid shipments and increased transport costs.
Increased commodity prices
Piracy is constricting the supply of commercial cargo to Somalia. Increasingly, commercial cargo vessels are being diverted to Persian Gulf countries to reduce the risk of piracy which is leading to a reduction in the amount of cargo arriving in Somalia. As a result of piracy, most urban markets in southern Somalia are reporting a slowdown of imported commodities, followed by price increases over the last six months for rice, sugar and fuel. For instance, in Mogadishu’s main Bakara market, rice prices are twice that of a normal year and increasing. Contrary to the norm, rice prices increased by 17 percent from 6,000 SOSH per kilogram in September 2005 to 7,000 SOSH per kilogram in November 2005. Rice prices normally fall between September and November after the high season monsoon is over because the calmer seas allow smaller vessels which account for a significant portion of the cargo that enters Somalia to safely navigate the Somali coast.
Piracy has also resulted in fuel shortages in Somalia. Due to high global fuel prices and disruptions in supply to the country, fuel prices have increased by ten percent between September and November from 10,000 Somali Shilling (SoSh) to 11,000 SoSh per liter.
The combination of reduced supply, higher fuel prices and, therefore, higher per unit transport costs and longer supply chains created to avoid the southern Somali coast (i.e. via Kenya)--have resulted in increases in basic commodity prices having a significant impact on food security by reducing the purchasing power of households. This situation is unlikely to change, unless some significant action is taken to bring piracy under control.
Reduced income from commercial trade
Since the civil war broke out, many Somalis, especially those in the south, have been struggling to improve their livelihoods by stepping up commercial activities to the point that many household livelihoods revolve around self employment. According to UNDP about 30 percent of per capita1 2000 is used as a normal year for comparison.
Income from ocean transport operations in ports
Sea ports (fig 2) are important centers of employment. For instance, in a normal year about 22 vessels arrive in Elmain harbor in northern Mogadishu. About 200 people earn between two and four US dollars a day each time a vessel passes through the port. However, piracy has reduced the number of ships entering Elmain harbor to 11 so far this year.
Thus, the demand for dockside labor has been significantly reduced. In addition to the direct reduction in port labor, petty traders in port cities have also lost business. A similar pattern is visible throughout southern Somalia’s ports.
Increased transport costs
Not only has piracy increased fuel costs which have a direct impact on in-country transport costs, it is forcing humanitarian and commercial cargo through more expensive terrestrial routes including via Kenya and Djibouti. These additional transport costs are either being passed on to consumers in the form of price increases or resulting in higher cost humanitarian operations which potentially mean less humanitarian aid at a time when the food security southern Somalia is critical following the failure of both the Gu (March – May) and Deyr (October – December) rains this year. The World Food Programme (WFP) indicates that it costs 25 - 30 percent more to transport food aid to Somalia by road via Kenya than by ocean freight.
Delays in delivery of humanitarian aid
Humanitarian interventions are being hampered in a number of ways. Although community elders were able to secure their release, two vessels carrying WFP food aid have been hijacked so far this year. As a result, humanitarian organizations are looking for alternative routes to bring food aid into southern Somalia, including overland from Kenya and through Djibouti. Despite high costs, WFP has already delivered about 500 metric tones via land (from Kenya to Wajid District of Bakool Region in southern Somalia) to avoid potential delays due to piracy.
Piracy is also exacerbating fuel shortages affecting flights and thus humanitarian access to drought affected regions. This has a significant impact on humanitarian interventions, particularly on relief transport costs and on assessment and monitoring.
Conclusion
Over one million people are food insecure in Somalia. Over 600,000 of these people are currently facing severe food shortages in southern Somali. Piracy is chocking the maritime supply of basic commodities because private commercial vessels are unwilling to risk sailing in Somali waters. Food imports have been especially affected at a time when they are most needed to off-set poor and failed production in 2005. At the same time humanitarian organizations are intensifying their interventions to mitigate the extreme food insecurity created by conflict, crop losses, high cereal prices and insufficient income- earning opportunities. But these critical interventions are being slowed down by piracy.
Although livestock has traditionally been Somalia’s predominant industry, the livestock export ban between 1998 and 2004 has reduced its importance pushing more people to rely on the ocean for their livelihoods. The looming possibility of a ban being placed on international vessels sailing in Somali waters by the IMB, would have a serious impact on the livelihoods and thus the food security of the country, similar to the impact of the livestock ban.
Although the Transitional Federal Government of Somalia has made an effort to improve the situation by contracting the Topcoat Marine Security, piracy remains rife. If action to contain the piracy problem is not successful, the coastline could be declared a war zone resulting in a ban on international marine transport. This would have profound consequences for vulnerable populations who would find themselves subject to even higher basic commodity prices and be stripped further of income-earning opportunities. Furthermore, humanitarian organizations would face even greater challenges in accessing
FSAU Somalia Food Security and Nutrition Brief -
Focus on Post Deyr Season Early Warning, December 2007
FSAU Food Security Analysis Unit. Somalia
Mogadishu remains violent, extremely tense and volatile. Reports indicate that inhabitants who remain in the city are now living in a state of terror and are under constant threats of harassment. Many districts within the city are deserted leaving assets, household and business assets open for looting and destruction. The ongoing and increasing civil insecurity and tension will continue to limit trade and economic activities, as well as restrict port and market movements
in and out of the city, thus ensuring continued high prices of basic commodities and reduced income earning opportunities.
The ongoing and increasing levels of tension and instability, both within Mogadishu,as well as the surrounding areas, have resulted in another wave of population displacement in the last month. The current
best estimate of the number of peoplewho have left Mogadishu since February is now roughly 670,000 (Source: Protection Cluster, Dec. 14, 2007). The main destinations of these recent IDPs are the Shabelle and central regions, as well as Hiran region. The IDP breakdown by regions is Lower and Middle Shabelle 295,000 representing 45% of the displaced, Mudug and Galgadud 173,000 or 26%, Hiran 47,000 or 8%, and Bay 37,000 or 6%, and the remainder in Juba, Bakool, Gedo, the northeast and the northwest.
More on
http://www.fews.net/centers/files/Somalia_200711en.pdf
Remarks by Special Envoy for Somalia John Yates
Woodrow Wilson International Center for Scholars
October 18, 2007.
A briefing on Somalia
I’d like to review our goals for Somalia and the nature of our efforts thus far, then I’ll be happy to take some questions.
I have been in Nairobi since January of 2007 and was appointed by Secretary Rice as Special Envoy for Somalia in May of this year. I lead a team based at our Embassy in Nairobi but dedicated entirely to Somalia. Of course, there are countless other actors both in Washington and various overseas posts concentrating on our efforts towards Somalia.
The United States continues to engage with the leadership of the Transitional Federal Government (TFG) and Somali stakeholders across the political spectrum to achieve U.S. foreign policy objectives in Somalia: 1) eliminate the terrorist threat; 2) promote political stability and support the establishment of a functioning central government; and 3) to address the humanitarian needs of the Somali people. U.S. priority initiatives in Somalia remain focused on three priorities designed to restore governance and long-term stability. First, encourage political dialogue between the Transitional Federal Institutions and other key Somali stakeholders with the goal of resuming the transitional process outlined by the Transitional Federal Charter leading to national elections in 2009. Second, achieve full deployment of an African stabilization force, known as the African Union Mission in Somalia (AMISOM). Third, mobilize international assistance to help build the mid-level governance capacity of the Transitional Federal Institutions and support the continuation of the transitional political process as outlined by the Transitional Federal Charter. Clearly, all three elements are intertwined. Neither the humanitarian crisis nor the extremist elements will go away without a stable government. Likewise, the government is unlikely to become stronger without a political process that isolates extremist elements in Somalia.
The United States remains actively engaged in a range of bilateral, regional, and multilateral efforts to encourage positive developments and further political progress inside Somalia. On a bilateral basis, the United States continues to interact with TFG representatives and Somali stakeholders to achieve U.S. policy goals through the U.S. Embassy in Nairobi, Kenya, which maintains responsibility for U.S. engagement in Somalia. Officers in the Somalia Unit at Embassy Nairobi meet and communicate regularly with President Abdullahi Yusuf Ahmed, Prime Minister Ali Mohamed Gedi, Speaker of Parliament Sheikh Adan Mohammed Nur “Madobe” and other members of government and parliament, as well as key segments of Somalia society.
We also continue to meet and discuss Somalia with regional leaders on a regular basis. The U.S. embassies in Djibouti and Ethiopia regularly call on host-nation counterparts to review developments in Somalia. The U.S. Mission to the African Union (AU) is actively engaging with the AU leadership on its plans in Somalia.
