Cholera outbreak in Somalia's Galgaduud region
In March and April 2007 heavy fighting in Mogadishu resulted in a large number of civilian casualties and thousands of people fleeing the capital. The violence has prevented many people from accessing health facilities. In Afgooye, a team of senior MSF Somali staff have supplied medicines to existing health structures and non-food items to more than 3,500 families, including 7,000 pieces of plastic sheeting. MSF is providing 72,000 litres of clean water every day to the IDPs through water trucking distributions. In the two health structures that MSF is supporting around 1,700 cases of watery diarrhoea have been reported, including 33 fatalities. MSF has set up isolation units in both structures
On April 26, MSF chartered a plane containing 2,000 litres of ringer lactate for treating cholera, chlorination kits, emergency kits for 10,000 people (for a three month period, or 30,000 people for one month), 1,000 mosquito nets and other logistical materials. On May 4, another 14 tonnes of medical and logistical materials were sent.
MSF has been operating a primary health care clinic in the Yaqshid area of Mogadishu since 1994. It stands as one of the few public health facilities in northern Mogadishu, thus absorbing many patients from the neighbouring districts, with a number of consultations far beyond what a single facility can absorb. In 2006, the MSF clinic provided 114,000 out-patient and 4,800 maternal care consultations.
In March and April 2007 heavy fighting in Mogadishu resulted in a large number of civilian casualties and thousands of people fleeing the capital. The violence has prevented many people from accessing health facilities. MSF teams have opened a cholera treatment centre in Forlanini, south Yaqshid, and have so far treated over 1,300 patients. This is more than double the numbers treated in previous cholera outbreaks in the capital.
On April 20, a mortar hit the MSF out-patient clinic in Yaqshid. As it was a Friday the clinic was closed and fortunately no-one was hurt. MSF staff spent a day reorganizing the clinic and it is now open and running as normal. MSF is extremely concerned about this incident and calls on all parties engaged in the fighting to respect humanitarian facilities and workers.
MIDDLE SHABELLE REGION
In Al Ma'an watery diarrhoea cases were reported and the team is planning to set up a cholera treatment centre. In Mahaday, MSF runs six primary health care out-patient clinics, which offer mother and child services and expanded programs of immunizations (EPI) through 3 mobile teams. Most of the target population is rural, some of them from the Bantu minority. MSF provided 108,000 out-patient consultations in 2006. In February 2007, MSF opened a maternity ward in Jowhar, with 60 deliveries and 10 caesarean sections in the first month of operations.
MSF estimates that there are around 40,000 IDPs in Jowhar. The majority of them are living with families. MSF is providing water and distributing non-food items to around 1,500 IDPs who are not staying with host families. MSF also conducted a measles vaccination campaign targeting 700 children.
After doing assessments, MSF started mobile clinics and non-food items distributions on April 30 in Balad, two hours from Jowhar on the road to Mogadishu, and Al Ma'an, a small port location north of Mogadishu, where there are around 30,000 and 7,500 IDPs respectively. In Al Ma'an watery diarrhoea cases were reported and the team is planning to set up a cholera treatment centre.
Since the start of the latest fighting in Mogadishu, MSF has been assisting new waves of internally displaced people (IDPs) in several locations throughout the country, providing water and basic necessities and setting up cholera treatment centres. MSF is also conducting assessments in several locations to respond to the ongoing deterioration of the humanitarian situation in Somalia.
MSF has worked continuously in southern and central Somalia for over 16 years and is currently providing medical care in nine regions - Bakool, Bay, Galgadud, Hiraan, Lower Juba, Middle Juba, Mudug, Middle Shabelle and Lower Shabelle. Today we have around 60 international staff and over 800 national staff working in Somalia.
In 2006, we performed more than 300,000 out-patient consultations, and 10,000 in-patients were admitted in our hospitals.
MSF operations in Somalia
BAKOOL REGION
Opened in 2000, the 240-bed Huddur health centre, the largest structure of its kind in southern and central Somalia, provides a wide range of medical services through both out-patient and in-patient services: therapeutic feeding, kala azar treatment, mother and child healthcare and tuberculosis (TB) treatment.
MSF also runs four health posts in the Bakool region, in Labatan Jerow, El Garas, El Berde and Rabdurreh. The health posts provide primary health care and refer patients to the health centre in Huddur when needed. The health posts in Rabdurreh and El Berde offer decentralized tuberculosis treatment.
An ambulatory feeding programme is also in operation. Eight expatriate staff and 125 local staff ran the MSF Bakool project in 2006. The target population is the approximately 250,000 people living in Somalia's Bakool region, with some patients coming from outside Bakool.
BAY REGION
In Dinsor, MSF runs a hospital providing, on average, 4,000 consultations per month in the out-patient department. Sometimes as many as 5,500 consultations are done. Some 25 percent of consultations are for children under five. The 85-bed in-patient department admits around 450 people per month.
MSF teams in Dinsor provide therapeutic feeding, surgical care, and TB treatment. They also respond to disease outbreaks and emergencies. A laboratory has been open since March 2005 and an antenatal clinic since February 2005. Between February and September 2006 the project offered ambulatory care, but this had to be stopped for security reasons.
