Since it was rehabilitated on 16 June, over 19 500 people around the Salama borehole in North Galkayo can now access safe water again. Credit - WHO/Somalia 24 July 2022 – For just over a month, from 7 May to 16 June 2022, Fatumo Yusuf Diriye spent 3 hours every day, walking to and from the nearest water source, 6 km away, to fetch water for her family. As she could carry only 2 ‘jirigaans” or pails of water at a time, and had to wait her turn in a long queue, her family had to use this water sparingly. They resorted to using ashes or sand to clean their hands. 

Fatumo knows that having to deal with unsafe water has contributed to her 3 children under 5 falling sick with diarrhoea many times before. On many occasions, she has had to rush them to the nearest health facility for support. This is one burden that families like Fatumo’s, who depend on her daily earnings from a local market, can do without.

Visit from the Government and WHO officials 

One day, early in May 2022, Fatumo heard there was a team of high-level officials from the Government and World Health Organization (WHO) visiting the camp where she lived, in North Galkayo, to assess the effects of the ongoing drought. Even though she could not go to see them, later on, she heard a few community members had requested the heads of the high-level team to support them to fix 2 water pumps which were not functioning for longer than she could recall. The Salama water pump, which is a borehole close to Fatumo’s home, was one of them, and the Halaboqad borehole was the second one that hadn’t been functioning for quite some time. 

The visiting high-level team was led by HE Dr Fawziya Abikar Nur, the Federal Minister of Health and Human Services, and HE Abdi Nasir Yusuf Haji, the Vice Minister of Health for Puntland state. Representing WHO, Dr Ahmed Al-Mandhari, WHO Regional Director for the WHO Eastern Mediterranean, and Dr Mamunur Rahman Malik, WHO Representative to Somalia, were also part of the team. 

Delivering swiftly on a promise 

WHO conducts regular surveillance to test water quality, as water is linked with public health. Credit - WHO/Somalia

Fatumo, who has been living in a camp for the internally displaced since 2017, had heard the WHO team agreed to provide support, but was not sure how this would pan out. To her joy and surprise, within a few days, an expert came by to assess the Salama borehole. Around a month later, the Salama borehole was functioning again.    

“Our lives have changed thanks to having water now from the Salama borehole, for drinking and also for all our household purposes,” says Fatumo, as it takes her just 30 minutes to fetch water now. The Diriye family can now collect at least 4 buckets of water, as their source, the borehole, is just above half a kilometre away. Hers is just one of the families living in one of 6 camps and 2000 households that now have access to clean water from the Salama borehole. 

With WHO’s interventions to rehabilitate both the Salama and Halaboqad boreholes, 19 716 people now have access to clean water. This will translate to clean drinking- water, fewer waterborne diseases, like cholera and diarrhoea, healthier populations, and better sanitation. By protecting their families from preventable diseases, Fatumo and many parents like her can devote their time and resources to raising their families instead of coping with the stresses related to fighting diseases.

Access to water is a recognized human right 

Fatumo carries water back home to top up her supply for the day. Credit - WHO/Somalia Currently, only 52% of the population in Somalia has access to improved drinking-water (the population using safely managed drinking-water services). In the internally displaced persons’ (IDP) camps like Salama, this number is staggeringly low. Recurring droughts, such as the one ongoing, make water an even more scarce resource. 

Around the world, WHO and the United Nations Children’s Fund (UNICEF) found that in 2019, 2.2 billion people lacked access to safely managed drinking-water services. In July 2010, the United Nations General Assembly recognized access to water and sanitation as a human right. The Health Assembly acknowledged that every human needs to access “between 50 and 100 litres of safe, acceptable and affordable water a day for personal and domestic uses”. The General Assembly also stated that families’ main water source should be within 1 km of their home and that it should not take longer than 30 minutes for a family to access water. 

To complement this, the UN Sustainable Development Goal (SDG) 6 aims to ensure availability and sustainable management of water and sanitation for all. This will reduce the burden of waterborne diseases, and advance progress towards universal health coverage.

