16 September 2020 – Somalia is no stranger to emergencies. For decades, Somalis have passed down to younger generations their rich, vibrant culture, along with mechanisms to cope with all kinds of challenges they have faced over the years. Their resilience and Somalia’s health system have been tested yet again in the last 6 months ─ this time with the outbreak of coronavirus disease (COVID-19) in the country.    

Even before 16 March 2020, when H.E. Fauziya Abikar Nur, the Federal Government’s Minister of Health, announced the first case of COVID-19 in the country, the United Nations agencies spearheaded by World Health Organization (WHO) provided substantial and timely support to the Federal Government of Somalia and its other Member States. This support allowed the country to prepare for what lay ahead. In February, public health measures for disease prevention, detection and response were significantly enhanced across the country. By early April, with support from WHO and other partners, the Ministry of Health had strengthened the capacity of 3 designated laboratories for COVID-19 testing. Since then, over 18 000 COVID-19 samples have been tested in these laboratories. WHO worked hand in hand with other United Nations agencies in the country, such as the International Organization for Migration (IOM), United Nations Children’s Fund (UNICEF), United Nations Development Programme (UNDP), United Nations Population Fund (UNFPA) and other national and international partners to improve preparedness, readiness and response to mitigate the early impact of COVID-19 outbreak.  

Swift response to the outbreak

WHO and its partners deployed 44 well-trained rapid response teams in March, now almost doubled to 73, to detect cases and to trace their contacts early on in the outbreak. More than 3300 frontline health workers have visited over 1.5 million households in the last 6 months, reaching approximately 6 million people, in 49 districts across the country. They played a critical role in reducing transmission and slowing the trajectory of the epidemic. 

Dr Naima Abdullahi, WHO Public Health Emergency Officer for Banadir, is one of the lucky Somalis who gets to serve her country while fulfilling her dream. 

“Since COVID-19 was confirmed in Somalia, I have been working in an isolation centre, at De Martino Hospital,” says Dr Naima. “My work includes providing support to Federal Ministry of Health teams to conduct COVID-19 tests, trace contacts, build capacity and manage cases. I also support with interpersonal communication, collecting data and conducting community awareness activities.”

Since I was a child, it was my dream to work for the United Nations, because my mother worked as a nurse at that time. Every time I saw her help children and women in our village, I used to tell her that I wanted to be like her,” adds Dr Naima.

Raising awareness to save lives  

In efforts to increase awareness around COVID-19, in collaboration with WHO, UNICEF and other partners, the Somali Federal Government rolled out a public health campaign to raise awareness about COVID-19 in communities across the country. Key messages were shared using radio, billboards, face-to-face training and social media channels. Innovative ideas, including using chatbots, in Somali, on WhatsApp and Facebook Messenger, helped to spread awareness on self-care among online audiences.

To analyse epidemiological information on the COVID-19 outbreak in Somalia, the Federal Ministry of Health and WHO have been collecting information on COVID-19 prevalence across Somalia and publishing it in the form of a weekly situation report. They have also been updating an online dashboard on a daily basis.   

Lauding the frontline health workers

Health workers across the country have worked tirelessly to prevent the spread of COVID-19 and provide support to infected people. Despite over 250 health care workers being infected by COVID-19, their commitment, dedication, and tireless efforts in saving lives and reducing transmission in the last 6 months have earned recognition from all.  

“The effort that Somali health workers have made to contain the pandemic and help those affected by the virus has literally saved lives. This heroic work is a testament to their commitment and dedication, often under extremely challenging conditions,” said the UN Secretary-General’s Special Representative for Somalia, James Swan.

“They achieved these life-saving outcomes despite a very fragile and weakened health system in Somalia – the result of 3 decades of conflict, protracted crisis and repeated humanitarian emergencies. The results show their fortitude, as well as the importance of the Somali authorities and national and international partners working together,” he added.

Teaming up to rebuild a robust health system 

Close collaboration among United Nations agencies, and with health authorities, has helped mount a strong response to the outbreak. Despite the nationwide lockdown and suspension of commercial flights, the UN Assistance Mission in Somalia (UNSOM), World Food Programme (WFP) and WHO partnered to collect, transport and ship COVID-19 samples from remote and inaccessible parts of the country and hand over these samples to the designated testing laboratories.