Our ultimate goal is to see Somalia through to free and fair elections in 2009. These elections would signify the successful achievement of the goals of the transitional process that started in 2004. The most recent milestone on this road to elections was the National Reconciliation Conference (NRC), which took place between July and August of this year. The primary objective of the NRC was to achieve equitable representation in the Transitional Federal Institutions and agree on a roadmap for the remainder of the transitional process. Unfortunately, due to the lack of participation from key opposition figures – despite repeated invitations from the Congress managers and encouragement from the international community – the Congress has not yet fully achieved these objectives. However, there were some positive outcomes from the NRC, and we have encouraged the TFG to continue to reach out to key stakeholders and to implement the conclusions of the Congress in good faith and in keeping with a continued process of dialogue and reconciliation. In moving forward with the transitional process, all transitional committees appointed by the TFG must be fully inclusive of all key stakeholders, including those who may not have participated in the Congress. We are again calling on all players in the transitional process to join and participate in a non-violent political process that will ensure a successful roadmap to 2009.
More immediately, we must have a ceasefire among all armed groups in Somalia to establish a framework for longer-term security sector reform and isolate extremist elements that are able to exploit the current environment. The level of violence must be reduced, if not for the sake of the political process then for the sake of the innocent civilians who continue to suffer injury and death at the hands of extremist elements who continue to resort to armed conflict in pursuit of their individual agendas.
The humanitarian situation in Somalia is a grave one. USAID is spearheading our aid efforts and we’re working closely with the United Nations and the international community to optimize those efforts. We have provided approximately $24.5 million to date in fiscal year 2008 (which only began on October 1) in humanitarian assistance to the UN and international agencies and NGOs to provide life and livelihood saving assistance to internally displaced persons, host communities, agrarian and pastoralist populations in all regions of south central Somalia. Between FY 2007 and FY 2008, we have also provided approximately $59 million in food aid to vulnerable Somalis through the distribution networks of CARE and the UN World Food Program. We will continue to monitor the situation and coordinate with the donor community to ensure an effective response to Somalia’s dire humanitarian needs.
In closing, I’d like to share with you a recent example of our engagement with key figures in Somali society. I hosted an Iftar dinner in Nairobi on September 30 and nearly 80 people accepted the invitation. We had several notes afterwards from guests who said that many of the people under the tent seated at the tables were people who would not ordinarily share a meal together. We take some hope from events like this. By the same token, we were struck when a speaker at the Iftar declared that Somalis want to hurt no one, to which the crowd replied in sync, “Except for themselves!” It struck me that a key factor in Somalia’s political future would be in translating this self-awareness into a willingness to work together in pursuit of common objectives and towards reconciliation in the near future.
It is important for the Somali people to focus on the future, moving forward in the transitional political process as envisioned by the Charter, rather than focusing on the current composition of the TFG and its Institutions. Like in Liberia or the Democratic Republic of Congo, the Transitional Federal Institutions are not permanent institutions – they are a transitional mechanism that provides a framework for achieving the objectives outlined in the Charter and the formation of representative governance institutions following the transitional process.
We understand that this is an ongoing process, and that we have not reached the end. Along with our regional and international partners, the United States will remain engaged in supporting this much-needed process of inclusive dialogue, however long it may last, while also responding to the humanitarian needs of the Somali people.
http://www.wilsoncenter.org/events/docs/YatesRemarksWilsonCenter101507.doc+somalia+filetype:doc&hl=en&ct=clnk&cd=1&gl=us&lr=lang_en
SOMALIA COUNTRY PROFILE. THE STATE OF THE MEDIA IN SOMALIA
Presented by: Omar Faruk Osman, Secretary General, National Union of Somali Journalists (NUSOJ)
Background
Somalia’s media has evolved since it first blossomed in 1991, with private newspapers that were aimed at a rather narrow urban, literate and politicized elite, up to the time when it became a much more populist, commercial and community-based media with a tendency to side with various clans. The increase in the number of media outlets has corresponded with the arrival on the labour market of a generation of journalists, unskilled in either the basics of the profession or its ethical requirements. However, this increase has not led to greater pluralism, as journalists have tended to target the same small market, cover the same type of issues in the same way, and strive to match the real or alleged expectations of the public.
The majority of the media institutions in the country are privately-owned. Business people own over 64 newspapers (mostly A4-sized as newsletters) and 17 FM radio stations. Countless websites are daily visited by many Somali people in the diaspora as well as in the country. But most of the websites are mouthpieces of different clans.
Infringements of media freedom in Somalia have been unprecedented in the year 2006. Multiple pressures including the use of intimidation and detention based on false allegations, self-censorship, propaganda and suppression of the truth have been the major features of the onslaught on the rights and freedoms of the media. Press freedom is further undermined by media workers’ poor social conditions.
The number of offences against journalists and media businesses in 2006 were roughly the same as in 2005; however more substantial perils such as threats to journalists’ lives because of their work were monitored by the members of Press Freedom Protectors Group working with the backing of the National Union of Somali Journalists.
During this year, a range of sophisticated measures have been used to curb media freedom. Some politicians verbally or tactically intimidate journalists while some were put in custody for short periods.
Current State of Media Freedom
The most recent case involving harassment of journalists occurred at the end of October, when three journalists were arrested by forces loyal to the Transitional Federal Government in Baidoa. The three; Fahad Mohammed Abukar of Warsan Radio in Baidoa, Mohammed Adawe Adam of Shabelle Radio in Mogadishu and Muktar Mohammed Atosh of HornAfrik Radio in Mogadishu were reportedly arrested while returning back to Baidoa, from their trip to Burhaka where fighting had been on and off between government troops and the militias loyal to the Islamic Courts Union. The journalists were in a while released after a week of detention and investigations.
In March, journalist Hassan Kafi Harred of Radio Banadir was briefly detained at Baidoa police station by militias loyal to the Rahanweyn Resistance Army. Security forces in Baidoa briefly detained Ms. Maryan Mohammud Qalanjo, one of Radio Shabelle’s Baidoa correspondents, striking her with their rifle butts. She was later released and told she was banned from working as a journalist. In June, the newly established temporary leadership of Middle Shebelle region jailed Abdikarin Omar Moallim, the regional reporter of Radio Banadir, overnight.
The editor of widely-read daily newspaper Jamhuuriya, Mohammed Abdi Urad, was arrested in Hargeisa by soldiers from Somaliland Criminal Investigation Department after a warrant for his arrest was issued by the Hargeisa regional court on 18 June. Journalists Mohammed Adawe and Ali Ajey of Radio Shabelle were briefly arrested on 18 June by the security committee of Baidoa town on the orders of the Minister of Farming who was at the same time the acting Minister of Interior of the Transitional Government, Colonel Hassan Mohammed Nur (Shatigudud).
In August 2006, a car traveled by the leaders of the National Union of Somali Journalists was ambushed on the road to Mogadishu from Baidoa. The driver of the car Madag Garas was killed while the vice president of NUSOJ supreme council Fahad Mohammed Abukar was injured at the right hand.
Since the war between the Islamic Courts Union (ICU) and the Alliance of Restoration of Peace and Counter-Terrorism (ARPCT) started in Mogadishu in February, journalists came under growing pressure to operate self-censorship. Media outlets, particularly the electronic media, were deeply divided in reporting the war and the news from the warring sides. The radio directors tightened their control on news put out by their stations because some of them were supporting the warring sides in different ways.
Media Legislations
The Transitional Federal Government of Somalia recently announced that it is in the process of drafting a media law. NUSOJ approached the ministry of information to get generally accepted media law by all stakeholders. The government accepted to open dialogue with other stakeholders such as the media community, human rights activists and lawyers. TFG recognizes the National Union of Somali Journalists, and registered it as an independent trade union organization for journalists.
In October, the Islamic Courts Council proposed 13 rules to standardize the media. The media community in Mogadishu asked to be given time to discuss it, and to get back to them, and the consultations are currently ongoing.
Somaliland, which declared itself an independent republic from Somalia, has a media legislation which allows for media freedom and the establishment and existence of journalists’ associations. But the Somaliland opposition parties accuse the ruling party of not allowing establishment of independent radio stations.
International Relations and Training Opportunities
The Journalists in Somalia represented by the National Union of Somali Journalists (NUSOJ) have international relationships with the International Federation of Journalists (IFJ) and the Reporters without Borders (RSF). NUSOJ is affiliated to the East and Horn of Africa Human Rights Defenders Network (EHAHRD-Net) and other regional organizations. The journalists in Somalia receive trainings from NUSOJ and other media organizations.
http://yorku.ca/crs/AHRDP/Journalist_Conference/Somalia%20Country%20Report.doc.
Somalia: Trafficking Routes
Somalia is a country of origin for trafficking in women and children. Somalis are trafficked to Europe, to the Middle East, and to some countries in Africa. There is also trafficking within Somalia.
