The Foreign, Commonwealth and Development Office supports COVID-19 response in Somalia

28 June 2021 – Hawa Ibrahim Ali recalls being taken aback when she first heard about the coronavirus disease (COVID-19) in 2020. As a district medical officer for the Federal Ministry of Health and Human Services, and a hospital manager whose job it is to oversee 13 health facilities in 3 of Benadir’s districts, Hawa was worried about how Somalia, her country, would cope with a disease that was defeating the world’s best developed health systems one by one.

However, she was pleased to see the support that poured in for Somalis to take on this contagious virus. One key donor was the Foreign, Commonwealth and Development Office (FCDO). Early in the COVID-19 outbreak, the World Health Organization (WHO) invited Hawa, along with many others, to participate in training supported by the FCDO on the Early Warning and Response Network (EWARN), a surveillance system that collects information on epidemic-prone diseases with the aim of triggering prompt public health intervention. This sort of capacity-building was definitely something health personnel needed, she thought at the time.

Hawa Iibrahim Ali checks information from the EWARN system. Credit: WHO Somalia/I Taxta

COVID-19 added into the EWARN system

During her training, Hawa noted that in immediate steps to collect information on COVID-19, WHO had integrated a module on COVID-19 into the EWARN system that Somalia uses. This meant that from then on, health facilities were required to report details of anyone who presented with COVID-19 symptoms.

At the training session, participants representing local health facilities were given the COVID-19 case definition and a hotline to call in the event that an emergency case arrived at any of the health facilities.

Concurrently, in an effort to expand the geographical coverage and outreach of EWARN, with FCDO support, WHO added 31 new health facilities to the EWARN network in the Benadir region. Within the first year of this addition, from May 2020 to May 2021, Somalia’s EWARN system had received more than 113 alerts and reported COVID-19 cases to the EWARN system. By early 2021, 85 health facilities were actively searching for COVID-19 symptoms in Benadir.

“None of this would have happened without the support of the donors and WHO,” said Hawa. “We are very grateful for the support Somalia has received during these tough times, and hope our partnerships get stronger to help more Somalis in the field of health.”

EWARN reporting rate and case detection has dramatically increased

Credit: WHO Somalia/I Taxta

The 3-day training conducted for health workers focused on 3 pillars – detecting, verifying and responding to diseases. As a result of the routine EWARN training that was conducted, and the expansion of the EWARN network, with FCDO support, the EWARN reporting rate and case detection of COVID-19 cases dramatically increased from 57% to 79% from April 2020 to May 2021.

To address the COVID-19 outbreak in Somalia, a chain of activities was being conducted concurrently. While the COVID-19 alerts were being detected and verified, samples were being shipped from all districts to laboratories for testing. Additionally, health personnel were being empowered to search for diseases and in contact tracing and management. Overall, 48 nongovernmental organizations running 83 health facilities were trained in Benadir.

Rapid response teams collect and facilitate testing of COVID-19 samples

Of the 113 alerts made, Somalia worked on a verification process for samples from 47 suspected cases as they did not meet the COVID-19 case definition. With the support of WHO, the FCDO and Federal Ministry of Health, through well-trained district polio officers and district medical officers, district rapid response and district medical personnel collected samples from patients and shipped them to the National Public Health Referral Laboratory, where 15 of the 47 samples (32%) turned out to be positive.

Meanwhile, with support from WHO, district polio and medical officers and community surveillance teams began to roll out extensive training for health workers in health facilities and hospitals on contact tracing and monitoring and following up on positive cases of COVID-19. Additionally, WHO conducted training for health care workers on the case definition of COVID-19, and how to fill in case investigation forms.

Credit: WHO Somalia/I Taxta

Training rapid response teams

During 2 training sessions in March and April 2020, 97 members of rapid response teams were further equipped and trained in the use of various electronic means of data collection, including the open data kit data collection method. Almost one third of these trainees were women.

“This training enabled us to reach more than 176 households with 880 individuals in 2 months, to collect information,” said Hawa.

“We detected – with the support of WHO and the FCDO – 131 contacts of COVID-19 cases,” adds Hawa. “Of this total, 43 turned out to be positive and 88 completed the 14-day follow-up period, a process that helps to monitor patients and their contacts.”

