7 May 2019 –  From the moment we’re born, we’re all at risk of contracting diseases. So the question is, are we aware enough? Are we responsible enough? Are we immune enough? Not long ago infections like influenza, tetanus, chickenpox and measles were prolonged, painful illnesses, which often resulted in death. Immunization saves millions of lives every year and is widely recognized as one of the world’s most successful and cost-effective public health interventions.

The Expanded Programmme on Immunization (EPI) started in Somalia in 1978 with the support of WHO and UNICEF. Due to the prolonged conflict and instability Somalia’s health system, including immunization services, is very weak, fragmented and severely under-funded. Control of vaccine-preventable diseases remains a huge challenge in Somalia, due to the low routine immunization coverage and the continued inability to reach children in security-compromised areas, hard-to-reach areas, nomadic children and competing health priorities for parents other than immunization of children. Low routine immunization coverage and a history of serious outbreaks that have hit Somalia in the past are a strong reminder of the risks posed by large cohort of un-immunized children. Vaccine-preventable diseases are prevalent in Somalia and child mortality is 137 per 1000 live births.

Somalia has been providing the traditional 6 antigens in routine immunization and with the support of GAVI - the Vaccine Alliance and immunization partners like UNICEF and WHO. The country has introduced pentavalent vaccine in 2013 and inactivated polio virus vaccine in 2015 and plans to introduce measles-containing-vaccine second-dose (MCV2) in 2020. With the continuous support of GAVI, Centers for Disease Control and Prevention, Atlanta, Bill & Melinda Gates Foundation and Rotary International and other important donors immunization coverage has improved in recent years; however, Somalia has still not attained the desired levels of coverage.

To improve immunization coverage more efforts needs to be in place for integrated approach along with other programmes like nutrition, malaria, water and sanitation and communication programmes to complement the reach of immunization and improve coverage of all eligible children with equity.

Somalia faced a deadly measles outbreak in 2017; out of the 31 000 people affected, 83% were children under the age of 10. WHO Somalia’s Emergency Response team, Somali national authorities, and partners targeted 4.7 million children in the nationwide measles campaign. During this intervention, around 4.5 million children were vaccinated. As a result of the nationwide immunization campaign conducted, as of April 2019, Somalia witnessed a decline in the trend of cases reported this year. This steady progress can be attributed to partners’ commitment to strengthen routine immunization and to reach out to unvaccinated children to boost their immunity. However, Somalia’s children are still not out of danger – measles outbreaks are likely to spread in security-compromised inaccessible areas.

Somalia’s last outbreak of wild poliovirus, which occurred from 2013 to 2014, affected 194 children. Since then, as a result of mass and more focused immunization campaigns, and robust surveillance for polio symptoms to guide immunization activities, the country has been free of wild poliovirus. However, due to the challenges faced in reaching hard-to-reach areas, the country is currently experiencing 2 outbreaks of rare strains of the poliovirus, which have affected 13 children so far. The last nationwide polio campaign, conducted in March, vaccinated more than 2.7 million children under 5. More than 84 000 children were vaccinated for the first time.

Marked during the last week of April, World Immunization Week aims to promote the use of vaccines to protect people of all ages against disease. WHO wants to assure parents and communities in Somalia that vaccines are safe, effective, and can lead to lifetime immunity from diseases.

While celebrating World Immunization Week with the theme “Protected Together: Vaccines Work”, Dr Mamunur Rahman Malik, WHO Representative for Somalia, called for scaling up the routine immunization programme in Somalia through working together with partners, communities and grass-root level organization. In  2018, Somali authorities, WHO and partners vaccinated more than 400 000 children against measles as part of routine immunization programme. Yet, about 170 000 children were missed or did not receive the first dose of measles vaccine last year. “Our priority is to reach out to all these children who misses the routine vaccine doses or remain unvaccinated owing to access or any other barrier.  Leaving no child behind, we can ensure every child’s right to lead a healthy and productive life- if all who need to vaccinated are vaccinated in a timely way,” he stated.

In the last decade, Somali health authorities and WHO worked with Gavi and other key partners to strengthen routine immunization. This protected 2.4m children against 8 vaccine-preventable childhood diseases.