Factors That Contribute to the Trafficking Infrastructure
Trafficking in African women and children for forced prostitution or labor is exacerbated by war, poverty, and flawed or nonexistent birth registration systems, according to a recent study by the United Nations Children’s Fund (UNICEF). Poverty aggravates already desperate conditions caused by conflict, discrimination, and repression. Because children who are not registered at birth never formally acquire a nationality, they are easily moved between countries. The study also found that Africa’s 3.3 million refugees and its estimated 12.7 million internally displaced people are those most vulnerable to trafficking.1 HIV/AIDS has left millions of Sub-Saharan African children orphaned. By 2010, an estimated 20 million children under 15 years of age in Sub-Saharan Africa will have lost one or both parents from HIV/AIDS.2 Those children are left extremely vulnerable to trafficking for forced labor, forced prostitution, or forced combat.
Since the 1991 overthrow of Somali’s central government under dictator Mohammed Siad Barre, rival militia have been battling for control of the country.3 In effect, Somalia was stateless throughout the civil war of the 1990s. A 3-year interim government and a transitional National Assembly, installed in November 2000 with international support, achieved little change in this situation. Representatives of 22 Somali groups opened reconciliation talks in Kenya in October 2002 and agreed to establish a federal transitional parliament in January 2004, details of which were still being negotiated in March 2004.4
More than a decade of conflict has left Somali women and children particularly vulnerable to trafficking. According to a UNICEF report, women and young girls have been victims of violence in the form of rapes, beatings, and genital mutilation.5 Parents send their children abroad in the hopes for improving their lives despite the dangers children face when traveling unaccompanied in foreign countries.6 Lawlessness is reported to be increasing in the waters off Somalia’s 3,000-kilometer coastline, creating a breeding ground for illegal fishing, dumping of toxic wastewater, and trafficking and smuggling in people.7 In addition, Somali networks operating in Mozambique and South Africa are believed to be involved in the trafficking of drugs and firearms, as well as in the trafficking of children for the commercial sex industry, particularly in South Africa. 8
Forms of Trafficking
Of African countries, 89 percent are affected by trafficking flows to and from other countries in Africa. In 34 percent of African countries, trafficking also takes place by sending victims to Europe, and 26 percent of the trafficking flows to the Middle East.9 The number of African countries reporting trafficking in children is twice the number of those countries reporting trafficking in women.10
Separated or “unaccompanied” Somali children have been sent by their parents to Europe and North America. Children are pressured, deceived, or forced by their parents and smuggling agents to assume fake identities. Some do end up in the care of relatives. Others may be abandoned at the airport or train station, used for welfare benefit fraud, or used in domestic labor or forced prostitution. Up to 250 children are sent out of Somalia in this way every month.
Children who are forced to migrate without an accompanying adult relative are especially vulnerable to neglect, abuse, and exploitation.11 The United Kingdom is a favored destination for such children because of its large Somali community and generous welfare system.12 Most of the smugglers are Somalis who have U.K. passports and who pass the children off as their dependents.13 Some Somali smugglers claim that corrupt U.K. officials have sold them passports.14
A report submitted at the end of 2002 by the United Nations secretary general to the Security Council for the first time included a list of parties to armed conflict that recruit or use children in violation of their international obligations. Limited to situations on the Security Council’s agenda in January 2003, the list included parties to conflict in Afghanistan, Burundi, the Democratic Republic of the Congo, Liberia, and Somalia.15 The use of child soldiers is widespread among all those groups involved in the Somali conflict.16 A large number of children have carried arms and been involved in militia activities.17
Somalis seeking refuge abroad fall prey to smugglers, who have been known to set sail with their victims and then to force them overboard before arriving in port towns. For example, in August 2003, 30 Ethiopian and Somali refugees were forced overboard in the Gulf of Aden off the Yemeni coast. Many of them drowned.18 Other Somalis pay thousands of dollars to be taken to Italy in unseaworthy boats.19
Government Responses
The Criminal Code prohibits “practicing prostitution.”20 The punishment for the crime is a fine and imprisonment for 2 months to 2 years. The penalty is increased, however, if the perpetrator of the offense is married.21
The code also prohibits inciting a person to perform “lewd acts” in a public place.22 Moreover, it prohibits instigating, aiding, or facilitating prostitution or living off the proceeds of prostitution. The punishment is imprisonment for up to 8 years. If the act is committed against a person who is not capable of giving legal consent, or if the victim has been entrusted to the offender for care, education, instruction, supervision, or custody, the penalty is imprisonment for up to 6 years.23 The code also prescribes punishment for anyone abducting a child under 14 years of age.24
Nongovernmental and International Organization Responses
In Mogadishu, UNICEF supports the Elman Child Soldier Rehabilitation Project, a program designed to reintegrate former child soldiers by providing vocational training, assistance in building conflict resolution skills, and psychological counseling. The first phase of the project reached 120 former combatants; the second phase will provide reintegration and rehabilitation services for an additional 420 former child soldiers.25
httP//www.protectionproject.org
GIRLS' EDUCATION IN SOMALIA
©UNICEF Somalia
Somalia's education system has been in a state of crisis for many years and was dealt a crushing blow by the war that broke out in the early 1990s. As a result of persistent insecurity, economic collapse, and lack of governance, many schools closed. Only 11% of primary aged children are enrolled in school: 10% of girls and 12% of boys. These indicators place Somaliaamong the lowest ranking countries in the world.
THE BARRIERS
The political vacuum created by the absence of central and regional administrations has profoundly affected Somali education. Other factors working against girls' participation in education include:
1. The subordinate role of women in society. This has led to inadequate numbers of female teachers and other educational professionals and to low female representation on community education committees depriving girls of educated female role models.
2. Gender stereotyping. The curriculum, instructional materials and teaching and learning practices are frequently gender biased. The recently introduced lower primary syllabus, textbooks and accompanying teacher in-service training under the leadership of UNICEF have provided a strong foundation toward elimination of gender discrimination. However, these important first steps need to be sustained and expanded.
3. Child labour. According to the End-Decade Multiple Indicator Cluster Survey (MICS 2000), 49%
of girls aged 5 - 14 are working in Somalia.
4. Inadequacies in school infrastructure. Only 1,105 primary schools are operational.
Although most operate double shifts, they reach only 17% of school age children. Twenty-two percent of primary schools cater for upper grades from 5 to 8, so many older pupils must travel long distances to school which poses a major obstacle for continuing girls’ education for, amongst other things, issues of security. Half of the schools in Somaliahave no latrines, the other half rarely have more than one
UNICEF’s activities in girls’ education include:
1. Developing gender responsive educational policies and plans particularly for the northern zones.
2. Improving school infrastructure and implementing a gender disaggregated education management information system across all Somali schools.
3. Community empowerment and capacity building of key actors in the education system.
4. Developing a gender-focused curriculum and providing textbooks and learning materials.
5. Providing professional and gender training and capacity building opportunities for teachers, head teachers and education authorities at zonal, regional, district and school levels to enhance their technical and management skills with particular focus on enhancing girls’ education.
6. Developing approaches to monitor and assess learning achievement and implementing an effective school supervision strategy to improve the overall effectiveness of schools.
KEY ACHIEVEMENTS
In spite of the challenges, UNICEF and its partners have made notable progress in primary education.
1. A sustainable, community-based partnership strategy has improved access to schools and the local financing and management of primary education.
2. The total number of primary schools has risen by about 29% annually over the past 2 years. The total number of operational primary schools now stands at 1,105. The enrolment of students has also risen by about 28% annually during the same period and now stands at 261,492 children (35% girls), and there are now 8,500 teachers in the system (an increase of 30%).
3. A new curriculum, syllabus, and textbooks for lower primary level have been developed, printed and distributed to all schools in collaboration with UNESCO and other partners. Teacher's guides and other materials have been developed and distributed in line with the new curriculum.
4. Phase-1 In-service training programme for all (about 6,500) lower primary teachers and head teachers has been completed.
GIRLS' EDUCATION: SOMALIAAT A GLANCE
FUTURE PLANS
Building on existing activities, UNICEF plans to:
1. Support the finalisation and adoption of the gender responsive education policy and framework for action in the Northeast region or ‘Puntland’ and the Northwest region or ‘Somaliland’.
2. Conduct ongoing and phased gender training and professional development for teachers, head teachers and other education personnel at zonal, regional district and school levels.
3. Develop and implement an effective school and classroom supervision strategy which would enhance the enrolment, attendance, participation and learning achievement of girls at primary levels.
4. Continue to advocate for the removal of gender stereotyping in learning materials and processes.
5. Support improvement of the learning environment in project areas by implementing a low cost "School Improvement Programme," and providing basic sanitation facilities including separate latrines for girls. Advocate for and support the establishment of upper primary grades to lower primary schools to stem the dropout of girls during transition form lower to upper primary grades.
6. Mobilize communities, authorities and partners to emphasise the importance of girls' education and enhancing their enrolment and effective participation in education.
