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Somalia – “Ensuring a rapid medical response and cover basic health needs”
On April 17 2007, MSF launched an emergency medical response in Afgooye, Lower Shabelle Region, a town situated about 30 kilometers west of Mogadishu. Due to the insecurity that has been reigning in the area since the population displaced by the fighting in Mogadishu poured into the town, MSF decided to dispatch a team of senior Médecins Sans Frontières (MSF) Somali staff from Nairobi and the Dinsor Health Center to evaluate the needs of the thousands of displaced. Two months after the emergency assistance program started, and following a recent project visit by the MSF’s Nairobi based medical coordinator Dr Monica Rull, we look back at the recent achievements and the future perspectives for MSF in that part of the war torn country. “ When the team first arrived, they supplied medicines to existing health structures and non-food items, including plastic sheeting and mosquito nets, to more than 3,500 families. Provision of clean water to the displaced was a priority as well and they put in place a water trucking system to cater for the massive needs of a population left with very little” says Dr Monica Rull following her first visit to the project form Nairobi where the MSF coordination team for Somalia is based. “ At the time, we had quite a few case of watery diarrhea. In fact, throughout April and May, we treated close to 150 suspected cases of cholera by setting up an isolated treatment center. We dispatched some senior Somali staff from our project in Dinsor hospital to contain the outbreak and assist the local medical team. While the majority of patients treated recovered, 4 patients died as a result of the outbreak. By the 6th week of intervention, the program came to an end.” The inpatient department (IPD) of Afgooye hospital is currently undergoing basic rehabilitation by MSF in order to increase the hospitalization capacity from 10 to 30 beds. Between 150 to 160 patients are seen every day at consultation. The target population in Afgooye approaches 60`000, including displaced people and residents. “Our activities also include the provision of primary health care, free of charge, to the target population through the set up of the OPD (Out Patient Department) and we also support case management of the patients admitted in the IPD. We have now reinforced our team by recruiting 2 new medical doctors from Mogadishu and we also brought an experienced clinical officer from our project in Dinsor” adds Monica. “We would all prefer to have an expatriate team physically present in Afgooye, but for the moment it is not possible due to the insecurity, the situation in the town is not stable enough. In the meantime, we will continue to do regular visits from Dinsor and Nairobi to support the team until we can have a permanent and complete team of expatriate volunteers in Afgooye.” In most MSF projects in Somalia, expatriate volunteers work hand in hand with Somali staff thanks to the recognized proximity of MSF to all local Somali actors in a spirit of neutrality and impartiality. On May 26th, MSF started a nutritional screening with MUAC (Middle Upper Arm Circumference) of all children between 6-59 months attending the OPD. “ The results of that screening have shown that some young children are at risk of falling deeper into severe malnutrition” says Monica. “The team in the field will start to do weight for height screening to all the children attending the OPD to have data that are more accurate. We must monitor the malnutrition rates since according to the information above mentioned, 30% of the children attending the OPD are moderately malnourished or at risk of malnutrition. We seem to be above the emergency threshold. The MSF intervention in Afgooye hospital also includes technical support to the sterilization process (using the MSF standard protocols) as well as support to the IPD structural organization. “We must improve basic practices that, in the end, make a real difference for the patients. The mortality rate remains too high at the moment, mostly related to surgical complications and the lack of an adequate set up. In the hospital, patients suffering from wounds and trauma represent close to 44% of all cases. There are also a lot of women suffering from obstetrical complications, so we have therefore decided to dispatch our expatriate midwife based in Dinsor to the area. Her objective will be to investigate further the general condition of female patients arriving at the hospital and set up the proper response within the hospital set up” adds Monica. MSF also opened another OPD in Hawa Abdi, some 17 kilometers East of Afgooye. In this OPD, MSF staff conduct close to 60 consultations per day. In order to reinforce the Hawa Abdi OPD and to ensure a doctor is present 24hours a day, and available for emergencies in Afgoye hospital, MSF has hired a third medical doctor. “The MSF OPD in Hawa Abdi clinic provides primary health care free of charge to an estimated target population of 15’000 internally displaced people (IDPs)” says Monica. “Some of those IDPs have been in the area since the early 90s, but the great majority of them are new arrivals who came following the violent clashes that took place at the beginning of the year in Mogadishu”. Some of the displaced people who fled to Afgooye have now returned to Mogadishu, but many are unable to return as they have no resources and the buildings that they were living in have either been destroyed or taken over. “However, there is a considerable percentage of the IDPs who were already former IDPs in Mogadishu, who were living in governmental structures and are not allowed to go back to those. This can explain that the number of IDPs going back to Mogadishu is quite modest (according to UNHCR, only 20% of the IDPs who came to Afgooye have moved back to Mogadishu). Should the marketplace activity in Mogadishu return to normal and the situation stabilize, we could see a number of them commute every day between Afgooye and Mogadishu and resume a “normal” business activity. But there is a potentially large scale human disaster looming if this unstable situation was to last. People need to feel they can build back a life for themselves and their families after this recent displacement. In the meantime, our job will be to ensure a rapid medical response and cover basic health needs of the people, displaced and residents alike” concludes Monica. » Read other articles on Somalia » Read about other featured projects
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