SOMALIA DART SITUATION REPORT 3 - HEALTH

UNCLAS SECTION 01 OF 05 NAIROBI 000255

SIPDIS

AIDAC

AID/DCHA FOR MHESS, WGARVELINK, LROGERS
DCHA/OFDA FOR KLUU, GGOTTLIEB, AFERRARA, ACONVERY,
CGOTTSCHALK, KCHANNELL
DCHA/FFP FOR WHAMMINK, JDWORKEN
AFR/AFR/EA FOR JBORNS
STATE FOR AF/E AND PRM
STATE/AF/E FOR NGARY
STATE/PRM FOR AWENDT, MMCKELVEY
NSC FOR TSHORTLEY
USUN FOR TMALY
BRUSSELS FOR PLERNER
GENEVA FOR NKYLOH
USMISSION UN ROME FODAG FOR RNEWBERG

SIPDIS

E.O. 12958: N/A
TAGS: EAID PREF PHUM PREL SO

SUBJECT: SOMALIA DART SITUATION REPORT 3 - HEALTH
UPDATE

REF: NAIROBI 00206

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SUMMARY


1. The November-December floods raised concern that
Somalia would see an increase in cases of water-borne
diseases, malaria, and respiratory infections.
Additionally, recent outbreaks of cholera and Rift
Valley fever (RVF) have prompted Somalia health sector
agencies to coordinate response plans for a difficult
operating environment with limited access to vulnerable
regions, particularly southern Somalia. End Summary.

BACKGROUND


2. The UN Office for the Coordination of Humanitarian
Affairs (OCHA) estimates that there are currently as
many as 1.8 million vulnerable Somalis. The USG
Disaster Assistance Response Team (DART) is monitoring
the impact of recent flooding and conflict on this
population. This cable is an update on current and
emerging health care concerns in Somalia.


3. According to the 2007 UN Consolidated Appeals
Process (CAP) for Somalia, there are only 39 trained
doctors per one million people in Somalia, and the
doctors are unevenly distributed throughout the
country, largely concentrated in major cities. There
are as few as 141 qualified midwives, a contributing
factor to the high rates of infant and child mortality,
and the lack of certified and credentialed health
workers as well as literate Somalis to train in medical
skills remains a challenge. Since the collapse of
formal government health care services in the early
1990's, health care activities in south and central
Somalia have been implemented by a variety of
international and local non-governmental organizations
(NGOs),UN agencies, and international organizations.


4. The Somali Support Secretariat (SSS),formerly
functioning as the Somalia Aid Coordination Body
(SACB),coordinates agencies operational in the health
sector in Somalia, and supports the burgeoning
ministries of health in Somaliland and the semi-
autonomous region of Puntland. The SSS also
spearheaded the formation of health care policies and
treatment guidelines as well as leading various working
groups and task forces that monitor, assess, and
oversee health related issues.


5. With the formation of the UN "cluster system" to
enhance coordination, program quality, and
accountability, the UN World Health Organization (WHO)
has been designated as the lead agency for the health
sector. WHO is currently expanding its in-country
capacity to assist with acute health care
interventions. WHO assists health facilities by
providing supplies and equipment for hospitals and
coordinates the implementation of the health
information, disease surveillance, and communicable
disease response initiatives.


6. The UN Children's Fund (UNICEF) is the lead agency
for primary health care and nutrition support services
including assistance to NGOs implementing community-
based health care, maternal and child health clinics,
reproductive health initiatives, and supplementary and
therapeutic feeding programs. WHO and UNICEF both

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facilitate vaccination services.


7. The International Committee of the Red Cross (ICRC)
is a strong agency in the Somalia health care sector
that provides assistance to war-wounded, casualties of
conflict, internally displaced persons (IDPs),and
responds to large-scale communicable disease outbreaks
such as cholera.