PARTNERSHIPS
There is no central national partner in Somalia, therefore UNICEF works with a range of partners. In 2003, UNICEF was elected Co-Chair of the Education Sectoral Committee of the SACB and, in this capacity, has been able to strengthen its role in education by providing strong networking and coordination both at the Nairobi and zonal/regional levels. The major external partners in the education sector include the UN agencies (specifically UNESCO, UNHCR and WFP), international NGOs and donors. This coordination is also gradually strengthening at the zonal and regional levels where the important national actors include the local authorities, communities and NGOs who are playing a critical role in provision of quality education. In the Northern Zones, the role of zonal level local authorities is significant. However, in the Central and Southern Zone, their role is limited to those district and regions where functioning local authorities exist.
unicef.worldbank.ch/girlseducation/files/Somalia_2003_(w.corrections).doc
Somalia and Water
1. Access to safe water is a significant problem in Somalia, aggravated by the destruction and looting of water supply installations during the civil war, the continuing conflict, and a general lack of maintenance. This situation is compounded by erratic rainfall patterns that produce both drought and flooding.
2. It is estimated that 65 per cent of the population does not have reliable access to safe water throughout the year.
3. Less than 50 per cent of Somalis live in households with sanitary means of disposing excreta. Lack of clean water significantly contributes to the high rates of illness and death in Somalia.
4. The impact of poor environmental sanitation is particularly felt in the cities, towns and large villages or other places where people live in close proximity to each other.
5. Defecation is generally close to dwellings and water resources and lack of garbage collection and the proliferation of plastic bags affect the urban environment and water sources.
6. Poor hygiene and environmental sanitation are major causes of diseases such as cholera among children and women. Cholera is endemic and claims hundreds of lives annually, particularly in densely populated areas. Access to clean water is essential for prevention of diarrhoea diseases and cholera.
7. North-eastern Somalia's self-declared autonomous region of Puntland was the worst hit region in eastern Africa when the Indian Ocean tsunami smashed along more than 650 km of coastline. It's an area that is remote and inaccessible but nevertheless densely populated at this peak season for fishing communities.
8. The Tsunami killed at least 150 people in the Puntland, and the total or partial loss of housing, household goods and means of livelihood have affected more than 18,000 households. Wells throughout the affected region were inundated and contaminated causing acute shortages of drinking water and leaving the population in a state of heightened vulnerability.
UNICEF urban projects benefited about 300,000 people, while about 100,000 more people throughout Somalia were the beneficiaries of rural water supply projects. The rehabilitation of 30 bore-wells and mini-water systems in rural areas and the protection and rehabilitation of 134 hand-dug wells was also achieved. As a result, clean water reached at least an additional 400,000 people, a major increase over and above 150,000 new beneficiaries in 2002. Personal hygiene and sanitation practices were improved in over 80 per cent of the supported communities.
http://www.lgfl.net
WHO Somalia, 10 August 2007
Acute Watery Diarrhoea Update Somaliland
This update describes the development, status, and activities implemented by the humanitarian community in response to the Acute Watery Diarrhoea outbreak in Somaliland. The update follows the structure as proposed in the WHO guidelines for cholera outbreak response.
The report is built on surveillance data that health service providers and NGOs transmit on a weekly basis from health facilities and hospitals in Somaliland.
Dr Hammam El Sakka,
http://www.emro.who.int/somalia
In this issue
* Between 1 January and 10 August2007, 3864 Acute WateryDiarrhoea (AWD) cases werereported from Somaliland including46 related deaths (CFR 1.24%).
* In the current week(epidemiological week 32), the reported number of cases decreased by 5%, in comparisonto the previous week (143 and 159 cases respectively).
* In the current epidemiologicalweek, no AWD related-deathswere reported from all regions.
* Overall, Toghheer region (Burao) reported 56% (2179)of the total number of reported cases, including 43% (20/46)of the total related deaths. The trend shows amarked decrease in the reported cases compared to the lastepidemiological week.
* Although Awdal region (Borama) reported only 12% (477) of the total reported cases, itreported the highest CFR at 1.68%. Photo: Dr Hammam El Sakka, WHO Somalia Overall, the number of reported Acute Watery Diarrhoea cases is decreasing in Somaliland due to decrease in the number of reported cases from Toghheer region. However, a slight increase was observed in the number of AWD cases reported from Wogooyi Galbeed and Awdal regions.
Between 01 January and 10 August 2007, a total of 3864 cases of clinically diagnosed Acute Watery Diarrhoea (AWD) including 46 related deaths (CFR1 1.19%) were reported from Somaliland. Cases were reported from 3 regions (Toghheer, Awdal and Wogooyi Galbeed) with an estimated population of 1,063,855; the overall attack rate2 (AR) is 0.36%.
In the current week (epidemiological week 32), the reported cases decreased by 5% in comparison to the previous week (143 and 159 cases respectively) mainly due to decrease in the number of reported cases in Toghheer region. The overall CFR continues to decrease from 5.26% in epidemiological week 20 to 1.19% in epidemiological week 32. In the current week, no AWD related-death was reported from any region; accordingly the CFR showed a decrease in comparison to the previous week (0.00% and 0.63% respectively). The weekly distribution of AWD cases and CFR is shown in figure 1.
Overall, 63% (2423/3864) of the AWD cases occurred in equal to or above 5 years old age group including 54% (25/46) of all reported deaths. Although the less than 5 years old age group reported 37% (1441/3864) of the number of cases, the Case Fatality Rate (CFR) was higher compared to the more than 5 years old age group (1.45% and 1.03% respectively). The weekly distribution of AWD cases by age group is shown in figure 2.
The first report of an increase in AWD cases was received form Burao district in Toghheer region in epidemiological week 12. After reaching the peak in week 22, cases started to decrease up to the current epidemiological week. Burao district is divided into 4 main sectors. Cases were reported form different locations named; Sheik Bashir (reported the majority of the cases), Farah Omer, Aden Suleiman, Mohamed Ali and Kossar. Only 3 cases were reported from villages outside Burao town named; Ununlay, Lebiguun and Kabadhere villages. In the current week, Burao district reported 88 cases with no related-deaths (CFR 0.00%), in comparison to the previous week, a decrease of 14% was observed (88 and 117 cases respectively).
In epidemiological week 14, the first cases of AWD were reported from Hargeisa district, Wogooyi Galbeed region. Hargeisa town reported 3 cases of AWD and the number of reported cases continued to increase reaching the peak in epidemiological week 23. However, an increase of 4% was observed in the current epidemiologic week compared to the previous week (24 and 22 cases respectively).
Starting from epidemiological week 16, Borama district, Awdal region reported AWD cases with a high CFR of 4.35%. The peak was reached in epidemiological week 23, but a sharp decrease was observed in the last 4 weeks. In the current week, Borama reported 20 cases with no related-death (CFR 0.00%). In comparison to the previous week, the number of reported cases was increased by 22% was observed (31 and 20 cases respectively).
During the same reporting period, 56% (2179/3864) of AWD cases were reported from Toghheer region (Burao) including 43% (20/46) of the total related deaths (CFR3 0.92%). Thirty-one percent (1208) were reported from Wogooyi Galbeed region (Hargeisa) including 39% (18) of the total related deaths (CFR 1.49%). Although Awdal region (Borama) reported only 17% (8) of the total related deaths, it reported the highest CFR at 1.68%.
Overall, equal or more than 5 years old group represented 63% (2423/3864) of the total number of reported cases. The age distribution in both Burao and Hargeisa is almost identical; the less than 5 years old group represented 34% and 35% respectively of the total reported cases. In Borama, the less than 5 years old represented 60% of the total reported cases which may indicate that the cholera case definition is not appropriately used. The age distribution of reported AWD in the 3 regions is shown in figure 4 and table 1.
V. cholerae serogroup O1, serotype Inaba.
Between 23 March and 24 April 2007, a total of 62 stool samples were tested in Hargeisa general hospital laboratory; of these 42% (26/62) were positive for V. cholerae serogroup O1, serotype Inaba. Eighty-five percent (51/62) of the samples were from Hargeisa and the remaining 15% were from Burao. Overall, the mean age of positive samples was 28.03 years, ranging from 6-70 years. Fifty-three percents (14/26) were females. The antibiotics sensitivity test showed 42% (11/26) of the isolated V. cholera was resistant to Chloramphenicol.
From the 51 samples collected from Hargeisa 43% (22/51) were positive, and, the mean age of positive samples was 28.82 years, ranging from 6-70 years. Fifty percent (14/22) were females.
From the samples collected from Burao 36% (4/11) were positive, and the mean age of positive samples was 34.00 years, ranging from 7-70 years. Seventy-five percent (14/26) were females.
In the epidemiological week 29, 7 stool samples were collected from patients with AWD in Awdal region (3 from Borama and 4 from Hariirad village), Samples were tested in Hargeisa Hospital, and all samples were negative for V. cholerae.
3
http://www.who.int/topics/cholera/control/en/index.html “Prompt and appropriate medical management of cases can significantly decrease mortality (Case Fatality Rate); when applied properly; case-fatality rate should be below 1%. In untreated cases the fatality rate may reach 30-50%. These levels are often observed in crisis situations with overcrowding, limited access to health care and precarious environmental management”.