Within the first 6 months of the outbreak, WFP transported 3279 samples collected from remote and inaccessible areas, shipped over 10 000 sample collection kits and 17 790 items of personal protective equipment throughout the country in support of the Federal Government.

Additionally, IOM, UNFPA, UNICEF and WHO supported 18 isolation centres across Somalia, providing them with ventilators, oxygen concentrators, intensive care unit beds and other equipment required for optimizing patient care. Over the last 6 months, over 560 patients received treatment and care in these isolation centres.

“We are all in this fight together. This unprecedented event required an unprecedented response. COVID-19 has affected all humanity and its impact on vulnerable countries like Somalia will be felt long after the outbreak ends. Acting as “One UN”, we responded in a timely, integrated and coordinated manner. The UN team in Somalia will continue to support the Government in protecting the most vulnerable Somalis and helping the health system recover from this crisis,” said Mr Adam Abdelmoula, Deputy Special Representative of the UN Secretary-General, and UN Resident Coordinator and Humanitarian Coordinator for Somalia.

Despite the ongoing pandemic, UNICEF, UNFPA and WHO continued to support the Federal Government to scale up essential health services in order to mitigate the negative impact of COVID-19 on health gains. The successful organization and completion of mass immunization campaigns against measles and polio in Banadir region targeting over 400 000 children under 5 years of age was a striking example of how United Nations agencies are supporting the Government to ensure that health gains are not reversed.

The outbreak is not over

“Even though we have seen a drop in the number of cases and deaths recently, the outbreak is far from over. We applaud the dedicated Somali health workers who continue to stand tall in the face of mounting challenges to save lives from COVID-19 and other diseases. I would like to remind everyone that no one is safe until everyone is safe. I urge Somali communities to do their part responsibly and sensibly and exercise caution to avoid getting infected by COVID-19. To our donor community, I extend our sincere gratitude for the support provided. We will continue to work together with our partners to strengthen the country’s public health system within the goal of achieving universal health coverage and building back better,” said Dr Mamunur Malik, WHO Somalia Representative.

The challenge for Somalia now is to continue to keep health workers like Dr Naima and communities across the country safe from COVID-19, monitor the transmission risk and prevent further spikes while maintaining routine and other emergency healthcare services for everyone, everywhere.  

Related links

Somalia COVID-19 dashboard

COVID-19 information notes

COVID-19 monthly infographics

Press releases

30 August 2020 – For 3 days during a blazing Mogadishu summer, across 17 of Banadir’s districts, around 2500 women and 790 men pulled on their masks and sat cautiously at a safe distance from each other to undergo refresher training. They were preparing for no ordinary feat – conducting a health campaign that will see them offering around 400 000 children aged under 5 measles and polio vaccines, and vitamin A and deworming tablets at fixed and outreach sites, all amid a COVID-19 pandemic.

Even though the trainees have years of experience in planning and conducting immunization campaigns, some are a little anxious about how Somali families will react to them trying to offer health services during an ongoing pandemic of a highly contagious disease. Throughout the campaign, which started on 30 August and will run until 1 September, health workers will observe comprehensive COVID-19 infection prevention measures, such as regular handwashing and wearing face masks, to keep families safe. In addition, health workers will share information with families on how to prevent the further spread of COVID-19.

“I hope that caregivers and parents see that our teams have all been trained and retrained to consider the health safety measures of families above all,” says Mohamed Shire, Polio Eradication Officer for the central region of Somalia. “While ensuring families’ and our own safety, we will conduct our duties to protect every Somali child from diseases.”

Vaccinating children against 2 diseases or more at one time is a common practice across much of the world. Health workers understand that parents have a lot to deal with, and that vaccination often gets pushed aside by work, household tasks and childcare. The inclusion of other health interventions in polio campaigns, such as measles vaccine, vitamin A tablets or deworming pills, is a safe and easy way to help parents give their children the best possible protection against childhood diseases. 