Describing the process, district polio officer Ruqiya Mohamud Hirape from Benadir’s Waberi district adds, “We have rapid response teams at community, district and state levels. They connect us all to communities.”

Helping communities overcome COVID-19

Forty-five-year-old Amina Hassan visited Hawa Ali one day, along with her 6 children and the rest of the family.

“I was so surprised – one day, a lady named Amina came with her husband, children and the grandparents to thank us and everyone who provided any support to this project. She was just so happy to have her husband safe and well at home after he fell ill, and to be able to start her life again with the family united,” said Hawa.

With the training that supported Hawa and her colleagues to identify quickly and address serious COVID-19 symptoms, communities have been receiving timely attention to avert severe effects of COVID-19.

“I am 45 years old and my main role is to stay at home and look after my babies and my husband, Ahmed Hassan. Ahmed is the only breadwinner for us all. When he was confirmed as positive for COVID-19, I was shocked and afraid, and thought of death. The district medical officer and polio officer helped us understand why and how Ahmed needed to isolate and how I could look after him. Also, I cannot forget the way you reassured me spiritually, Hawa, which gave me confidence at a very difficult moment for me and my family,” said Amina.

“You called me consistently for 2 weeks, every day, to check on Ahmed’s temperature and took down information regularly on phone,” Amina continued. “Thank you all. And continue the good work you are doing for the community and Somalia at large. We will never forget you.”

During the period of support, 35 health facilities were added to the existing EWARN in Benadir, bringing the total to 689 health facilities across Somalia.

As a result of this expansion, 49 additional districts have rapid response teams that are trained, equipped and ready to undertake verification and field investigations.

To celebrate International Nurses’ Day, marked around the world on Florence Nightingale’s birthday on 12 May, and International Midwives’ Day, which falls on 7 May, the World Health Organization (WHO) in Somalia is acknowledging the remarkable contribution of nurses and midwives in the country.

WHO spoke to 2 experts to hear about their experiences.

Omar Mohamed Abdi, a trained nurse by profession, also serves as the Head Anaesthetist at the Bosasso General Hospital. As part of his work, he prepares patients for surgery and teaches students anaesthesiology.

As a child, Omar wanted to join the health sector. He feels this was probably as, back then, many children didn’t know much about other careers. He just wanted to work hard like his father, a labourer who paints homes, and his mother, who worked at a livestock market. But most of all, Omar wanted to help his community and do as much as he could for them.

Nurses need advocates

In the last 4 years at work though, Omar was surprised to learn how tough life can be for nurses. Very few people actually value the contribution of nurses, he says.

“Being a nurse is a noble profession – nurses are a bridge between a doctor and a patient,” says Omar, “but unfortunately, nurses are yet to receive the respect they deserve in the society. Generally, managers expect nurses to do odd jobs, switch their duties abruptly from one ward to another and, on some occasions, discharge nurses very easily, which is difficult for their careers.”

Omar explains that life would be better for nurses if they had an association that could band them together and advocate for their basic rights. Without an association, it is hard to keep track of whether or not one is truly qualified as a nurse. On some occasions, people pretending to be nurses have actually neglected patients and caused them more damage, adds Omar, which gives nurses a bad reputation.

Nurses work really hard, are underpaid in Somalia, and hardly get opportunities to train and advance their skills, as not many people value them, adds Omar. He feels he was one of the lucky ones as, in January, he had the chance to participate in a training course in basic emergency care, organized by WHO. Jointly developed by WHO and the International Committee of the Red Cross (ICRC), endorsed by the International Federation for Emergency Medicine (IFEM), and certified and facilitated by the African Federation for Emergency Medicine (AFEM), this course was designed for frontline health care providers who manage acute life-threatening conditions with limited resources. However, nurses need more training like this, he adds.

Beaming with this news, 26-year-old Omar announces he has teamed up with some of his colleagues to change the status quo. They have created a nurses’ association in Puntland State of Somalia, but need a lot of support from policy-makers and international and national organizations to be effective. For now, Omar hopes that in line with this year’s theme for International Nurses’ Day, the next generation of nurses becomes a voice to lead and a vision for future health care. 

