10 June 2020 – Somalia continues its fight against COVID-19 which has so far infected over 2300 people and killed 83. The fragile and weakened health system is being overwhelmed by demands for patient care in light of the pandemic, and Somalia has recorded the highest death toll among East African countries.

The surveillance system’s ability to rapidly detect, trace, track and test cases is being challenged. In the absence of a functional disease surveillance system in the country, the Early Warning, Alert and Response Network (EWARN), established in 2008 and reactivated as a web-based electronic early warning system for disease outbreaks in 2017, has been expanded to early detect suspected cases of COVID-19 in in both primary and secondary level health care centres across the country.  

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WHO has been supporting this expansion through adding new health facilities, especially those in the private sector, to the reporting system of EWARN. Within the next couple of weeks, WHO plans to roll out the EWARN system to an additional 230 health centres from the current existing 533 reporting sites. The system reports on 14 epidemic-prone diseases on a weekly basis and by 2019, an estimated 6.5 million people, including 2 million internally displaced people, were covered by the EWARN system. With this expansion, COVID-19 will now be a reportable health condition in Somalia.

The expansion of EWARN relies on knowledge and skills of health care workers on the correct use of case definition and use of threshold values for generating alerts. Currently, a mobile app is also used to report on any suspected case of COVID-19 or any other reportable health condition in real-time, edspecially in security-compromised areas. Last week, the WHO country office conducted training of health care workers in the capital city on surveillance for COVID-19 as part of EWARN expansion. The health care workers were trained on reporting, as well as on tracking alerts using the mobile application.

In May, 127 health care workers were trained by WHO as part of the EWARN expansion programme and 50 additional health facilities have been added to the reporting system. Data from the EWARN surveillance system are regularly analyzed to better understand the progression of the disease at both national and sub-national level and monitor the effectiveness of ongoing public health interventions to combat and contain transmission. The WHO country office has also mobilized an additional 65 rapid response teams who regularly verify and investigate all alerts reported from the EWARN system. EWARN in Somalia, apart from proving its value as a real-time early warning system is the main building block in the country now for the collection, analysis and reporting of suspected cases of COVID-19.

Somalia EWARN success

Mogadishu, 1 June 2020 ‒ The Delegation of the European Union (EU) to Somalia conducted another special flight for WHO in Somalia to airlift lifesaving medicine and other emergency hospital supplies to Jowhar, Kismayo and Baidoa ‒ areas recently affected by flooding caused by heavy rainfall. These WHO emergency medicines and medical supplies will be used for augmenting emergency health care for people affected by the recent floods. Previous EU-operated flights to the flood-affected areas took place on 20‒21 May 2020.  

The flights delivered 9144 kgs of supplies of oral rehydration solution, cholera saline and other emergency medicines for patient care, benefiting approximately 2000 individuals over the next 3 months.

Heavy rains are predicted for the remainder of June. The emergency supplies will support emergency health care for cholera and other waterborne diseases for the vulnerable populations of affected areas and also basic health care services in the areas long after the flood water recedes.

“The EU welcomes the opportunity to join forces and resources with WHO in Somalia,” said EU Ambassador to Somalia Nicolas Berlanga. “Somalia faces a confluence of health challenges, including the urgent task of responding to the COVID-19 outbreak. The recent floods that have impacted so much of the country will only complicate that effort. These are complex challenges that require enhanced coordination and rapid response,” the Ambassador added.

Dr Mamunur Rahman Malik, WHO Representative in Somalia, said, “As we continue to fight on all fronts against COVID-19 and now on reducing the health impacts of the floods, I thank the Delegation of the European Union for their generous support in providing the airbridge between the capital city and flood-affected areas for dispatching critical life-saving supplies, especially at a time when these areas are cut off from the rest of the country owing to lockdown and restriction of flights. Our collaboration with the EU will save lives and minimize the health impacts of these catastrophic events. This solidarity remains critical for Somalia besieged by so many health challenges”.   

This joint operation is part of a new bilateral coordination mechanism, established between the WHO country office and the Delegation of the EU to Somalia, which aims to strengthen operational response activities, including for COVID-19. On 3 May, EU flights also airlifted critical medical equipment and supplies from Mogadishu to Kismayo to support Jubaland state in tackling COVID-19. In addition, the European Civil Protection and Humanitarian Aid Operations (ECHO) recently provided US$ $1.8 million to WHO’s COVID-19 preparedness and response operations in Somalia.