17 July 2022 – In 2021, Somalia barely had time to take its eye off the COVID-19 pandemic, when the ongoing severe drought crept up. As a result, many Somali communities, over 40% of whom are known to live rural and nomadic lifestyles, lost their livestock and crops.

Health Cluster Coordinator for Somalia Ms Erna-Roelofje Christina Van Goor visits a hospital in Dhushamareb to view health services being offered, Galgaduud, June 2022. Credit: WHO Somalia/Fouzia BanoTo deliver a multifaceted response to the ongoing drought, Somalia’s Health Cluster has been working hand in hand with international and national health agencies in the country.

Delivering a joint response with partners

Led by the World Health Organization (WHO), the Health Cluster convened regular meetings with partners, including the federal and state ministries of health, where the Organization shared updates on the drought situation and the anticipated public health impacts. These meetings offered partners a platform to discuss their response activities related to the drought, in addition to gaps and challenges.

The Health Cluster has also been participating in inter-cluster platforms. Led by the United Nations Office for Humanitarian Affairs (OCHA), stakeholders’ inter-cluster response for drought entailed the reconstitution of the Drought Operations Coordination Centre. The Health Cluster is playing a key role in coordinating the overall health response in the country and working hand in hand with the water, sanitation and hygiene (WASH) and nutrition clusters for programmatic integrations.

Health Cluster partners have so far benefited from 2 rounds of Somalia Humanitarian Fund allocations, that amounted to approximately US $9 million to respond to the drought, targeting the most severely affected populations. These allocations have taken advantage of the cross-cluster collaboration, with most funding channeled to integrated health, nutrition and WASH projects.  

Visiting the most hard-hit drought-affected areas

The Health Cluster serves as a coordinating body for health actors across Somalia to ensure the most vulnerable people have access to health services, Istanbul internally displaced persons camp, Jubaland, May 2022. Credit: WHO Somalia/AreteThe Health Cluster participated in inter-cluster caravan missions to various drought-affected areas to assess the health situation, identify gaps and opportunities for support. The areas visited include Bardhere, Luuq and Elwak in Gedo region, Garowe, Hargeisa and Jowhar, among other areas severely affected by the drought. From these missions, the Cluster observed the high prevalence of waterborne disease outbreaks, mainly due to a lack of sufficient clean water and hygiene services.

Suspected measles cases were also observed in most areas, including in camps for internally displaced persons (IDPs), where families complained about rashes and high-grade symptoms. The team noted large numbers of people suffering from malnutrition, which is known to be a key contributing factor in susceptibility to diseases, especially among children under 5.

Mental health and gender-based violence risks during drought

Mental health and psychosocial support services remain a key gap in internally displaced persons camps, with children showing signs of trauma and depression, as noted by the Cluster. The emotional impact of changes to family and community life appears to have affected children’s lives in the camps at alarming rates. Interaction with women in the camps revealed high cases of gender-based violence, mostly attributed to the lack of shelter as most newly arrived women and girls sleep outdoors.

As a result of these missions and observations made, funding allocation has been better prioritized to reach the most vulnerable populations in these severely affected areas. An integrated approach to the response to drought has been noted as the most effective and efficient way of providing assistance. These caravan missions have also provided an opportunity to monitor partners’ interventions related to health. However, as the agencies struggle to step up effective drought response, the needs of the underserved communities are clearly outpacing the available services.   

Children and adults queuing to collect water from the newly rehabilitated Salama borehole, North Galkayo, Puntland, 2 July 2022. Credit: WHO Somalia6 July 2022 – Water is a key prerequisite to safe hygiene and sanitation practices and — by that measure — good health and dignity. However, a large proportion of the Somali population has limited access to this valuable resource. Estimates from a survey conducted by the government and UN in 2014 state that 24% of Somalis live in rural areas, 23% follow nomadic lifestyles, and 15% (around 2.6 million) live in camps for the internally displaced. This means most communities living across Somalia’s expansive, dry landscape rely on rivers, wells, water trucks and boreholes to access water of compromised quality. The ongoing drought, which is the worst the Horn of Africa has witnessed in four decades, has placed water even further out of reach.

