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Somalia – MSF resumes activities in Dinsor, new project opens in Beledweyne In the following interview, Gustavo Fernandez, Head of Mission in Somalia for MSF Switzerland, expalins some of the challenges faced by MSF in bringing medical humanintarian action to the people of Somalia. He talks about the recent return of MSF teams to Dinsor and the newly opened project in the city of Beledweyne. » Listen to and watch Somalia: Geography of the forgotten photogallery The recent political developments in Somalia have changed the balance of power in Mogadishu, but has anything changed for ordinary Somalis as far as access to health is concerned? In fact, nothing has changed. Most of the time, access to health services remains extremely difficult, if not impossible, for the Somali population. The complete lack of public health services has led Somalis to depend on the assistance provided by non-governmental organizations (NGOs), which is far from sufficient since NGOs cannot guarantee a permanent presence most of the time. This assistance is largely concentrated in the north of the country, leaving the populations of central and south Somalia under inhumane living conditions. You have recently returned to Dinsor where you assessed the activities of MSF in the local health centre. What is the situation in the area and what are the main challenges ahead to address the needs of populations? As we returned to Dinsor, a malaria outbreak was just starting. More than 100 people per day are currently treated in our structure. Trucks full of patients are coming from the surrounding villages. All our medical staff is making extra efforts to cope with this situation and all of us have joined in the medical consultations due to the huge amount of patients that require immediate attention. Besides the malaria increase, we have also noted an increase in child malnutrition, which only reflects the fragile health status of the immense majority of children in Somalia. One of the most difficult challenges is to meet the enormous needs of the population. We have increased our activities on a monthly basis as we have faced one emergency situation after another: drought, floods, malaria, armed conflict. Sadly, I must say, it seems that the Somali people have not been given a rest for a long time. Of course, our permanent presence will always be a challenge and a need. We have been forced on numerous occasions to evacuate due to security reasons. The last time was in December 2006, and we had to leave our Somali colleagues behind to address all the medical problems and needs of patients in an area where MSF remained on the ground as the sole health services provider. On our return to Dinsor, just 7 days after the recent armed conflict ended in the area, there was again a complete lack of international presence in the region to assist populations. Do you think that the recent military and political developments will push the very few international NGOs present with expatriate staff (such as MSF) to review the way they work in Somalia? I think that all NGOs providing humanitarian assistance must review permanently the way they implement their activities and the means they use to conduct these activities, and always remember the very basic principles of humanitarian assistance. This assistance is meant to be delivered on the basis of needs, independently from any political, military, or any other agenda. On this issue, we have a few very recent unhappy examples such as the US air force dropping non-food items to Somali refugees and to Kenyan villagers in northeast Kenya at the request of UNHCR and CARE. Or in Ethiopia, where the US military similarly airlifted supplies for villagers affected by flooding in the Ogaden region at the request of the International Rescue Committee, a US-based NGO. In the end it reinforced the perception in Somalia that humanitarian aid is not independent and not delivered solely on the basis of need. This practice of independent humanitarian assistance has been vital for MSF in order to maintain an on-the-ground presence of international volunteers when no other agencies could. It also enabled us to run activities under some really challenging conditions. MSF has worked relentlessly to build this independence from all political and military actors. It included securing our own logistic support, engaging with all the actors, focusing on the quality of our work as well as securing access to places where neither the UN nor ECHO or other NGOs were flying. This is the case for our two projects; in Dinsor as well as Beledweyne, the airstrip has been closed to those agencies but remains accessible to MSF due to the means used (privately chartered flights). The expatriate team has just returned to Dinsor. How difficult will it be to resume activities in the area, particularly the outreach work in villages outside of Dinsor? The team in Dinsor is facing a great challenge and has to cope with all the current needs. Specifically, the outreach activities would be very difficult to resume at the moment, due to the instability of the context, the increase of the road banditry and the constant military movements in the area. We are considering the possibility however and we are working at obtaining assurances of support and security from local and national authorities, along with the possibility to run fully and independently our operations as soon as possible. MSF recently started a new project in the city of Beledweyne. How different is that project from that in Dinsor, and what challenges do you expect the teams to be faced with there? Beledweyne is the capital of Hiran Region, which makes the city hospital the referral one not only for the region but also a referral health structure for populations living in parts of Galguduud region, eastern parts of Bakool region, and Ethiopian Zone 5 (Beledweyne town itself has around 60,000 inhabitants while the whole district has a population of 120,000; in Hiran the population is estimated at around 280,000 people). The medical needs do not differ much from any other place in central and south Somalia: respiratory infections are common, malaria and malnutrition are frequent causes of mortality, and there is a complete lack of secondary health care services in the area. For Médecins Sans Frontières, this is a massive new challenge. We need to build up, once more in this area, a proximity relation with the population, a humanitarian space, and reinforce the impartial, independent, and neutral sense of our humanitarian assistance. We expect this hospital to become a major health referral point in a very short term due to the enormous amount of needs that we have identified in the area. Read other articles on Somalia
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