Impact of COVID-19 on routine immunization coverage of life-saving vaccines

Across the globe, while the highly transmissible disease and community spread seems to be continuing, the COVID-19 virus has also taken a swing at both the delivery of health services, and health-seeking behaviour. In Somalia, health facilities have recorded a drop in caregivers’ visits to have their children immunized since March this year, when the first case of COVID-19 was confirmed in Mogadishu. When comparing overall vaccination coverage for the first half of last year with the same period this year, health facilities noted that pentavalent 1 coverage dropped by 11%, pentavalent 3 coverage reduced by 7% and measles 1 coverage dropped by 3%.

The pandemic also meant health workers ‘paused’ other regular, planned activities, such as the integrated polio-measles campaign, as they worked to prevent the spread of COVID-19 and provide much needed treatment for infected people.

Dr Asma Ali, acting Head of WHO’s Polio Programme in Somalia, is relieved to be resuming health activities in Somalia again.

“This campaign in Banadir was supposed to take place in November last year, following a similar intervention in the rest of the country, but was postponed to 2020 due to some technical delays. Unfortunately, COVID-19 came about and took over. Thankfully, we now have a chance to continue to boost the immunity of so many young children again,” Dr Asma explained.

A hub for Somalis and a hotspot for the spread of diseases

Since the start of the year, 744 children in Banadir have reportedly been infected with measles, which accounts for around half the total number of cases in the country. This highly contagious infectious disease can cause a fever and rash among other symptoms in unvaccinated children.

Home to the largest number of displaced people in Somalia, and a hub for Somalis travelling internationally, Banadir also confirmed cases of 3 children with a rare strain of poliovirus that can be found in pockets of children with low immunity.

Two forms of polioviruses, in circulation in Somalia since the end of 2017, have caused paralysis in 19 children so far across the country.

Protecting children from preventable diseases

Dr Mamunur Malik, WHO Somalia Representative, emphasized to Somali communities that every adult has a responsibility to help Somali children lead healthy lives.

“I would like to encourage parents, caregivers and all adults in Banadir and surrounding areas to make the most of this opportunity and visit vaccination sites to ensure every child under 5 is vaccinated against polio and measles, and that every child receives additional supplements to keep them healthy. As caregivers we all have an obligation to ensure our children lead healthy and productive lives,” said Dr Malik.

“As the COVID-19 response continues, it is critical that immunization drives are sustained at the same time,” added Penelope Campbell, Chief of Health, UNICEF Somalia. “Measles and polio are vaccine-preventable diseases and through this campaign, we can stop the further spread of these outbreaks and save the lives of countless children.”

More than 1200 teams with skilled personnel will be offering vaccinations against measles and polio, and supplements to children at fixed sites in Banadir during the 3-day campaign. In addition, social mobilizers from target communities will be spreading messages on the benefits of vaccination and supplements.

The successful completion of the current mass immunization campaign against measles and polio in the midst of an ongoing pandemic in Somalia will not only protect an estimated 400 000 Somali children against vaccine-preventable diseases, the campaign will also focus on the importance of resuming essential health care services, like  routine immunization activities in fragile settings using standard health safety measures. The campaign will also give a signal to all health partners that despite challenges of maintaining physical distancing, with the use of masks and other measures in health facilities and vaccination sites, it is practically possible to organize such mass campaigns and other routine health services through effective planning, coordination and implementation of appropriate risk mitigation measures addressed at individual and population levels.

Note to editors

The integrated measles and polio campaign in Banadir is being conducted by Somali health authorities, with technical support from WHO, UNICEF and other Global Polio Eradication Initiative (GPEI) partners, and national and international partners, including Gavi, the Vaccine Alliance.

Facing a virus while setting up data systems to fight the virus 

18 August 2020 – “You’re not a laboratory expert! Why do you have to go to the laboratory during these pandemic times?” Samira asked her husband, Mohamed Yare, with a hint of agitation in her voice.

Thirty-one-year-old Mohamed Yare, who serves as WHO’s National Polio Surveillance Data Manager, half-chuckled and tried to explain to his wife that he was only providing support to the Ministry of Health in Somalia in the development of a COVID-19 data collection system. This system would be integrated into the surveillance and information management system, while enhancing information management at the laboratory level. Even though the country has a functioning health management information system, and is now piloting a district health information system (DHIS-2) in some regions, they required technical support to include COVID-19 in their surveillance systems. He explained further that if this worked out, the database would help the Government to key in, track and monitor information about people infected with COVID-19.