Visit to camps for internally displaced persons

On a bright, sunny morning on 10 May 2022, a high-level mission from Somalia’s Federal Ministry of Health and Human Services, the Puntland state Ministry of Health and the World Health Organization (WHO) visited North Galkayo to assess the health situation brought about by the drought.

Led by HE Dr Fawziya Abikar Nur, the Federal Minister of Health and Human Services, and HE Abdi Nasir Yusuf Haji, the Vice Minister of Health for Puntland state, the team included Dr Ahmed Al-Mandhari, the Regional Director for the WHO Eastern Mediterranean Regional Office and Dr Mamunur Rahman Malik, WHO Representative to Somalia.

Dr Ahmed Al-Mandhari, WHO Regional Director for the Eastern Mediterranean, and Dr Mamunur Malik, WHO Representative to Somalia, visiting the Salama borehole when it was not functioning, North Galkayo, 10 May 2022. Credit: WHO Somalia/Fouzia Bano

During a visit to two camps for internally displaced persons (IDPs)– the Salama and Halaboqad camps – the team observed that the communities living there had no access to water. At the Salama camp, a borehole that used to provide water to around 2000 households and 12 000 people residing in six camps was broken. Similarly, the borehole at the Halaboqad camp, which usually serves around 7716 people, was not functioning as its water pump required solar batteries or a generator and pipes to carry water.

When delivering promises turns into happiness

The local communities, while meeting Dr Al-Mandhari and Dr Malik, raised their attention of the acute water shortage they were facing in the camp. After seeing the plight of the local communities and believing that access to safe water is a human right for everyone, everywhere, Dr Ahmed Al-Mandhari and Dr Malik committed to support the rehabilitation of two boreholes in both camps, which can permanently solve the acute water crisis faced by marginalized community members. Within the same week, WHO arranged for engineers to assess both boreholes.

In a month’s time, by 16 June 2022, both boreholes were rehabilitated, and a total of around 19 716 people living in both locations now have access to safe water, which has already started to change the life of these communities. This intervention will significantly reduce the prevalence of diseases among communities being served in addition to meeting their daily needs for water. The communities are happily using safe water from this borehole for all their household needs and thanking WHO for delivering its promises to safeguard lives of their children and elderly people.  

WHO urges partners to redouble efforts

During his mission, Dr Ahmed Al-Mandhari urged partners to redouble efforts to support Somali communities during this trying time.  

Rehabilitation efforts at the Halaboqad borehole after the high-level visit, North Galkayo, June 2022. Credit: WHO Somalia “It is really very heart-breaking to see the impact of drought. Let us come together to save lives,” said Dr Ahmed Al-Mandhari, the WHO Regional Director for Eastern Mediterranean Regional Office. “We see children, mothers and families suffering due to the shortage of water and food. I have seen young babies emaciated and admitted in hospitals due to malnutrition and related complications, such as pneumonia. These are all not just numbers, but human lives, and future generations of Somalia suffering from drought and the related impact of it – physical, mental, emotional or psychological. Let us all work towards fulfilling the spirit and values of the WHO Eastern Mediterranean Region vision 2023: health for all by all – calling for solidarity and action.”

“Currently, 3.5 million people in Somalia lack adequate access to water,” said Dr Mamunur Malik. “This increases communities’ chances of contracting diseases like cholera and diarrhoea. We are hereby appealing to both the health and the water, sanitation and hygiene (WASH) clusters in Somalia to work hand in hand to protect Somalis from preventable diseases and give them access to safe water and sanitation services, which are their human right.”

A lady draws water for her household from the Salama borehole, North Galkayo, July 2022, Credit: WHO SomaliaDr Malik added that WHO estimates that for every US $1 that donors and partners spend today to prevent and prepare for epidemics in Somalia, it will save US$ 35 in response to epidemics. Early action saves more lives, he emphasized.

