Somalia, in East Africa, is among the least developed nations listed in the 2012 Human Development Index. Although it came out of anarchy and civil war in 1990, its state of health is still poor. The country recently adopted a federal system, but the federal institutions or states did not formulate a good health policy. Worse, Somalia has been facing a continuing drought since 2011, putting the health of vulnerable groups like women and children at risk.
Somalia has a high fertility rateÐeach woman has 6.6 children on an average. This is accompanied with high maternal and child mortality. Neonatal deaths, which happen in the first 28 days of life, are the third highest in the world.
Most deaths are caused by easily treatable illnesses like pneumonia, diarrhoea and measles. With the low rate of immunisation, the incidence of diarrhoea in children under five has remained at 24 per cent for decades. In 2014, the estimated immunisation coverage for measles and Diphtheria Pertussis Tetanus (DPT3) was well under 50 per cent. Pneumonia, which can easily be treated with antibiotics, kills more than two children every hour in Somalia. A 2017 report by non-profit Save the Children says 24 per cent of all under-five mortality is due to pneumonia.
Undernutrition is, however, the underlying cause of most deaths. More than 300,000 children under the age of five are acutely malnourished. According to the Somali Media for Environment, Science, Health and Agriculture (SOMESHA) and Monitoring and Evaluation Department for Social Affairs (MEDSA), children suffering from acute malnutrition are nine times more likely to die of disease than a well-nourished child.
Somalia’s drought has led to severe malnutrition in children. More than 30 per cent of the under-five children are stunted. Over the last 15 years, the number of stunted children has increased from 50.4 million to 58.5 million. Up to half of all deaths in the under-fives are associated with under-nutrition. These have to be treated with life-saving therapeutic food at nutrition centres run across Somalia by the United Nations agencies, NGOs and INGOs.
Three quarters of the children below two years are anaemic as their mothers know little about nutrition. Less than one in 10 infants are exclusively breastfed up to the age of six months. They get tea or sugar water with breast, formula or animal milk. Only one in 10 children at the age of one gets the correct combination of breast milk and solid foods recommended by WHO/UNICEF.
With poor health facilities in the country, it seems impossible that Somalia will reach the Sustainable Development Goal 3 (SDG3) target for child health (see `SDG: A far fetched dream’,). SDG3 sets 2030 as the year for Somalia to end preventable deaths of newborns and children under five years of age, and reduce NMR to at least 12 deaths per 1,000 live births and under-five mortality to 25 deaths per 1,000 live births. Somalia is completely off track to reach the Millennium Development Goals (MDGs). Abdiqani Sheikh Omar Hassan, former Director General of the Ministry of Health and founder of the Somali Young Doctors Association, says, “During my tenure, the aim was to achieve universal health coverage, and provide safe and affordable medicines and vaccines to all. But due to lack of funds, prolonged conflict and civil insecurity, Somalia will not be able to implement the SDGs.” The federal Ministry of Health has formulated a plan to reduce maternal and child mortalities through improved access to essential health services, and prevention and control of communicable and non-communicable diseases. But, Hassan warns, the plan’s implementation depends on the occurrence of droughts, cooperation between the states health ministry officials, nation’s security and political stability.
(This article was first published in the 1-15th December issue of Down To Earth under the headline ‘Mothers’ struggle’. It is part of a series on healthcare in Africa. See links below)….Continue reading by Mr. Daud Abdi Daud
SOMESHA, Secretary General