Being deployed to support Somalia’s data teams

Early one morning, in April 2020, when the polio programme team lead from WHO Somalia called Yare to request him to help develop a COVID-19 database for Somalia’s Federal Ministry of Health, Yare knew he had an important task ahead of him. And yet, this job came with its own risks. As the Ministry of Health had difficulty in accessing surveillance data, it was thought that information related to all “suspected” cases could be collected from the central laboratory in Mogadishu, as samples for these “suspected” cases were sent there for COVID-19 testing, with some accompanying epidemiological information that could be used to generate a standard national line-list for COVID-19. However, working in Mogadishu’s National Public Health Laboratory and training data personnel based there meant that Yare may be exposed to the risk of contracting COVID-19.

On 14 April, Yare started his new mission to help the Government set up the database for COVID-19. Before heading to work, he collected his personal protection equipment (PPE) for the week, including several masks and gloves, from his colleague and friend, Hirsi Shire Hussein, Logistics Assistant from the WHO country office in Mogadishu. Once he was fully kitted, Yare set off to support in designing the database and, eventually, help train 8 data entry teams to use it.  

After reflecting on the situation carefully, Yare packed his clothes into a bag, deciding to forego the comfort of his home and family to check into a hotel nearby, while he worked at the laboratory. This decision would minimize the risk of Yare carrying home any viruses or infections to his wife and 2  young sons. After all, he knew that the COVID-19 virus was known to ‘live’ on clothes, phones and laptops.

On 23 April, at the start of Ramadhan, Yare’s mother called him to wish him well.

“Allah will protect you, but don’t forget to say your prayers,” she said to her conscientious son.

Comforted with his mother’s familiar voice, Yare beamed, and promised to say a longer prayer every day for his health and protection.

Fears turning into reality  

When he felt a little feverish during the second week of his new mission, Yare’s shoulders sank as he realized his fears may be turning into a reality. As soon as he felt a fever coming on, he rushed to the laboratory he was serving and asked his new friends to run a COVID-19 test on him. Within a few days, he received his results – his fear turned out to be true as he tested positive for COVID-19. In his heart, he wondered how his family would react.

Yare immediately self-isolated in the hotel where he had moved to during his mission. As soon as Samira found out about her husband’s results, she insisted she wanted to visit, but Yare convinced her to stay at home – safe and away from him while he self-isolated. He promised to update her every day about his condition, and assured her he was receiving good food at the hotel, in disposable containers, to minimize the risk of spreading the virus to anyone else.

Yare began to take paracetamol for his fever, and what he believed he should start to do – take warm water with honey and lemon every day, to give him some relief, and help boost his immunity. Within a week, Yare felt much better. He credits his family and friends for helping him to get through this time. Many of them called him every day and talked for hours to keep him company. Yare was one of the lucky ones – he didn’t have to face any social stigma because of his condition – while knowing that a new disease like COVID-19 could be a sensitive topic in many parts of the country and world.

Within 20 days, Yare went for another test, which was negative. After his test results were negative, Yare was reassured he could get back to work and meet his family again.

Databases helping assess COVID-19 information and track epidemic progression

Thanks to the support that Yare and his partners with expertise in data management at the Ministry of Health provided, Somalia’s Ministry of Health and Government were in a position to analyze information on how many people were infected or died from COVID-19. Data on COVID-19 are shared from the Banadir Hospital, De Martino Hospital and other health facilities.     

To date, Mohamed Yare still provides support to the Ministry. He receives calls from teams working on the COVID-19 databases, asking for advice on how to deal with mistyped user names and forgotten passwords, for instance. Yare is one of the important links between Somalia’s Government and WHO – he shares daily updates on the COVID-19 situation between the Ministry of Health and WHO, supporting their efforts to jointly monitor and address the COVID-19 situation.   

“I am so happy that I got a chance to help my country in some way during one of its critical junctures,” said Yare, with a big smile. “And the best thing for me is that my wife, mother and children are so proud of me and the work I have done, and I continue to do until now.”

Note:

WHO ensures that polio field team workers and other frontline workers are provided with PPE in their day-to-day fight in the COVID-19 response, in addition to other routine duties they conduct. WHO remains proud of and grateful to the health workers who risk their lives every day to provide health services to the people of Somalia.