A significant increase of cholera cases has been recorded over the last few weeks. MSF has set up a cholera treatment centre in Dinsor and has begun water sanitation activities. So far, there have been 450 suspected cases admitted and more cases have been reported in the area.
GALGADUD REGION
Since January 2006, MSF has been supporting the 80-bed Istarlin Hospital in Guri El town, approximately 450 kilometres north-west of the capital Mogadishu. Over 100 out-patient consultations are done per day and 40 to 70 life-saving surgeries performed per month. In recent weeks, consultations in the out-patient department have increased by around 40 percent, with a large proportion of patients arriving from Mogadishu. In Gal Hareeri, MSF opened a temporary emergency cholera treatment centre between March 21 and April 17, providing treatment to over 500 patients.
MSF also operates an out-patient clinic in Dhusa Mareb, the district capital of Galgaduud, which provides primary health care. Referrals are made to Guri El as needed.
HIRAAN REGION
According to an exploratory mission to the outskirts of town conducted on April 20, an estimated 360 families were found living in critical conditions with no access to water and a complete lack of shelter. MSF opened a hospital programme in Belet Wayne on February 17, 2006, with a focus on surgical care. In March 2007, the team screened 324 patients, carried out 51 major surgical interventions, and admitted 40 patients for minor surgery. The hospital is being renovated and MSF plans to open a paediatric ward, medical ward and provide maternity care by the end of May 2007.
In Belet Wayne, the majority of IDPs fleeing violence from Mogadishu have so far been accommodated by relatives in town. According to an exploratory mission to the outskirts of town conducted on April 20, an estimated 360 families were found living in critical conditions with no access to water and a complete lack of shelter. MSF teams have distributed plastic sheeting and soap to these families, and have started water and sanitation activities such as digging latrines.
LOWER JUBA REGION
In Jamaame, MSF opened a small hospital with a large nutritional component and outreach activities on March 13, 2007. In the first two weeks of activities, 120 people received treatment in the nutritional programme. Four mobile clinics comprised of three national staff and two international staff screen between 300 and 1,000 children and pregnant women per day for malnutrition. They also do general consultations with out-patient treatment and referrals where necessary.
The project currently has 200 children receiving supplementary feeding and does around 500 consultations a week, including mobile clinics. There are around 15-20 in-patient admissions a week and the main morbidities are malnutrition, pneumonia and diarrhoea. The teams also provide medical care for a number of gunshot wound victims, accident victims and women with complicated deliveries every week.
In early April, MSF set up a cholera treatment centre admitting 40 patients in two weeks. An estimated 1,000 IDPS arrived in Jamaame from Mogadishu during April.
MIDDLE JUBA
The team has the capacity to respond to outbreaks such as cholera, meningitis and measles. Treatment and support for victims of sexual violence is also available. With seven international and 100 Somali staff, MSF is offering primary health care, with in- and out-patient services to over 3,500 patients every month. In both Marere and the nearby village of Jilib, MSF is operating a nutritional programme with therapeutic and supplementary feeding centres. In 2006, the supplementary feeding centre treated over 2,800 children and the therapeutic feeding centre 920. The team has the capacity to respond to outbreaks such as cholera, meningitis and measles. Treatment and support for victims of sexual violence is also available.
The Marere project, as others, suffers from regular short-term evacuations of international staff due to ongoing insecurity. The capacity of the Somali staff to continue activities in their absence has been well developed, and the projects have experienced no major disruptions.
On Friday April 27, the team was forced to evacuate due to insecurity and mounting tension in Jilib.
MUDUG REGION
In recent weeks cholera cases have been reported in Galcayo. MSF has set up a cholera treatment unit in the paediatric ward of the hospital. As of May 6, MSF staff had treated 91 patients. In south Galcayo hospital MSF is currently running one of the few surgical programmes in central and south Somalia. For emergency obstetric cases and the many wounded from violence, surgical care is a life saving action and each year the hospital treats over 500 victims of violent trauma.
MSF medical teams are also prepared to respond to larger clashes in the wider area around Galcayo.
MSF teams offer in- and out-patient services, paediatric and maternal care, treating over 3,500 patients on average each month. The team has the capacity to respond to outbreaks such as cholera, measles or meningitis. There are 120 Somali staff and nine international staff work in the project. In south Galcayo, MSF also operated a therapeutic feeding centre, admitting over 50 malnourished children each month.
In both south and north Galcayo, MSF runs tuberculosis (TB) treatment centres and currently has between 250 and 300 patients on treatment. Galcayo is divided in two along a north-south "green line", each zone controlled by different clans. Civilians, particularly men, have difficulty crossing this green line. MSF was supporting a hospital on either side of the line, targeting a population of 600,000, but following problems with the authorities in Puntland, the project in the north was closed in June 2006.
In recent weeks cholera cases have been reported in Galcayo. MSF has set up a cholera treatment unit in the paediatric ward of the hospital. As of May 6, MSF staff had treated 91 patients.