Strong-spirited midwives and nurses need updated, standard curricula

“To be a nurse and midwife means to be of service no matter what the circumstances are. However, people forget that nurses and midwives are not just health workers – they are mothers, sisters and leaders in their communities, who need support,” says WHO’s Reproductive Health and Nursing and Midwifery Programme Officer based in Somaliland, Asia Osman Ahmed, fondly known as ‘Mama Asia’.

Mama Asia has been training midwives in Somaliland since 1996, but she emphasizes she feels like that is just a drop in the ocean. There is a need to keep training and overseeing the work of midwives, she says, and to update their curricula, so that every midwife knows exactly what she/he is doing when a mother seeks their support.

With limited resources, work has already been tough for Somali midwives, but the coronavirus disease (COVID-19) outbreak has made it even more challenging. Nurses and midwives continue to be on the front lines, trying to dodge the COVID-19 disease daily, and yet with limited personal protective equipment, they go out every day to provide essential health services. 

When discussing the challenges that Somali women face, Mama Asia’s eyes well up. In the last week, Mama Asia witnessed yet another set of unbearable incidents. Young Deqo,* who had undergone female genital mutilation (FGM) as a child waited desperately at a health facility for help, as a traditional midwife who tried to open up Deqo’s stitches so that her husband could enjoy being intimate with her had cut up part of her rectum somehow and given her second degree tears.

During her visits to mother and child health clinics, Mama Asia also came across Zahra,* who had just delivered a healthy baby boy. She watched in dismay as Zahra’s mother-in-law shamed her publicly for not being circumcised. In fact, she even named her grandchild ‘Ina Baro’, which means ‘child of one who is not circumcised.’ Mama Asia was happy to see Zahra stand strong and refuse to be circumcised after the delivery, despite the pressure her husband’s family put her through. 

“WHO is going to develop the capacity of Somali midwives so they can stop the cultural practice of FGM in communities, and encourage facility-based births,” said Dr Al-Umra Umar, WHO’s Team Lead for Reproductive, Maternal, Neonatal, Child and Adolescent Health. “WHO will work with the Government to link community midwives to qualified midwives, who have been trained by partners such as the United Nations Populations Fund.”

Three decades after Somalia’s civil war, the country is still grappling with limited skilled personnel. The Somali Health and Demographic Survey 2020 states that only around one third (32%) of births in Somalia are delivered with the assistance of skilled health personnel (a doctor or clinical officer, or a nurse, midwife or auxiliary midwife), and only 21% of women visit health facilities for child birth.

“Using skill-transfer projects like this, we can emphasize the importance of seeking health advice early in pregnancy, so childbirth is a safe experience for every mother, wherever she lives. At the same time, we will be expanding the knowledge of more people aspiring to be midwives and adding to the skilled health workforce,” adds Dr Al-Umra.  

Despite the challenges faced, in the last 2 decades, Somalia has made some progress – the maternal mortality ratio has reduced by 31%, from 1210 deaths per 100 000 live births in 2000 to 829 deaths per 100 000 live births in 2017 and the number of skilled birth attendants increased from 22% in 2010 to an estimated 29% in 2017. However, there is more work to be done to ensure every mother can access health care at all times, especially as the COVID-19 outbreak has further reduced health access in urban areas by around 42%, according to a vulnerability assessment study conducted by the Horn Population Research and Development, with support from the United Nations Children’s Fund (UNICEF).

*names changed to protect identity

MOGADISHU, 4 May 2021 – Vaccines protect us against preventable diseases, including COVID-19. They bring us closer to a healthier world and are permissible to be taken during the holy month of Ramadan – these are the main messages the Federal Ministry of Health and Human Services, World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) in Somalia are sharing this World Immunization Week, running from 24 to 30 April 2021. On this occasion, the Federal Ministry of Health, WHO and UNICEF are renewing their commitments to ensure that every child is counted for vaccination against vaccine-preventable diseases.

This year, World Immunization Week comes at a time when the country is conducting one of its largest, much needed vaccination campaigns, against COVID-19. Every year, during the last week of April, World Immunization Week is observed to encourage the use of vaccines to protect people of all ages against disease. The theme for this year is ‘vaccines bring us closer’ – to encourage greater global participation around immunization and to demonstrate to communities, politicians and other audiences that vaccines do indeed bring families, communities and countries closer together.