Somalia has shown remarkable progress in achieving good immunization coverage for some diseases that is realistically feasible to achieve in a fragile state, lot of works still need to be continued and scaled up to fill the immunization gaps through enhancing partnerships with other local stakeholders which is the key theme of this year’s World Immunization Week. Responding to outbreaks of measles or polio is a priority but can be prevented through achieving high coverage in routine immunization programme and also by reaching out to the children who do not receive any vaccine during the first year of their life.

Despite the gains made by vaccination over the years, there are still unvaccinated and under-vaccinated children in Somalia today. As a consequence, millions of children are being put at risk against vaccine-preventable diseases.  As part of this year’s campaign, grass-root level vaccinators who spearhead all barriers to reach every child in inaccessible areas of the country were honoured as immunization heroes. Their roles in keeping children healthy and securing a safer future has been acknowledged throughout the country.

Mogadishu, Somalia, 9 April, 2019 – WHO in Somalia joined the world in marking World Health Day on 7 April by forming a human solidarity chain with representatives of United Nations agencies and key partners in Mogadishu. All around the world solidarity chains were formed to mark the Day and symbolize the importance of strong partnership and commitment in improving health care.

The theme of this year’s campaign was improving primary health care ‒ an entry point to the health care system ‒ as a path to achieving universal health coverage. Universal health coverage means that all people and communities can access quality health care, in an equitable manner, without being exposed to financial hardships.

Somalia is currently in the process of finalizing a roadmap in its drive to progress towards universal health coverage. This roadmap complements Somalia’s national health policy goals, and takes into consideration the current health situation across the country. With support from WHO and key partners, including donors and UN agencies, Somalia will look at ways to support communities so they can access health services.  

“The Somali people are among the most  resilient in the world,” said HE Dr Fauziya Abikar, Minister of Health of Somalia’s Federal Government. “If we focus on primary health care through which a mother and child can access the best services, we can contain bigger challenges.”       

The Head of the UN Support Office Mr Amadu Kamara stated, “For a country like Somalia, where life expectancy for women and men is low, improving primary health care is of utmost importance. We express our solidarity and support, on behalf of all UN agencies in the country, towards using primary health care as a fundamental approach to improving health care.”

“Between 80 and 90% of essential health services can be delivered at primary health care level, including in emergencies,” said Dr Mamunur Malik, WHO Representative in Somalia. He added that WHO and Member States were promoting family practice-based, primary health care as a way to improve the overall health situation in countries. Dr Malik called upon all actors, from policy-makers to UN agencies and individuals in the community to come together to work towards the equitable and attainable goal of “Health for all, by all”. He also commended health workers in Somalia, particularly women, for their dedication to providing health services under challenging circumstances in the country.    

In Hargeisa, on World Health Day, health authorities presided over a graduation ceremony for 12 medical doctors from remote rural areas after they had completed a 9-month training course in emergency obstetric care, aiming to save the lives of mothers and newborns. The training was conducted by health authorities, WHO, the University of Hargeisa and other partners.

In Baidoa, health authorities and representatives of UN agencies came together to celebrate the occasion and raise awareness of the importance of universal health coverage and the ways in which Somalis could gain access to better health care.  

In other events to commemorate World Health Day, which marks WHO’s founding in 1948, Dr Mamunur Malik held bilateral discussions with HE Dr Fauziya A Nur to reaffirm their commitment to strengthening Somalia’s health system. WHO also held an open question and answer session on Twitter (@WHOSom) on Sunday, where members of the public had the opportunity to talk to a WHO health expert, Dr Rizwan Humayun, to learn more about universal health coverage and the health situation in Somalia. 

Mogadishu, 26 March 2019 – A nationwide polio immunization campaign has been launched in Somalia that will run from 24 to 27 March. The campaign aims to vaccinate an estimated 3.1 million children under the age of 5 in the country.   

The campaign is part of WHO’s efforts to ensure that Somalia remains polio free as it has from indigenous wild poliovirus since 2014. However, 2 strains of circulating vaccine-derived polioviruses – vaccine-derived poliovirus type 2 (cVDPV2) and type 3 (cVDPV3) are concurrently circulating in the country and have left 12 Somali children paralyzed.

Since the first week of September 2018, the country has not witnessed any new case of cVDPVs in children with acute flaccid paralysis. The same virus has also been confirmed in Kenya. Vaccine-derived polio viruses are rare and only occur when polio vaccination rates are low resulting in low immunity against polio virus.

The national polio immunization campaign is being launched by the Government of Somalia with the active support of WHO and UNICEF. The campaign is being supported by the Global Polio Eradication Initiative.  

