Primary health care visits and vaccination coverage have sharply declined in Somalia amidst the COVID-19 pandemic, raising concerns that diseases such as respiratory infections, measles, and acute watery diarrhea (AWD) as well as malnutrition could be going untreated, all while floods have forced tens of thousands of people from their homes. The International Committee of the Red Cross (ICRC) has documented seven times more cases of suspected AWD than possible COVID-19 cases in the last two months, underscoring what is at-risk if seasonal disease outbreaks are neglected.
“The fight against COVID-19 has put an additional strain on health care resources and is stretching our ability to respond to multiple health threats at the same time,” said Ana Maria Guzman, the health coordinator for the ICRC in Somalia. “We are also seeing a decline in clinic visits during the pandemic, which is deeply worrying in that preventable deaths from diseases such as malaria or complications in child birth could claim more lives than COVID-19 itself.”
Health care visits to Somali Red Crescent clinics by children under five and pregnant women dropped by more than 50 percent from approximately 181,000 medical consultations in the first seven months of 2019 to nearly 83,000 in the same period this year. Vaccination coverage for children against diphtheria, hepatitis B, tetanus and whooping cough declined from 77 percent in 2019 to 56 percent in June 2020, according to the World Health Organization.
At the same time, a community-based disease surveillance tool launched by the ICRC and Somali Red Crescent in June has detected seven times more suspected cases of AWD than COVID-19. Of the more than 65,000 visits, the team has recorded 161 cases of suspected COVID-19 versus more than 1,100 suspected cases of AWD. Twenty-five cases of suspected measles were also documented in the Kismayo area.
“What we have already seen in our community-based surveillance tool is what is at stake if we focus all of our resources on fighting COVID-19 and neglect seasonal disease outbreaks like AWD and vaccination campaigns against measles and other preventable illnesses,” said Guzman.
This year, seasonal Hagaa rains have been heavier than average, triggering widespread flooding and destruction of homes and crops. Between May and July 2020, more than 190,000 people in the riverine areas have been affected by floods, while more than 650,000 people have been forced to leave their homes due to floods since the beginning of the year. Safe drinking water and food are both limited, putting families at-risk of malnutrition and waterborne disease.
“The floods have forced people into displacement camps where they have little to no clean water, sanitation, or food,” said Habiba Ahmed, a Somali Red Crescent nurse who works in a clinic in Balcad. “We are seeing AWD cases rise, with most patients coming from villages on the outskirts of Balcad in Middle Shabelle who have had to walk long distances to reach our clinic.”
- Cases of AWD are rising in South West State, Banadir, Jubaland and Galmadug even as rains gradually diminished. The outbreak is fueled by limited access to safe drinking water, poor sanitation, and population displacement because of floods. More cases of AWD are being reported in children under five years old, who are particularly vulnerable to disease, especially if their immune systems are compromised by malnutrition.
- Many communities suffering from AWD outbreaks are on the outskirts of towns where health care facilities are located. This often means that they must travel long distances to seek care.
- The heavier-than-normal rains have forced hundreds of thousands of people from their homes and destroyed property and crops. Jowhar was one of the most affected areas, where flooding hit more than 20 villages and forced families to seek refuge in a makeshift displacement camp at the town’s airport.
- Across the country, the Somali Red Crescent and ICRC are seeing an alarming decline in health care visits among children and pregnant women during the COVID-19 pandemic, a worrying trend that could lead to lives being lost to preventable and treatable issues such as malaria, diarrhea, and malnutrition or complications in childbirth.
- In June 2020, the Somali Red Crescent and ICRC set up a community-based disease surveillance mechanism in which about 100 volunteers across the country visit households and report in real time what health risks they observe. Since June 22, more than 65,000 households have been surveyed, with 161 suspected cases of COVID-19, more than 1,100 cases of suspected AWD, and 25 suspected cases of measles (only monitored in Kismayo) reported.
- The suspected AWD caseload recorded by the community-based disease surveillance system far exceeds the emergency threshold of 60 suspected AWD cases, prompting the ICRC and the Ministry of Health to respond.
- The ICRC provided oral rehydration salts and zinc tablets to SRCS clinics to help with the treatment of AWD. To stop the spread of AWD, handwashing stations were set up around the clinics and more than 100,000 bars of soap handed out. The clinics also received chlorine so that they can follow infection prevention control measures.
- Nearly 5,000 people attended health promotion sessions on AWD prevention, while information was broadcasted on 11 radio stations country-wide and SMS messages with AWD prevention information were sent to more than 58,000 people.
- Since January 2020, nearly 260,000 people have received primary health care services in SRCS clinics in the central and southern part of Somalia, including 12,700 children under five years old and 4,300 pregnant and breastfeeding women received treatment for malnutrition.
- The Somali Red Crescent and ICRC provided more than 94,000 sandbags to communities to help them protect their property and crops against floodwaters.
Patients at the waiting area of a clinic run by the Somali Red Crescent, April 2020 (Credit: Ismail Taxta/ICRC)