4 All V. cholerae serogroup O1 serotype Inaba positive samples collected in South and Central zones of Somalia were sensitive to Chloramphenicol.
World Health Organization Dr. Hammam El Sakka: elsakkah@nbo.emro.who.int
TB control in Somalia
DOTS implementation in complex emergencies –Somalia’s experience
(Dr Firdosi R Mehta, MO STB & Dr N. Mojadidi WR, WHO Somalia)
Background and Epidemiology
Tuberculosis is endemic in Somalia and is one of the leading causes of morbidity and mortality. Aside from security TB in Somalia is reported as the greatest barrier to stability and economic development. The civil war caused an unprecedented collapse of the national TB Control Programme.
The Programme was supported in its initial stages by FINDA (Finish International Development Agency). Subsequent attempts to support TB have been supported by WHO in collaboration with International NGOs. In 1986 FINDA conducted a Tuberculin survey in Kismayo, Burao and a refugee health unit. The results for children over 10 years showed a high annual risk of infection – 3.66%, 3.08% and 4.9% (Clinic Infect Dis. 1994 Jan; 18(1): 106).
In a refugee camp in 1989, 3 of all adult deaths were due to TB. In two camps in eastern Sudan in 1990, 38% and 50% of all adult deaths were due to TB (WHO/TB/97.221).
Somalia is estimated to have one of the highest incidence rates of TB in the world. It is estimated that each year, around 12,000 sputum positive cases occur, out of which only 3 are detected and receive treatment in a supervised DOTS Programme. TB can be considered a major public health problem in Somalia, affecting the most productive age groups of the community.
TB Control Strategy
The strategy used at all the TB centres is DOTS. All 5 components of the DOTS strategy are implemented in Somalia; WHO and INGOs are committed to TB control in Somalia. WHO appointed a full time MO for TB in '98. WHO produced and distributed TB treatment guidelines in 1994.
Case finding is mainly passive, though smear microscopy and DOTS is practiced strictly in all implementing centres. Patients are observed daily by a health worker at the clinic. A system of appointing a guarantor at the start of treatment helps in assuring compliance. Quality drugs are procured by WHO and distributed to all centres. WHO recommended recording and reporting procedures are in place.
TB Control activities.
Ten international NGOs and one individual presently support and operate 16 TB centres in 11 out of 18 regions giving a DOTS coverage of approximately 56%. DOTS coverage has increased from 45% in ’98 to 56% in end ’99 under the leadership of WHO’s revitalization policy for the TB program in Somalia. Using regular budget funds WHO has been providing laboratory support, training, anti-TB drugs and limited laboratory quality assurance to these programs. All these programs have fully implemented the DOTS strategy and have achieved remarkable results under extremely difficult situations. The location and population covered is given in table 1 below.
Table 1: Location and catchment Population of TB centres
Location Region NGO Est. Population
Adale Middle Shabelle ADRA/SAACID 451,300
Boroma Awdal Annalena Tonelli 147,300
Berbera Galbeed COOPI 336,000
Burao Togdheer COOPI 248,400
Bosasso Gardo Bari Mercy Intl. AAH 247,400
Hargeisa Galbeed KJRC
Las Anod Sool NPA 66,300
Mogadishu Benadir Mercy Intl. 752,000
Mogadishu Benadir ADRA/SAACID
Jilib Middle Juba Mercy Intnl 205,900
Kismayo Lower Juba MSF- B 300,200
Luuq Gedo AMREF 358,400
Abuudwaq Galgadud AMREF 200,800
Garbahare Gedo MEMISA
Belethawa Gedo TROCAIRE
Total (16) 11 10+1 3,314,000
Case notification and trends.
During 1999, a total of 4784 cases of TB (all forms) were reported (table 2). During 1995, 1996, 1997 & 1998, 2504, 3920, 4450 & 4320 cases were reported (all forms).
DOTS is practiced strictly in all implementing centres. A system of appointing a guarantor at the start of treatment helps in assuring compliance.
As can be seen from the notification figures in table 2, the number of SS+ cases being detected and put on treatment, (the infectious pool) is increasing over the years.
The highest number of cases are in the most productive age groups of 15-44 years, and the ratio of males to females is 2:1.
Table 2: Case notifications
Year Smear+ve Smear-ve Ex-pulm Relapse Others Total
1995 1572 582 247 103 0 2504
1996 2894 366 394 266 0 3920
1997 3093 423 453 143 338 4450
1998 3121 442 328 172 249 4320
1999 3449 424 524 204 183 4784
The most productive age groups of the community (15-44 years) are most affected. Women seek treatment less than men.
DOTS Outcome
Remarkable progress has been made in a short span wherever TB centres are present, with average smear conversion rates of 92%, cure rates of 88% and success rates of 90%, reported in 1998 (Table 3) despite some centres being located in areas of conflict and insecurity. Table 4 shows that the overall cure rates have increased from 71% in 1996 to 88% in 1998.
Recording and Reporting
Treatment registers, treatment cards and laboratory registers are well maintained at most centres. In 1998, second half, new TB and laboratory registers were printed and distributed, in addition a wall chart on case definitions etc., was printed and distributed to all centres as a ready reference. An innovative quarterly TB Newsletter has been started by WHO in 1999, to act as a feed back & advocacy tool. 3 issues have been published & distributed till now.
Remarkable progress has been made in a short span, with conversion rates of 92% and cure/success rates of 88/90%.
Human Resources and training.
All centres have national staff supervising TB activities. Each centre has a laboratory technician and other paramedical staff. Five national doctors were provided with WHO fellowships to attend the IUATLD TB training course in Iran in 1997 and 4 doctors attended the same course in Arusha Tanzania, in ’98 & ‘99. In service training is provided by the WHO TB Coordinator & national coordinators.
The WHO/UNV laboratory supervisor has provided training and conducted quality control checks mainly in the NE and NW regions.
Private sector
TB drugs are freely available all over Somalia from drug retailers. TB patients who can not receive treatment at TB centres continues to access the private sector for medication. Inaccurate treatment and prescriptions are common.
Constraints
Expansion of DOTS projects is dependent on the frequently changing security situation in the country.
TB projects are often stopped due to discontinuation of donor support.
Since there is no central government, there is no control over private practitioners and phamarcies. As a result TB treatment in the private sector is haphazard and indiscriminate. This may lead to dangerous increase in multi-drug resistance.
Shortage of funds to procure an adequate and uninterrupted supply of TB drugs.
Conclusion
TB control in Somalia is challenging in the complex circumstances of political instability and insecurity. However, analysis of the DOTS outcome data collaborated by field supervisory visits suggests that DOTS is applied correctly at most centres and demonstrates that DOTS works as effectively in complex emergency countries such as Somalia.
Improving access, training the private sector, strengthening the capacity of national staff and advocacy for resource mobilization are of paramount importance to expand coverage and sustain the gains made already under TB control in Somalia.
DOTS works as effectively in complex emergency countries such as Somalia.
htt://www.who.int
-----------------------------
Tackling TB: a homeless man is offered a cure
This is a story about Michael Berrian, a homeless man from Newark, New Jersey. He felt unwell for months before severe chest pain prompted him to call for emergency medical help. Rushed to a local hospital, and then diagnosed with TB, he is on his way to a cure with comprehensive care.
http://www.who.int/features/2008/tackling_tb/en/index.html
Health Action in Crises
Somalia
August 2007
THE PRESENT CONTEXT
The health status of Somalia’s estimated 8.2 million people is severely
affected by a civil war which has claimed up to half a million lives and left the country with some of the worst health indicators in the world. Close to 450 000 have sought refuge in neighbouring countries and up to 1 million are internally displaced. Ongoing violence continues to trigger fresh waves of displacement. Poverty, disease and limited educational and employment opportunities take a severe toll on the health and welfare of the population. As agriculture is affected by social disruption, environmental destruction and drought, food insecurity is a constant concern.
The self-declared republic of Somaliland (1991) and the self-autonomous region of Puntland (1998) are experiencing political development,economic recovery and relative stability, while the Central and SouthZone remain unstable and violent.
The Transitional Federal Government (TFG), formed in June 2005, has so far failed to produce effective governance. The Union of IslamicCourts took control of the capital and much of the centre and south until January 2007 when they were driven out; the fighting created up to new 400 000 IDPs. Insecurity and violence remain major concerns for health and development.