27 June 2022 – When young Nastexo and Salmo developed high fevers, coughs, sore throats, runny noses and watery eyes, Ilmo may not have known exactly what problem her children had, but their rashes gave it away. Ilmo, who lives in a drought-affected location in Baidoa, knew her children had measles as she had seen many cases recently and had learnt to look out for these symptoms. 

Ilmo felt helpless and tired when they both fell sick with this highly contagious disease, as they needed her undivided attention. Upon receiving advice from community health workers, she took Nastexo and Salmo to a health facility nearby where a doctor gave them vitamin A to boost their immunity and medication to give them relief. 

Health workers use vaccine carriers to store measles vaccines at the optimum temperature while visiting children to vaccinate them during house-to-house visits in the Istanbul IDP camp in Kismayo, Jubbaland state (April 2022). Credit: WHO Somalia/AreteIn collaboration with the Federal Ministry of Health and Human Services and partners, the World Health Organization (WHO) is supporting the work of 2163 community health workers who visit around 300 000 households every month across Somalia to look out for sick children in the households whose parents do not visit the health centres to seek health care for their sick children owing to myriad of reasons. These community health workers, deployed by WHO in the worst affected areas, look for sick children with suspected measles, pneumonia, diarrhoea or suspected cholera and malaria. They also screen children for signs of acute malnutrition using mid-upper arm circumference measuring tapes and search for other unusual health events in the community. This regular search helps communities to seek health care in a timely manner, which saves lives.  

Hunger setting the stage for measles spread 

The ongoing drought in the Horn of Africa, which WHO recently classified as a grade three health emergency – meaning that it is a severe crisis – is leaving children weak, hungry and susceptible to disease. Out of 6.1 million people across the country who are food insecure, nearly 1.7 million are suffering from extreme levels of hunger. An estimated 1.4 million children aged under 5 and more than 250 000 pregnant and lactating women will need treatment and care for malnutrition.

From the beginning of the year until week 21 of 2022 (29 May 2022), health facilities and community health workers reported 9562 suspected cases of measles, 7650 (80%) of whom are aged under 5 years. The highest number of cases have been reported from Puntland, South West State and Banadir. 

“We are going extra miles to reach out every child whose life can be saved and protected by measles and other vaccines. During the last 4 months of our intensified operation in the ground, over 92 000 children have been vaccinated against childhood vaccines including measles through our outreach services which we have supported and continue to support in the drought-affected districts. Approximately 19000 of these children were identified by our health workers as “zero dose children”, meaning that they have not received any vaccine in their life span. Unvaccinated children, coupled with malnutrition and mass displacement, will set the stage for diseases like measles to spread. Therefore, we are reaching to every child in these drought-affected districts and vaccinate them against measles and other childhood vaccines. In order to continue to maintain our life-saving interventions, we will need US$ 35 million to ramp up our operations until the end of 2022,” said Dr Mamunur Rahman Malik, WHO Representative to Somalia.  

Realizing the benefits of vaccination 

Ali Aden, a health worker, vaccinates children against measles at the Istanbul IDP camp in Kismayo, Jubbaland state (April 2022). Credit: WHO Somalia/AreteIlmo explains that she never had the chance to take Nastexo and Salmo for their childhood vaccinations, but now knows how important it is to vaccinate children. She explains that she will take the newest addition to the family, her 7-month-old baby, to receive routine childhood vaccinations to prevent him from falling sick like his siblings. 

The ongoing drought in Somalia is taking a toll on the livelihoods and health of millions of Somalis. As casual labourers, Ilmo and her husband do not earn much. Since the drought began, they have found it even harder to find jobs to make a living, and now with two children unwell, they were recently forced to live on one meal a day. Ilmo’s children were lucky enough to get attention, but there are children who do not receive timely support, as well as more families that are plunged into poverty as a result of trying to address their health needs.