Humanitarian Health Challenges in Somalia Saving lives and

Humanitarian Health Challenges in Somalia: Saving lives and reducing vulnerabilities Emergency Preparedness and Humanitarian Action WHO Regional Office for the Eastern Mediterranean Health Challenges in Somalia: 1 | Humanitarian Saving lives and reducing vulnerabilities

Context l More than 15 years of conflict and insecurity l South Central Zone worst off over 2 million people (> 450, 000 IDPs) in chronic need of relief and assistance l Dilapidated health systems – – – Unskilled work force Old or destroyed infrastructure Nonexistent governing structures and regulatory capacities Limited access Unchecked private sector Health Challenges in Somalia: 2 | Humanitarian Saving lives and reducing vulnerabilities

Health Issues l Chronic food insecurity - malnutrition rates over 25% in some areas l Prevalent infectious and communicable diseases - diarrhea, malaria, measles, ARI, Meningitis l Non-existent or very weak surveillance system l Low immunization coverage - re-surgence of polio cases l Difficult access to primary health care - nomadic population l Limited access and availability of safe water and sanitation services Health Challenges in Somalia: 3 | Humanitarian Saving lives and reducing vulnerabilities

Acute episodes: Drought Nov ’ 05 – April ‘ 06 l Worst drought in the Horn of Africa in a decade – more than 11 million people affected l Drought affected pastoral and agricultural communities, an estimated 1 million people in South Central Somalia l A regional problem: a cross-border issue (population and live stock movement) l Inequity of response on different sides of the border (pull-factors) l Increased competition for resources between crises in the region but also internationally. Health Challenges in Somalia: 4 | Humanitarian Saving lives and reducing vulnerabilities

Somalia cross border food security situation analysis Jan-Jun 2006 Health Challenges in Somalia: 5 | Humanitarian Saving lives and reducing vulnerabilities

Floods in South Central Somalia July ‘ 06 – Jan ’ 07 l Over 500, 000 people affected l Contamination of water sources l Acute Watery Diarrhea, Malaria, Acute Respiratory Infections l Vector-borne: Malaria and Rift Valley Fever Health Challenges in Somalia: 6 | Humanitarian Saving lives and reducing vulnerabilities

Map Somalia: Flood Hazard Distribution Map Health Challenges in Somalia: 7 | Humanitarian Saving lives and reducing vulnerabilities

Rift Valley Fever – Dec ’ 06 – Jan ‘ 07 l Hundreds of deaths in livestock l 103 suspected human cases; over 50 reported deaths l On-going conflict between TFG and UIC complicating surveillance and outbreak response Health Challenges in Somalia: 8 | Humanitarian Saving lives and reducing vulnerabilities

Somalia: Human RVF cases in Lower Juba Suspected cases reported from Afmadow & Kismayo Districts (close to Kenyan border) Health Challenges in Somalia: 9 | Humanitarian Saving lives and reducing vulnerabilities

Acute Watery Diarrhea Feb ’ 07 – to date l Mainly South Central affected l Over 12, 000 cases with over 400 deaths l Outbreak ongoing l Affected population moving out of Mogadishu to the periphery to evade conflict l Health care and monitoring capacities already very limited and overstretched Picture: Cholera Treatment Centre in Safarloyle, Somalia Health Challenges in Somalia: 10 | Humanitarian Saving lives and reducing vulnerabilities

WHO Response l Emergency supplies l Strengthening and facilitation of coordination l Disease surveillance and outbreak response l Provision of outreach essential health services l Immunization coverage l Water and Sanitation l Technical support to zonal/district authorities l Health education l Training of health staff Health Challenges in Somalia: 11 | Humanitarian Saving lives and reducing vulnerabilities

Challenges l Cross-border issues l Non-existent and/or changing counterparts l Pastoralism misunderstood l Inadequate local leadership l Limited preparedness plans and capacities l Extremely limited human resources l Insecurity and access l Funding constraints l Donor fatigue Health Challenges in Somalia: 12 | Humanitarian Saving lives and reducing vulnerabilities

ICT Challenges l Non-existent regulatory structures l Unreliable national/zonal networks l High logistical and operational costs l Virtual trouble shooting l Looting/confiscating of equipment and vehicles by factions (Polio equipment in January’ 07) Health Challenges in Somalia: 13 | Humanitarian Saving lives and reducing vulnerabilities

Lessons Learned l Effective early warning does not always translate into timely or adequate response in slow-onset (drought) disaster/s l Investment in national capacity l As emergency continues, enhance understanding of, invest and strengthen pastoralist livelihood systems Health Challenges in Somalia: 14 | Humanitarian Saving lives and reducing vulnerabilities