Main indicators1
Total population in million (2005) 2 8.2
% under 15 2 …
% of urban population (2005) 2 35
Life expectancy at birth m/f (2005) 45/45
Infant mortality ‰ (2005) 133
Under-five mortality ‰ (2005) 225
% population with sustainable access
to an improved water source (2004))2 29
% population with sustainable access to improved sanitation (2004) 2 26
Total adult literacy rate, m/f (2002) 19 25/13
Human Poverty Index rank out of 102 countries 2 …
Gross National Income (GNI) per capita (US$) (2005) 3 130
% population living with less than US$ 1 a day …
Total public and private expenditure on health as % of GDP …
Total per capita health expenditure (US$) …
Nurses/midwives rate /1000 (1997) 0.19/…
Physicians rate /1000 (1997) 0.04
Malaria rate /1000 (2003) 2.36
TB prevalence /100 000 (2005) 286
TB mortality /100 000 (2005) 40
Adult HIV/AIDS prevalence /100 000 (2005) 870
Reported # of people receiving ARTs (2006) 49
Total fertility rate (2000-2005) 2 6.4
% antenatal care coverage (2002) 47
% birth attended by skilled personnel (2002) 23
Maternal mortality /100 000 (2000) 1, 2 1100/1600
Sources:
1 WHO unless indicated otherwise
2 UNDP Report 2006
3 UNICEF
2 Somalia (August 2007)
MAIN PUBLIC HEALTH ISSUES AND CONCERNS*
Health Status
* Maternal health is among the poorest in the world with very low indicators when any are available. Malnutrition and anaemia among women are high and the practice of genital mutilation is almost universal. Rising incidence of HIV and sexual violence and a low contraception rate of 12% are all additional concerns.
* Communicable disease remains a major cause of preventable mortality. An estimated 87% of the population is at risk for malaria and TB while upper respiratory illnesses are common. Cholera,
measles and meningitis outbreaks claim the lives of many Somalis. Cholera is endemic in Mogadishu and there are seasonal outbreaks from November to May.
* With only 26% of the population having access to safe drinking water, diarrhoeal diseases are a major threat to health. During the first part of 2007, 36 275 cases of acute watery diarrhoea were
reported from central south Somalia, including 1102 related-deaths. The majority of health clinics and posts have no water supply. Similarly, schools do not have water and sanitation systems.
* The overall HIV prevalence is 0.9% with regional variations ranging from 0.9 in central south, 1% in Puntland to 1.4% in Somaliland. A 2004 survey indicated that HIV prevalence among pregnant women nationally was 0.6%, with the highest infections levels in the capital (0.9%). STIs are highly prevalent and the context features multiple vulnerability factors which might facilitate a rapid escalation.
* Malnutrition rates are high; significant regional differences exist, with Global Acute Malnutrition (GAM) ranging from 19.5% in Jilib in the Middle Juba region, to 31% in Dusomareb in the Galgadud region and 37% in Bulahawa in the Gedo region.
Health System
* Access to health services is very precarious due to insecurity, lack of trained staff in many health facilities or inability to meet the costs (out of pocket expenditure constituted 55% of all health care spending in 2001).
This applies particularly to women and children and to the central and southern regions.
* Primary coverage in 2003 was reported at 72% overall, 95% and 61% urban and rural respectively. However, these figures are likely a gross overestimate because they do not account for the significant social disruption in the intervening years.
* During the last 15 years, the collapse of national institutions has compelled WHO and its partners to take over vital public health functions usually carried out by the MoH and implement wide-ranging programmes.
UN Agencies and NGOs support a variety of health services: curative care, immunization, antenatal care, nutritional rehabilitation, family planning and rehabilitation of disabled people. Donor health funding is in the order of US$ 5 per capita.
* Efforts are ongoing to re-establish central institutions, but at present central authorities have minimal managerial, technical, implementing or enforcing capacity.
* The health network can be summarized as follow: 84 hospitals, 199 mother and child health/outpatient departments, 525 health posts, 91 private clinics, 51 school clinics, 3,949 hospital beds, 53 cold chains and 451 polio surveillance sites. Health facilities do not cover large pockets of the territory, especially in the south.
In Somaliland and Puntland, war-damaged hospitals and clinics have been rebuilt and qualified health professionals are returning to their practices.
* The private health sector, which has begun filling the gaps of the collapsed public health system particularly in the area of curative services, is in need of urgent regulation and policies. Private health clinics and private pharmacies have proliferated all over the country, especially in the main towns.
* Human resources for health remain scarce. As a result of the civil war, Somalia has lost at least one generation of trained health professionals. Few professionals have the skills and experience needed for reconstruction or public health management background. Low salaries in the public sector force professionals to devote considerable part of their working hours to the private-for-profit curative sector.
MAIN SECTOR PRIORITIES°
Nationwide, health facilities, services and personnel should be standardized and rationalized, taking into account a balance that should be created between curative and preventive services, urban and rural settings, rural and nomadic areas and standard salaries and incentives to operate in remote, disadvantaged areas.
The availability of basic services, such water, health and sanitation facilities, in South and Central Somalia will encourage the return of refugees to these areas.
In the Somalia CAP 2007, the main objectives are to:
* Increase access to essential health services of adequate quality by the most vulnerable population groups, especially IDP women and children;
* Scale up reproductive health services, focusing on emergency medical obstetric care and family planning;
* Increase the coverage of the public health programme, especially of the Expanded Programme of Immunization (EPI) and vitamin A distribution;
* Support health services providers through training and capacity building;
* Strengthen existing surveillance systems, supporting their integration with the health information systems;
* Strengthen coordination of health activities and stakeholders at all levels with special emphasis on emergency preparedness, response, gap filling, early recovery and capacity building;
* Increase the availability of mental health services to communities.
http://www.who.int/hac/crises/som/background/Somalia_Aug2007.pdf
On the front line: The Somalia diary life
Geraldine O’Hara clinical research fellow, Oxford Vaccine Group, Churchill Hospital, Oxford.
http://www.msf.org.
STUDENTBMJ, VOLUME 15, JANUARY 2007
As the tension heightens in the Horn of Africa, Geraldine O’Hara recounts her experiences of working with Médecins Sans Frontières in Somalia
“But what you don’t realise is tuberculosis carries a lot of stigma — like AIDS — so they won’t tell you if the child has been in contact with someone with tuberculosis, especially if it’s a senior member of the family.” The highly experienced local nurse smiles at me while saying this. I am quickly learning a lot here in Somalia.
At the end of February this year I left a cold and snowy England to be transplanted into the arid desert soil of Somalia. I’m now working as the doctor on a tuberculosis treatment project in a town called Galcayo in the Mudug region. The first comment from most of my friends was, “Have you watched Black Hawk Down yet?”
Trouble in the Horn Médecins Sans Frontières (MSF) first entered my consciousness as a teenager, and I had long harboured a desire to work for them. Eventually, in January 2006, the time was right professionally, after attaining membership of the Royal College of Physicians and with six months’ experience of infectious diseases as a senior house officer.
I am not ashamed to say that when finally confronted with the opportunity to go my heart lurched somewhat. It had been a nice idea, but the idea started to pall with the reality of leaving a career and family. However, I set about learning about Somalia with gusto.
Somalia occupies a part of Africa referred to as the Horn of Africa. In the 9th century, migrants from the Arabic peninsula arrived bringing with them traditional nomadic lifestyles, Islam, and the clan system, which today dominates Somali politics. Because of the shortage of usable land and water there were many clashes between groups. The clans essentially divide into five different groups—the Darod, the Hawiye, the Dir, the Issak, and the Sab. All these clans divide further into subclans and subsubclans.
Conflict is common not just between clans but also between subclans and subsubclans. From the late ‘80s onwards, clans and subclans began to develop militias to fight for control of Somalia and overthrow the then prime minister Mohammed Siad Barre.
This culminated in the ousting of Siad Barre in 1991. When the unifying point for fighting disappeared, clan tensions came to the fore and Somalia descended into chaos. Extreme violence became part of everyday life.
The country divided along clan lines and many people had to flee their homes back to the areas traditionally controlled by their clan. Many thousands of people were not categorised as internally deplaced.
There were 15 attempts at reforming a government between 1991 and 2006, but for many reasons no individual managed to pull the country together. In June of this year, militias loyal to the Union of Islamic Courts suddenly took control of Mogadishu and other parts of the south after defeating clan warlords.
Path to ruin
So what does this mean to the Somali in the street? Essentially there are no public schools or universities, few public hospitals, and no police or army to regulate the militias that still exist. The United Nations estimates that there are only four doctors and 28 nurses or midwives for every 100 000 people. Of the eight to nine million people in Somalia, three quarters do not have access to health care. At the same time, the lack of regulation in Somalia has prompted the most startling development of private enterprise: towns and cities now have private power and water supplies, mobile phones are common, and there are many internet cafes.
Our little Cessna plane touched down at the imaginatively titled Galcayo International Airport in the heat of the day. As I struggled to fit a scarf over my head to cover my hair and neck, the heat rolled unrelentingly across the desert in waves. Female MSF staff observe local rules of dress, with traditional long dresses and covered hair. I climbed into the car gingerly, acknowledging the guard with a rifle propped between his legs.
Somalia is the only place where MSF has guards, partly because of the security situation but also at the car owners’ request. Our guard delighted in conversing in English, which he had learnt from the American peace corps in the early 1970s. We bounced around the back of the car as we traversed some of the most uneven roads I have ever encountered. As we passed with our windows down, children shouted out “gala,” which means “white person.”
