Photo: WHO/Ismael Taxta

Mogadishu, 3 August 2021 – While marking World Breastfeeding Week this year, the Federal Ministry of Health in Somalia, the United Nations Children’s Fund (UNICEF) and World Health Organization (WHO) called for a concerted effort to create an enabling environment for Somali mothers to breastfeed their babies to improve their health, nutritional status and overall well-eing. 

“We are calling on all actors from household level through community leadership up to policy-makers and development partners to actively take breastfeeding as everyone’s responsibility,” said Dr Abdinasir Mukhtar Ibrahim, the Director General, Somalia’s Federal Minister of Health and Human Services. “Together, through commitment, concerted action and collaboration, we can build strong collaborative systems for provision of appropriate and skilled breastfeeding counselling to mothers and ensure that our children are fed in the appropriate way for a healthy nation.” 

This call to action comes as Somalia witnesses an increase in child malnutrition, including reduction in infant and young child feeding practices, due to steep declines in household incomes among other challenges posed by shocks such as drought, flooding and the COVID-19 pandemic. The advice is also in line with the global theme for the week: ‘Protect Breastfeeding: A Shared Responsibility.’ 

The Federal Ministry of Health, WHO and UNICEF recommend early initiation of breastfeeding within the first hour of birth, feeding the child only breast milk for the first 6 months (exclusive breastfeeding), and continuing to breastfeed for up to 24 months or beyond, with the introduction of nutritionally adequate and safe complementary (solid) foods at 6 months. 

“Breastfeeding provides children the best start in life,” said Nejmudin Bilal, Acting UNICEF Representative in Somalia. “It is a baby’s best source of nutrition, bolstering brain development with lifelong benefits. Early initiation of breastfeeding offers a powerful line of defense against all forms of childhood malnutrition including wasting.” 

During World Breastfeeding Week, the Federal Ministry of Health will launch breastfeeding awareness campaigns throughout the country and skilled breastfeeding counselling will be provided in a variety of settings, including health facilities and clinics and through home visits by community health workers. The campaign will also stress that it is still safe to breastfeed during the COVID-19 pandemic. 

“Even in the context of COVID-19, WHO recommends that mothers with suspected or confirmed COVID-19 should be encouraged to initiate and continue breastfeeding, while implementing appropriate hygiene measures, such as wearing a medical mask, if available, to reduce the chances of droplets with COVID-19 being spread to her infant. The benefits of breastfeeding substantially outweigh the potential risks of COVID-19 transmission,” said Dr Mamunur Malik, WHO Representative to Somalia. “So far, active COVID-19 (virus that can cause infection) has not been detected in breast milk of any mother with confirmed/suspected COVID-19.” 

In addition, as part of the Federal Ministry of Health’s national nutrition strategy 2020-2025, countrywide efforts will be scaled up with the primary goal to increase the number of babies aged 0-6 months old who are exclusively breastfed to above 50% by 2025.  According to the latest government data, only 34% of babies under 6 months are exclusive breastfeeding. 

World Breastfeeding Week in Somalia will focus on how breastfeeding contributes to the survival, health and well-being of all, and the imperative to protect breastfeeding worldwide. The 2021 theme is: Protect Breastfeeding: A Shared Responsibility​ and it is aligned with thematic area 2 of the World Breast Feeding Week/SDGs 2030 campaign which highlights the links between breastfeeding and survival, health and well-being of women, children and nations.             

Improving breastfeeding rates and practices requires action on the part of multiple actors including governments, health care institutions, health care workers and businesses. During the COVID-19 pandemic, the Federal Ministry of Health will continue to ensure that access to these essential services is not disrupted and that families continue to receive the breastfeeding counselling they need.

The importance of breastfeeding is mentioned in the Holy Quran 233rd verse of Sura Al-Baqarah in which it is stated that: "mothers [should] breastfeed their children for a total of two years”. 

“Breastfeeding must be considered a public health issue that requires supportive interventions at all levels. Together, we can ensure that every mother has access to skilled breastfeeding counselling, empowering her to give her baby the best possible start in life,” added the Director General.

Note to editors

 In 2018, a World Health Assembly resolution endorsed World Breastfeeding Week as an important breastfeeding promotion strategy.

• The theme for World Breastfeeding Week in 2021 is aligned with thematic area 2 of the WBW-SDG 2030 campaign which highlights the links between breastfeeding and survival, health and well-being of women, children and nations.
• The Federal Minister of Health and Human Services, UNICEF and partners will continue advocating for signing and full implementation of the International Code of Marketing of Breastmilk Substitutes and subsequent WHA resolutions (the Code).

For additional information, kindly contact: 

Fouzia Bano
WHO Chief of Staff ai,
Communications Officer
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+252 619 235 880 

Eva Hinds
UNICEF Communication Manager
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+252 613 642 635

Khadar Hussein Mohamud
The Federal Ministry of Health Head Coordination and Communication
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+252615602637                                   

Dr Mamunur Malik, WHO Representative to Somalia, and H.E. Staffan Tillander, Swedish Ambassador to Somalia, sign agreement to strengthen the National Institute of Health and health information systems in Somalia

Mogadishu, 28 June 2021 – On 16 June, Dr Mamunur Malik, WHO Representative to Somalia, and H.E. Staffan Tillander, Swedish Ambassador to Somalia, signed an agreement, totalling 4 300 000 SEK (US$ 517 868), aimed at strengthening the National Institute of Health and health information systems in Somalia, through the financing of 2 senior WHO national staff positions. 

The signature of this agreement marks years of close collaboration and partnership between WHO and Sweden in Somalia. It is built upon 2 non-financial memoranda of understanding signed between WHO and the Public Health Agency of Sweden, and between WHO and the SPIDER Center (Stockholm University). The former aims to support the establishment of an independent national institute of health in Somalia, while the latter aims to strengthen the digitalization of health information and the development of an integrated disease  surveillance and response system across the country. This agreement will therefore enable the WHO Somalia country office to recruit and retain 2 senior level national staff to support the activities of the National Institute of Health and other disease surveillance functions to support SPIDER-related activities. Both staff members will act as WHO’s primary focal points for close engagement and technical collaboration with these agencies, health authorities, as well as other relevant partners. 

“This agreement marks a remarkable chapter in the history of collaboration between WHO and Sweden in Somalia. The collaboration and agreement aim at improving health information management system in Somalia by working closely with SPIDER and will provide critical human resources support to operationalize and transform the newly functioning National Institute of Health of Somalia as a premier centre in the country for public health research, front-line health workforce development, public health laboratory, emergency preparedness and outbreak response, as well as for leading disease-specific control programmes in the country. We are confident that this support of Sweden will go a long way in protecting the vulnerable and promoting health with a view to building a safer world for everyone in Somalia,” said Dr Malik, WHO Representative. 

“Access to health care touches people in their everyday life. Somalia is step by step rebuilding its health systems, around the country, in towns, villages, for girls and boys, mothers and fathers, young and old. Working with WHO to support these life-saving efforts is part of our partnership with the Somali people,” said H.E. Staffan Tillander, Swedish Ambassador to Somalia. 

This important contribution from Sweden to WHO in Somalia further consolidates the innovative partnership that already exists between the two, as well as the collective efforts of both to achieve better health outcomes for all Somalis towards universal health coverage and health for all. 

Related links

WHO and SPIDER Center sign agreement to strengthen health information management in Somalia
8 March 2021

An innovative and unique partnership: WHO, Sweden and Somalia work together to improve health outcomes for all Somalis
1 February 2021

WHO and Public Health Agency of Sweden sign MoU to support establishment of National Institute of Health for Somalia
5 January 2021

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