With support from the Federal and State Governments of Somalia, WHO, UNICEF and other agencies have been providing vaccines – while observing COVID-19 protocol since last year – to Somalis of all ages and backgrounds – against preventable diseases such as measles, pertussis, diphtheria, tetanus, hepatitis B, Haemophilus influenzae type b, cholera, tuberculosis, polio and now against COVID-19.

Since the resumption of mass vaccination campaigns, which had been paused due to the COVID-19 epidemic in 2020, Somali authorities, with support from WHO, UNICEF and other partners, have conducted 5 targeted campaigns and one nationwide campaign, where approximately 3 million children were offered vaccines to protect them from polio. In addition, 514 567 (83% of the target) and 450 983 (73% of the target) children aged under one year received pentavalent 1 and pentavalent 3 vaccines respectively. Overall, 433 863 (70% of the target) children aged under one year received their first doses of measles vaccines to protect them against this highly infectious disease.

“Smallpox's last resting place was in Somalia. But, thanks to concerted and collaborative efforts, we were able to eliminate the disease. Polio is on the verge of being eradicated. In reality, with the help of partners, Somalia's circulating poliovirus type 3 (cVDPV3) outbreak was successfully stopped this year, 28 months after it was reported, with no further international spread from our country. That should suffice to convince us that we can do it again. If we act now and together, we will stop the spread of all vaccine-preventable diseases,” said HE Dr Fawziya Abikar Nur, Minister of Health and Human Services, Federal Government of Somalia. “However, politicians, our foreign and national partners, societies, parents, women, youth, scholars, the private sector, nongovernmental organizations and donors all have a role to play. We should all play a role in ensuring that Somalis receive vaccines appropriate for their age groups. Since the rollout of the COVID-19 vaccine on 16 March 2021, and until 28 April 2021, 121 743 people in Somalia had received their first doses of the Oxford Astra-Zeneca vaccine to protect them from COVID-19. The uptake remains considerably low (at 40.6%) though. There is a need to increase the uptake of vaccinations, by health workers, frontline workers, elderly populations and people suffering from chronic illnesses, with the first batch of 300 000 vaccines – which arrived in the country on 15 March 2021.”       

“We are at a critical time, where we can save humanity from the COVID-19 pandemic, especially as we have tools like vaccines to protect people. In Somalia, we remain concerned that the current uptake of the vaccine is not optimal. The pandemic will not end if it doesn’t end in Somalia and other conflict-affected countries with very weak and fragile health systems,” said Dr Mamunur Malik, WHO Representative for Somalia.

Addressing people’s concerns regarding the uptake of the COVID-19 vaccine during Ramadan, Dr Malik explained, “I want to assure people that 2 fatwas have been issued by the Al-Azhar Al-Sharif and the International Islamic Fiqh Academy (IIFA), the co-chairs of the Islamic Advisory Group. The fatwas offer advice that it is permissible to take COVID-19 vaccinations, as this vaccine goes into the muscles, not bloodstream. We must share information with our loved ones and friends about the benefits of vaccination. In the last decade, at least 10 million deaths have been prevented by vaccines, and more lives have been saved by vaccines in the history of medicine. Vaccines are the most cost-effective health technology ever invested in, during the history of our civilization. We are responsible for our health and that of our children. We should support them in accessing vaccines for their age too. No one is safe until everyone is safe.”

Since March 2020, when the first case of COVID-19 pandemic was confirmed, this had an impact on all health programmes, including routine immunization. An estimated,186 000 children missed their first doses of the measles vaccine in 2020 and around half a million are missing out on polio vaccines, also due to limited access and insecurity. 

However, the Government, WHO, UNICEF and partners are working to ensure health facilities and personnel use all precautions possible while delivering services.

“The devastating COVID-19 pandemic has reminded the world how important and effective vaccines are,” said Mohamed Ayoya, UNICEF Somalia Representative. “Vaccines protect us from life-threatening diseases and safeguard our future health. It is critical that we accelerate COVID-19 vaccinations and scale up routine immunization especially for children in hard to reach areas. Reaching and protecting these children is a priority.”  