Galcayo is a growing town of 80 000 people situated on the edge of the Puntland administration. It represents a microcosm of Somalia, because it is split along clan lines with the north belonging to one clan and the south to another. MSF works in the north as well as in the south.
This in itself engenders problems, because crossing the “green line” between the two areas is difficult. Because of violence, MSF is regularly forced to temporarily suspend its work and evacuate from one or the other part of the town.
In 1997, some 2.9 million deaths from tuberculosis were reported globally. This is certainly an underestimate of the true number. Tuberculosis seems to spring up whenever countries are in a state of flux, and it is a large problem in Somalia. The dissolution of the state has left many people in poverty and the lack of basic health services,poor nutrition and deprived living conditions all contribute to the spread of tuberculosis.
MSF took over a tuberculosis project from another organisation in 2005. Our team currently runs one clinic in Galcayo and supports another in Burtinle, two hours to the north. One of our main problems is persuading people to come forward to be screened. Tuberculosis carries a heavy social stigma, and people are embarrassed by the idea of being tested for the disease. I have to remind myself of this over and over again when I wonder why people aren’t keen to come forward.
In the country of children
Everyday at about 4 30 am the first call to prayer goes out and the town wakes up. It is cool so I attempt to rush around before the soporific heat sets in. Because it is hard for us to leave the MSF compound for security reasons, I try to do some form of exercise before the sun comes up. But there is a great temptation to turn over and go back to sleep. I hate mornings, and thankfully the team accommodates my grumpiness as we straggle out of the house.
Painted beside the gate of the main hospital are graphic illustrations of what can and cannot be brought in to the grounds—rifles, pistols, knives, and even walking sticks must be left with the guards. I greet the staff and head into the clinic, where one of the senior nurses is already giving consultations. The clinic operates a self referral system, so any health problems can turn up, from pregnancy related backache to haemorrhoids to every doctor’s nightmare—total body pain and weakness. The nurse who runs registration filters some patients with a few quick questions.
The only part of her that is visible beneath her full veil is her eyes, but my goodness she can communicate hundreds of different emotions with a slightly raised eyebrow or a twinkle in her eye.
My name proves difficult to pronounce for Somalis so she has decided I shall be known only as Doctor until she has thought of a suitable Somali name for me. Despite the language barrier and culture gap we get on extremely well. Our main bonding occurs while giggling at one of the drivers styling his hair in the wing mirror of one of the cars, unaware of our gaze. It seems women gently poking fun at men is a international sport.
A fight for survival
I lack many of the diagnostic tests I am used to and often find myself thinking on my feet. I find a peculiar satisfaction in using only the skills we doctors seem to forget sometimes—namely taking a patient’s history and performing the examination. I remember my early days as a medical student when lecturers stressed the importance of a good history. The only tests available in the tuberculosis clinic are sputum smears and chest radiography. We simply don’t have access to more complex tests and struggle even to test for tuberculosis and meningitis.
I catch the nurse glancing at his watch. I must speed up because he wishes to attend midday prayers. My next patient has had two courses of treatment for tuberculosis but is not cured. I am faced with the difficult task of telling him I simply cannot help him: we don’t have the facilities to perform drug sensitivity testing or the necessary drugs available. Speaking though a translator I feel clumsy trying to be sympathetic. I try to explain how to minimise the risks of tuberculosis transmission, but he is an old pro and starts to tell me them.
Gunshots and miracles
Partway through a consultation I hear gunshot—the first time I have ever heard gunfire outside a film. I quiz the staff, who smile and tell me it’s normal—just someone buying a gun and trying it out. The tuberculosis compound is apparently situated next to the unofficial gun market.
They find it funny that I cringe at the sound of gunfire and tell me with a smile that it is “normal for Somalia.” I feel angry for them that gunfire is just a part of everyday life. “Can’t someone stop it happening?” I say. They smile benevolently at me again and say “Who?” The district authorities are not particularly powerful, and the police
haven’t been paid in months.
After a particularly busy morning with a total of 40 patients, we break for lunch, and then I head into the feeding centre to review the children on tuberculosis treatment there. In the very young, tuberculosis often presents as malnutrition, and failure to respond to therapeutic feeding is a strong indicator that tuberculosis may be present.
Nothing prepares me for the feeding centre: almost 100 women and children in a room makes for a deafening noise. As the staff lead me round the patients I quickly acquire a large group of children behind me. This makes me feel like a serious professor leading a large ward round (although no one makes faces at serious professors or pulls their dresses). I haltingly try some of the Somali phrases I have learnt, which provokes good natured giggling.
Our next stop is the accommodation attached to the compound. Because our project serves a large area and treatment for tuberculosis requires a long commitment of at least six months, patients need to be accommodated in Galcayo. Many people can’t afford to rent rooms and don’t have families in the town so we provide dormitory style rooms for patients.
Return to abnormality
I return to our office, where the Somali staff are having an English lesson. Their dedication and hard work is a real inspiration, and I’m pleased later when one of the nurses seeks me out to ask a question about her homework. With world tuberculosis day approaching we are seeking out someone from the local radio to publicise it. As luck would have it, our laboratory technician has a sideline as a radio disc jockey and so offers to speak to his station. This provokes another round of teasing and joking. With four men and five women on the team, we are evenly balanced.
Naivety on my part about Islam meant I didn’t expect the level of joking between the sexes. Although there is no physical contact there is plenty of good natured banter.
The sun descends rapidly, and we enjoy some lovely cool night air. I return to the MSF compound again, with the windows down in the car, dodging the goat population that roams the streets. Night falls quickly, and we sit and chat about our days around the table. Soon it’s time for bed, and the whole process starts again.
http://student.bmj.com/search/pdf/07/01/sbmj32.pdf
WILDLIFE TRADE IN SOMALIA
Wildlife Middle East, Volume 1 Issue 4 March 2007
Osman G. Amir, Grundstrasse 27, D-64289 Darmstadt, Germany. Email: geedow@aol.com
Somalia’s fauna is rated among the most interesting in Africa, owing to its high species richness and level of endemism. The species richness reflects the high diversity of ecosystems and wildlife of habitats. About 142 vertebrates are endemic into the country, comprising 8 species of birds, 22 species of fresh water fish, 82 species of amphibians and reptiles and 30 mammals. The Somali fauna contains very highly adapted arid and semi-arid ecosystems of Northeastern Africa and is considered a high conservation priority. The initial objectives of the survey was to reassess the presence of Bulo-burte bush shrike (Laniarius liberatus) along the riverbank of Shabelle in Hiran region, and further the survey aimed to assess general impact of wildlife trade to the fauna in southern Somalia. However, the recent fighting between Mogadishu warlords and unions of Islamic courts made it impossible to achieve the first objective and therefore we had to execute the second objective.
The refined objectives were to identify trade-affected species; routes of wildlife trade in Somalia and export destinations, as well as to assess the wildlife trade and its impact on threatened fauna in
Somalia.
Somali wildlife has never been well protected, and important habitats harbouring Somalia’s biodiversity have been overexploited since the arrival of pastoralists at the Horn of Africa. Most big game such as elephant (Loxodonta africana), giraffe (Giraffe camelopardalis) and browse rhinoceros (Diceros bicornis) became already extinct in northern and central Somalia even before World War II. Hunting in Somalia required authorization by the Secretary of State for Forests and Game (law no. 65 of 13 October 1971). However, illegal hunting continued in many parts of the Somalia, sometimes causing cross-border problems with neighbouring countries. Most widely used traditional hunting weapons were a bow and arrow, but small antelopes such as duikers and dikdiks were also trapped with nets.
The situation of hunting has completely changed over the last two decades of civil war, as automatic guns became available for everyone and everywhere in the country, thereby strongly increasing both the number of hunters and illegal wildlife traders. In addition, many hunters adopted new hunting and trapping techniques, and learned to care and handle live animals bound to be sold in foreign counties.
The survey of wildlife trade in southern Somalia in 2006 revealed a strongly increased illegal trade of various species at local markets and for export purposes. About 32 species of vertebrates were identified during the survey. The intensity of wildlife harvesting varies among species, depending on the local situation and market demands. Eleven of these species are listed in the IUCN Red Data Book in 2004 as critically endangered (1), endangered (1) or vulnerable (9) and many others were also listed in Appendixes of the CITES. The illegal trade appears to exert a great pressure on the fauna of the country, particularly on threatened species such as cheetah (Acinonyx jubatus), leopard (Panthera pardus), lion (Panthera leo somalienis), elephant, dibatag (Ammodorcas clarkei), hirola (Damaliscus hunteri), beira (Dorcatragus megalotis), Speke’s gazelle (Gazella spekei), Pelzeln’s gazelle (Gazella dorcas pelzelni), Haggard’s oribi (Ourebia ourebi haggardi) and silver dikdiks (Modaqua piancentinii).