Around 15 000 frontline polio health workers are actively engaged in the campaign and will visit every house to ensure that all children under the age of 5 in the country get at least one single dose of oral polio vaccine during the campaign. Every under-immunized child, in every location in the country, including areas that have not been affected with the polioviruses yet, will be reached during this nationwide campaign.

The campaign is part of WHO’s polio eradication initiative in Somalia which aims to keep the country free from polio and to build immunity of all children under 5 against poliovirus. Multiple vaccination campaigns are also being planned in the future as part of this initiative to protect Somali children against the threat of polio.

The WHO country office in Somalia is working with Somali health authorities to improve routine immunization for polio and other vaccine-preventable diseases and strengthen surveillance to ensure that the country remains polio free. Apart from maintaining high levels of vaccination coverage, WHO is also supporting national and local health authorities to maintain a robust surveillance system for acute flaccid paralysis and rapid outbreak response capacities to investigate and detect any suspected case of wild or vaccine-derived poliovirus early.

Related links

The Global Polio Eradication Initiative (GPEI) 

What is vaccine-derived poliovirus?

11 March 2019 – In most parts of the world, women announce a pregnancy with excitement; they can count on quality and timely support when delivering a child. In Somalia, excitement is often lined with unease, as women are cognizant of the risks associated with pregnancy and delivery.

Inadequate health facilities, particularly in remote, rural areas, force women to deliver babies at home. Birth attendants are not always qualified; traditional birth attendants, who are used often, lack technical skills and may even be forced to use contaminated equipment at times. In many instances, expectant mothers simply cannot afford to visit health facilities.

In a country where women often have multiple children with little time between each pregnancy, the lack of infrastructure, including roads and ambulatory services, further exacerbated by insecurity, increases the chances of mothers and their newborns losing their lives, or women experiencing complications during childbirth.   

Cultural beliefs passed down over generations result in mothers having no say in providing consent for caesarean section during deliveries, should they require this support. Birth spacing is also a culturally sensitive topic to broach, leaving many women with no time to recover before they conceive their next child. A common practice in Somalia, female genital mutilation, causes obstructed labour. One out of every 12 Somali women dies due to causes related to pregnancy.

Changing the status quo

Halima Abdi Sheikh, better known as Mama Halima Abdi Sheikh, is a pioneer in maternal health services in Somalia. She has dedicated herself to improving the health of mothers, newborns and children – one delivery at a time. Serving WHO in Somalia as Maternal Newborn Child and Adolescent Health Officer for South Central Somalia since 1995, Mama Halima is a true advocate for women’s health. She is also a senior midwife, an educator and a leader. She works to share her passion to improve maternal and child health with Somalia’s next generation of health workers. Being one of the key founders of the Somali Midwifery Association, established in 2012, Mama Halima succeeded in bringing Somalia’s midwives together to speak with one voice and with one platform to represent them nationally. The association’s main aim is to provide quality and timely health care for newborns and mothers.

“Mothers in Somalia trust us. WHO provides medical supplies to treat mothers in health facilities. We are training health workers to upgrade their knowledge and skills so they can deliver babies professionally, and attend to mothers and children in a timely manner,” says Mama Halima, squaring her shoulders proudly. “WHO tools and guidelines are used to support the Government to ensure that Somalia’s maternal and child health services will meet international standards.

Hoping to leave a better legacy

“We have a long way to go, but we can do it,” says a hopeful Mama Halima. “All we need is support and for everyone to remember that they have a role to play.” She explains that Somali authorities and their international and national partners should prioritize the establishment of additional health centres and ambulances, each equipped with modern tools and trained staff. By increasing remuneration for health care providers, authorities can encourage the workforce to provide better services. Regulating legal frameworks on midwifery and maternal health systems would strengthen overall health service delivery. There is also an urgent need to develop the capacity of midwives and health workers by providing on-the-job training, introducing modern training centres and improving the quality of health education offered in Somalia.

When asked what changes she would like to see in the society towards women, Mama Halima ponders for a while, before saying, “I would love to see men change their attitudes, and prioritize and learn about the importance of women’s health. I would also love to see religious leaders empower women by airing their voices. If they can encourage birth spacing and advocate for better health for women and children, they would be leaving the best legacy for the next generation. Women really should receive quality health services. After all, women are raising the next generation of leaders.