In last quarter of 2021, the Somali Federal Government, WHO and UNICEF and other partners have plans to introduce a second dose of inactivated polio vaccine (IPV) and measles vaccines as part of the routine immunization programme, now being extended to children older than one year of age. This will boost their immunity, particularly in the event they may have missed one dose of measles or polio vaccines when younger.    

For additional information, please contact:

Khadar Hussein
Coordination and Communication Office
Ministry of Health and Human Services
Federal Government of Somalia
هذا البريد محمى من المتطفلين. تحتاج إلى تشغيل الجافا سكريبت لمشاهدته.
+252 615 602 637

Fouzia Bano
Chief of Staff ai, Communications Officer
WHO Somalia
هذا البريد محمى من المتطفلين. تحتاج إلى تشغيل الجافا سكريبت لمشاهدته.
+252 619 235 880 

Dheepa Pandian
Communication Chief
UNICEF Somalia
هذا البريد محمى من المتطفلين. تحتاج إلى تشغيل الجافا سكريبت لمشاهدته.
+252 613 375 885

--------

Note to editors

A statement from the International Islamic Fiqh Academy (IIFA) covers both the permissibility of all COVID-19 vaccines and of using Zakat to procure and distribute the vaccine among poor countries/communities. It can be found here:

Arabic  | English | French 

A fatwa statement from the Al Azhar reaffirms the permissibility of getting vaccinated while fasting in Ramadan

Messages from the WHO Regional Office for the Eastern Mediterranean on Ramadan 2021, citing both fatwas, can be found here:  

English | Arabic 

To meet urgent, unmet needs, WHO Somalia donated 200 lifesaving, re-fillable oxygen cylinders to the De Martino Hospital

26 April 2021 - In the last year, while traders worldwide watched as commodities’ prices rose and crashed, one precious commodity that soared in demand and value is medical oxygen. As the Federal Ministry of Health and Human Service (FMoH)’s National Incident Manager for the coronavirus disease (COVID-19) response in Somalia, and Director of one of the busiest hospitals in Somalia – the De Martino Hospital – Dr Abdirizak Yusuf Ahmed knows the importance of medical oxygen. 

After being through a year of planning, preparing, coordinating and putting up a brave front against COVID-19, his worst nightmare came true during one long, bleak night. Somalia was facing its second wave of COVID-19, and on 2 March 2021, Dr Abdirizak and his team of doctors had to work tirelessly around the clock, struggling to keep infected patients alive. That evening, all 25 beds in the intensive care unit (ICU) were occupied, and 70 Somalis were in need of oxygen. This was at a time when the country was facing a more severe wave of the COVID-19 pandemic compared to the one in 2020, causing a more devastating and heavier toll on lives and people than had been seen in 2020.   

“We ran out of medical oxygen,” he says, remembering all the details. “At midnight, there were already many cases, but more and more sick people kept pouring in. Most of them needed supplemental oxygen therapy. We tried every method possible to give them oxygen. At some point, we were even using Ambu bags and masks.” 

He recalls how he worked hard to keep a 16-year-old boy who had another chronic problem alive, but it was a real struggle. They lost 8 people that night. But then, almost as though a miracle knocked at their hospital door, the very next day a team of 3 technical experts from WHO arrived at 2 pm with 200 oxygen cylinders and 50 medical oxygen regulators.  

Dr Abdirizak felt like someone had lifted a boulder off his shoulders. He was moved to see people, who had very little hope 12 hours before then, survive and leave the hospital to rush back to their loved ones. 

Lives lost due to lack of oxygen 

According to the Lancet, a press release issued by Wellcome Trust, Unitaid, and WHO, who have set up a COVID-19 Oxygen Emergency Taskforce, stated that more than half a million patients with COVID-19 in low- and middle- income countries need oxygen therapy every day and shortages are causing preventable deaths. This figure excludes the millions of patients, including newborn babies and children with pneumonia, malaria, and other ailments, who also require medical oxygen therapy each year.  

In February 2021, the De Martino Hospital recorded a total of 104 deaths and 163 admissions due to COVID-19. The COVID-19 Oxygen Needs Tracker, available at https://www.path.org/programs/market-dynamics/covid-19-oxygen-needs-tracker/ and managed by PATH, a global nonprofit organization improving global health, estimated that during February, when the cases spiked, the daily oxygen need in Somalia also surged to 7000 cubic metres a day (1000 oxygen cylinders). 