Birds, such as ostrich (Struthio camelus molibdophanus) and bustards are hunted to prepare traditional medicines and as well for export. The bustards are also exported to the Gulf region for falconry purposes. Somalia harbours 8 species of bustards, representing 61 % of the total species bustards recorded in Africa (13 species). Birds of prey are also traded in Somalia and exported into gulf regions. Number of mammals, such as striped- and spotted hyena (Hyaena hyaena and Crocuta crocuta), hippos (Hippopotamus amphibious) and crested porcupines (Hystrix cristata) are hunted for medicinal purposes and exorcistic rituals. Some cat species such as lion cubs, cheetah and leopard, are traded in Somalia and exported into the Gulf region. The country harbours about 22 species of antelopes. Many species are nowadays exported to the Gulf region and Southeast Asia. The traded species comprise lesser kudu (Tragelaphus imberbis), gerenuk (Litocranius walleri), Speke’s gazelle, dibatag, beira and dikdiks (Madoqua guentheri, M. kirki, M. saltiana and M. piacentinii). The survey also revealed that there are large numbers of captive antelopes in Mogadishu and other parts of southern Somalia. Health conditions of these captive animals are usually poor because of the lack of proper feeding and adequate veterinary treatment.
Furthermore, there are currently no rescue centres that would allow local authorities to confiscate captive wild animals and release them in their original habitats.
Several reptiles, such as hawksbill sea turtle (Eretmochelys imbricate), green sea turtle (Chelonia mydas), leopard tortoise (Geochelone pardalis) and Somali chameleons (Chamaeleo spp.) are collected mainly for medicinal purposes and considered as aphrodisiac and the turtle-derived medicines are specially used to treat lung diseases such as tuberculosis, asthma and cough. The leopard tortoise and chameleons are also being exported to the Gulf region and Southeast Asia.
An increasing demand of tortoise bones in China and Southeast Asia may apparently encourage the collection of leopard tortoises in Somalia. During the rule of the dictator Siad Barre, the country had only three international airports, namely Mogadishu, Hargeisa, and Kismayo, and these exit posts for goods were controlled effectively by customs authorities. However, during the civil war a range of new small airstrips were established. These airports are operated by private people and entrepreneurs and lack any effective control of the import and export of goods. The majority of the Somali population covers its protein demand from livestock, and only few people depend on wildlife for their subsistence.
Nevertheless, there is profound lack of national awareness of Somali’s rich variety of flora and fauna, nor of its international importance. Therefore, the continued and uncontrolled wildlife trade along with the loss of important wildlife habitats threatens the survival of certain restricted species, some of which risk to drift into a bottle-neck situation such as silver dikdik, and the Speke’s gazelle which are both landlocked.
International conservation organizations must do more to halt illegal wildlife trade, to establish without further delay a network of small reserves, to protect the most seriously threatened species, to support local NGOs working in the field of natural resource management and to promote more sustainable ways to generate income from wildlife.
Somalia’s outstanding biodiversity is a natural heritage in the first place, yet in a wider sense it is a common heritage of mankind. Thus, the loss of endemic fauna would impoverish not only Somalia but the world in general.
Editors note: a pdf of the full report by Dr. Osman can be downloaded at
http://www.wmenews.com/
Establishing a Comprehensive Stabilization, Reconstruction and Counterterrorism Strategy for Somalia
Dr. Jendayi Frazer, Assistant Secretary for African Affairs
Testimony Before the Senate Foreign Relations Subcommittee Hearing on Somalia. Washington, DC. February 6, 2007
Good morning, and thank you, Chairman Feingold and Ranking Member Sununu. At this first hearing of the Africa Subcommittee, I congratulate you both on your new positions. I look forward to working closely with you and the other members of this Subcommittee during the 110th Congress. Thank you, for calling a hearing on this timely and important issue. I am pleased to have this opportunity to publicly discuss U.S. policy and engagement with Somalia and the Horn of Africa. Mr. Chairman, given your longstanding interest in Somalia, I am not at all surprised that this is the subject of the Subcommittee's first hearing.
Somalia occupies a unique space, both geographically and strategically. The country sits at the crossroads of sub-Saharan Africa and the Near East. The overall security of the region is affected by Somalia's continued lack of internal stability. In this regard, U.S. interests in Somalia and in the Horn of Africa region are to promote and support regional stability and representative government, to eliminate any platform for al-Qaida or other terrorist operations, to provide humanitarian assistance in the wake of drought, flooding, and 16 years of near-constant conflict in southern and central Somalia, and to work with governments in the region to transform the countries through investing in people and good governance and promoting economic growth.
For the first time in 16 years, Somalis face the prospect of rebuilding their nation. We have a real opportunity to help Somalis restore effective governance that is representative of the full spectrum of Somali society. We are pursuing a strategy to help establish stability, move forward with a process of inclusive dialogue and reconciliation, and begin reconstruction within Somalia. Under my leadership, there is a growing interagency team working together to advance our policy objectives in Somalia.
DECISIVE MOMENTS
A lot has happened since I last appeared before this Subcommittee in July 2006. At the time, the United States was encouraged by the June 22, 2006 agreement between the Somalia Transitional Federal Institutions (TFIs) and the then-Union of Islamic Courts. The United States supported this agreement, which came to be known as the Khartoum Declaration, including the points of mutual recognition and cessation of hostilities. While negotiations initially offered great promise, by late July the actions of the Islamic courts were beginning to run counter to the spirit and the reality of dialogue. Immediately after the Khartoum Declaration, the Union of Islamic Courts was re-named the Council of Islamic Courts (CIC) and Hassan Dahir Aweys, designated by both the United States and the United Nations as a terrorist, was elected to be the Chairman of the CIC Consultative Council. On July 19, 2006, the CIC attempted to provoke Ethiopia into a broader conflict by advancing towards the interim capital of Baidoa. During the following months, extremist elements within the CIC - particularly the radical al Shabaab organization - hijacked the broader Courts movement, driving the CIC towards an agenda of military expansion and aggression. Despite international efforts to encourage dialogue between the CIC and the TFIs, the CIC chose to repeatedly violate the terms of the Khartoum Declaration through the takeover of Kismaayo, the September 18, 2006 terrorist bombing attack on the Parliament building in Baidoa, and military build-ups around Baidoa and Puntland.
These were decisive moments. Ultimately, the CIC miscalculated in its decision to pursue a military agenda and to refuse to join the governance process and the TFIs through peaceful dialogue. When the Transitional Federal Government (TFG) and Ethiopia launched a counter-offensive against the CIC in December, the CIC structure disappeared faster than anyone had anticipated. However, they were also weakened immensely by the withdrawal of support from the Somali population. The extremists within the CIC very clearly did not reflect the will of Somalis, as represented by civil society and their government.
A HOPEFUL MOMENT IN TIME
Following these developments, Secretary of State Condoleezza Rice sent me back to the region to conduct regional diplomatic efforts. My trip included visits to Djibouti, Ethiopia, Kenya, and Yemen in support of broader efforts to achieve lasting stability in Somalia.
The most striking lesson I took away from my early January trip to the region is this: Somalis are ready. Somalis are ready for peace; they are tired of war. While the TFIs are not yet ready to stand entirely on their own without international support, they offer a promising vehicle forward for Somalia. While developments on the ground have maintained a frenetic pace, there are many reasons to be hopeful.
In an effort to make the most of this moment of opportunity, we have engaged in conversations and negotiations with Somalia's various stakeholders and regional governments. This approach is in keeping with Secretary Rice's Transformational Diplomacy approach. I have met with my counterparts in African countries and regional organizations, and I have been seeking the advice and counsel of African officials and diplomats to resolve this situation.
During my trip at the turn of the year, I participated in a series of high-level diplomatic meetings, conveying the United States Government's position on various issues. I spoke with President Museveni of Uganda and representatives of the African Union in Ethiopia. I also met with the leadership of the TFIs, including President Abdullahi Yusuf, Prime Minister Ali Mohamed Ghedi, and former Parliament Speaker Shariff Hassan Sheikh Adan, and representatives of Somali civil society.
On January fifth, Kenyan Foreign Minister Raphael Tuju, Norway's Deputy Foreign Minister Raymond Johansen, and I co-chaired a meeting of the International Contact Group on Somalia. This gathering demonstrated the depth of the international community's commitment to supporting a sustainable political solution in Somalia through broad-based national dialogue and providing appropriate development, security, and humanitarian assistance.
The Contact Group issued a communiqué at the meeting's end that recognized the historic opportunity now within the grasp of the Somali people, as they seek a sustainable political solution based on the framework of the Transitional Federal Charter. Further, the Contact Group affirmed the importance of inclusive governance and additionally emphasized that funding to facilitate the deployment of a stabilization force in Somalia, based on UN Security Council Resolution 1725, remains urgent. This communiqué and the other sentiments expressed by members of the Contact Group that day demonstrate the unity and common priorities of the international community on Somalia. These themes continued during my consultations and bilateral meetings on the margins of the January 29-30 African Union Summit in Eth