Effects of flooding

Heavy rains and floods have affected about 918 000 people across Somalia, displacing 412 000 and killing 24 in 29 districts so far. Belet Weyne in Hiraan region is the most affected district after the Shabelle river burst its banks on 12 May and flooded 85% of the town and 25 riverine villages. Jowhar, another agricultural centre, has also been hard hit by flooding. International aid organizations have warned of potential outbreaks of cholera and other waterborne diseases due to overcrowding in areas where those who have been displaced are seeking temporary shelter.

Related link

WHO and EU unite to fight COVID-19 in Somalia

 For further information:

Mr Kyle Defreitas
External Relations & Resource Mobilization Officer
World Health Organization, Somalia
Mob: +254-782-501-324
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Ms Fouzia Bhatti
Communication Officer
World Health Organization, Somalia
Tel: +252619235880
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20 May 2020 – Somalia continues its fight against one of the most catastrophic outbreaks the country has ever witnessed. In spite of recurrent humanitarian emergencies, war and conflict, Somalia has successfully eradicated wild poliovirus and ended transmission of measles and cholera outbreaks in the recent past. However, the current outbreak of COVID-19 has exposed some of the gaping holes and weaknesses in its health system to fight and respond to an outbreak of this magnitude and scale where human-to-human transmission can go unabated and the potential for cases to double in a week if the health system is not able to rapidly trace, track, test and treat those infected with the virus who remain undiagnosed and undetected.

WHO has been supporting Somalia since the beginning of this outbreak to enhance its testing capacities. As the country lacks a proactive testing strategy for COVID-19, the number of cases has continued to rise since late March when local transmission was first identified. The country has not been able to trace back the sources of infection of these locally-transmitted cases. This resulted in a widespread cluster of cases and many of these people did not know that they were harbouring the infection until it was too late.

Owing to societal norms, cultural practice and high population density in major urban cities, such as in Mogadishu, self-isolation and quarantine have been a real challenge. This resulted in active transmission in households, which has infected a large number of elderly people living in those same households. Recent data suggest that although the elderly population (above 60 years) comprise of only 1–2% of the entire population in the country, they are disproportionately affected bearing over 12% of the burden of infection from COVID-19.

Recently, the majority of deaths that have occurred in De-Martino hospital, the major hospital in the capital Mogadishu city for treating COVID-19 patients, are all elderly patients and people with chronic health conditions who have been infected at home by other family members. In the last 3 weeks of May, more deaths were reported (35/57: 61%) than compared with both March (4/57; 7%) and April (18/57; 31.5%) combined.

As of 19 May 2020, the country has reported 1502 cases, including 59 associated deaths. Among East African countries, Somalia has reported the highest death toll. The majority of deaths have occurred in the 60–70 year age group. 

The De-Martino hospital is equipped with 20 intensive care units. WHO has trained the health care workers of this hospital on case management and infection control measures. WHO has recently donated a number of critical hospital and medical supplies to this hospital for patient care. WHO is also assisting the hospital to automate its patient registration system for COVID-19 so that better quality data and other key information on patient’s survival and deaths can be recorded and analysed in real time to aid data-driven decisions for operational response. A number of other agencies like the United Nations International Office of Migration (IOM), the United Nations Population Fund (UNFPA) and USAID have donated hospital supplies and personal protective equipment for health care workers in the hospital, a sign of solidarity from all agencies to support a country facing one of the worst outbreaks in its history. WHO is also supporting 13 other isolation centres across the country with medical supplies, training of health care workers and budget support for salaries.

While Africa is potentially the next epicentre of this pandemic, it is critical to extinguish the outbreak in Somalia as the country’s weakened health system and infrastructure is no longer able to absorb the shock of this public health crisis. WHO continues to support the country with whatever resources the Organization has in the areas of improving coordination of operations response, surveillance and case detection, case management and risk communication, So far, only 26% of WHO’s urgent appeal of US$ 21.95 million for emergency response to COVID-19 in Somalia has been funded.