After noting the dire situation and growing numbers of cases and increased trend of deaths due to COVID-19, exacerbated by the lack of access to medical oxygen, HE Dr Fawziya Abikar Nur, the Minister of Health and Human Services of the Federal Government of Somalia, called for an urgent meeting on 11 February 2021 with Dr Mamunur Malik, the WHO Representative for Somalia and the WHO Incident Management Support Team (IMST). She described the dire need for medical oxygen and appealed for immediate support. Gauging the critical nature of the situation, the WHO technical team identified the shortage of oxygen cylinders as a bottleneck and agreed to procure 200 units of medical oxygen cylinders and 50 medical oxygen regulators with humidifiers to meet the growing demand for medical oxygen in the hospital. 

Empowering hospitals with sustainable solutions 

“While responding to the COVID-19 crisis, WHO is working to rebuild health systems in Somalia. In other words, while we provided oxygen cylinders, we are also making sure that the health care workers are adequately trained on their use, not only for COVID-19, but for other medical conditions too,” explains Dr Mamunur Rahman Malik, WHO Representative for Somalia. “In fact, from December to March, with funding from the World Bank, WHO Somalia collaborated with international partners and the teams in the Eastern Mediterranean Regional Office and Headquarters to train clinicians in basic emergency care and management of patients in intensive care units- one component of which was how to use oxygen concentrators. The provision of oxygen is one of the interventions we are using to help patients breath normally and survive after being severely infected with COVID-19. This will help health facilities and communities in the long run too, as we are meeting unmet needs of patients suffering from pneumonia and other diseases, who need oxygen to survive.”

“As soon as we received the request from the Federal Government of Somalia, our procurement team contacted local and regional suppliers. A tremendous coordinated logistics effort followed to drive the empty oxygen cylinders across the country from the supplier’s warehouse to Nairobi’s international airport, and packaging, airlifting them to Mogadishu in batches. We procured and shipped the oxygen cylinders from Kenya, as no one could supply them fast enough in Somalia,” said Dr Shajib Hossain, Medical Operations Lead, WHO IMST in Somalia, who also serves as WHO Somalia’s Planning Officer. “On 3 March, we handed over 200 oxygen cylinders and 50 medical oxygen regulators with humidifiers to the De Martino Hospital. Additionally, to fill in the gap until the FMoH takes charge of the operations, WHO has reached a service-level agreement with a local company in Mogadishu, Ugas Production, to ensure the regular refilling of the oxygen cylinders.”  

“We were able to respond swiftly and procure oxygen cylinders and with the arrangement for daily refilling with generous support from our partner, the European Union Delegation to Somalia. We remain grateful to them for their kind and timely support to Somali communities,” added Dr Malik. 

Dr Abdirizak, a father of four, who is an infectious disease specialist and public health expert, is giving this fight his all. He knows the pain some families are feeling – he lost his father to COVID-19 in April 2020, when the disease was still new to the world and Somalia. 

“Things were tough before the oxygen arrived, as we were using 200 oxygen cylinders a day. Some of the critical patients were using one cylinder every two hours,” adds Dr Abdirizak. “At the De Martino Hospital, we are so grateful to WHO and their partners, not only for oxygen but also for the technical support they have given us to manage the oxygen cylinders. We have reached a stage where we can stand on our feet – we know how to measure oxygen levels and use the cylinders. WHO also helped us setting up a supply, consumption system for the oxygen cylinders in close coordination with a local company to refill the cylinders. As our hospital provides free services, we get so many patients – we are thankful we can actually help the severe cases now.” 

WHO was able to procure and provide 200 oxygen cylinders and 50 medical oxygen regulators with humidifiers to the De Martino hospital in Mogadishu with financial support received from the European Union Delegation to Somalia. 

Other stories on medical oxygen in Somalia 

The life-saving power of medical oxygen

Solar-powered medical oxygen systems saving lives in Somalia: using innovation to accelerate impact in a fragile setting

UN story: Somalia/COVAX oxygen equipment