RESPONSE TO FLOODS AND CONFLICT


8. The recent November-December floods raised concern
that Somalia would see an increase in cases of water-
borne diseases, malaria, and respiratory infections.
While reports provided by WHO indicate a decrease in
the number of cases of malaria, kala-azar, and measles
over the past two months, most agencies agree that the
apparent reduction is actually due to limited
surveillance and reporting as well as a drop in client
attendance at health facilities during the height of
the floods.


9. In early January, health facilities in Lower Juba
Region started reporting increased numbers of malaria
cases, according to WHO. In anticipation of increased
incidence of malaria due to heavy rains, WHO and
UNICEF, along with implementing partners, distributed
100,000 insecticide-treated mosquito nets, to
vulnerable populations in the flood planes and riverine
areas in Juba and Shabelle regions over the past
several months.


10. WHO supports 12 mobile health teams to deliver
basic health care to IDPs and residents cut off from
routine health services due to floods and conflict in
the south and central regions. However, the conflict
between the Council of Islamic Courts (CIC) and the
Transitional Federal Government (TFG) have disrupted
mobile health services in Lower and Middle Juba regions
since early January. WHO anticipates the teams will
recommence medical services the week of January 15.
WHO is currently exploring options to expand the number
of mobile health clinics to areas of south and central
Somalia, which have few functioning health facilities,
especially in the Lower and Middle Juba regions.


11. WHO facilitates the local purchase of medicine and
supplies to fill gaps and maintain buffer stocks in
Wajid and Mogadishu. WHO, UNICEF, ICRC, and Medecins
Sans Frontieres (MSF) support hospitals and clinics in
south and central regions and all report having
adequate supplies and staff, according to WHO's recent
assessment of medical and surgical stocks. ICRC,
UNICEF, and WHO are waiting for airlift services to
resume and the Kenya-Somalia border to re-open to allow
overland transit to restock storage facilities in
Mogadishu, Wajid, Kismayo, Belet Weyne, and Galkayo
with essential drugs, health kits, and supplies that
have been depleted.


12. WHO has commenced operation of a Health Emergency
Operations Center in Nairobi, and is supporting an
emergency coordinator, communications officer,
logistician, information officer, public health
officer, epidemiologist, and security officer. The
staff will coordinate with OCHA as well as key UNICEF
staff to ensure all ongoing health services and
emerging health crises are adequately addressed.

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CHOLERA


13. In late December, WHO confirmed cholera in Kismayo
District, Lower Juba Region, followed by an outbreak in
Jilib District, Middle Juba Region. According to WHO,
both outbreaks are under control. A total of 90 cases
were treated at Kismayo Hospital with three deaths
reported. In Jilib, 120 cases were reported with three
deaths. WHO reports that both cholera treatment
facilities were closed the week of January 8, and that
both outbreaks have been contained. Health agencies
operational in these districts (Muslim Aid and MSF-
Holland) attribute the outbreak to contaminated water
sources and sanitation facilities destroyed by the
recent flooding. It is unusual for cholera to appear
during the rainy season in Somalia (although it is
endemic in the country).


14. On January 14, WHO reported an outbreak of cholera
(yet to be confirmed by biological test, but symptoms
are consistent with cholera) in Belet Weyne town,
Hiraan Region. WHO is sending cholera treatment
supplies, and the NGO International Medical Corps (IMC)
is coordinating specimen collection for testing and
plans to open a cholera treatment facility in Belet
Weyne town. MSF-Swiss, Save the Children-UK, and local
NGOs are also assisting in the region's cholera
response. A task force has been formed to organize
community mobilization, health education on cholera
prevention, early treatment, logistics, and
chlorination of water points.


15. WHO also reported 23 cases of suspected cholera in
northwestern Somaliland as well as in Saylac area
bordering Djibouti. UNICEF and WHO are sending
supplies and a joint response team to further
investigate.

CONFLICT CASUALTIES


16. WHO and ICRC are tracking the number of injured
seeking care at major hospitals in conflict areas as
well as monitoring the number of tetanus cases, which
are associated with trauma and combat injuries. WHO,
the ICRC, and MSF are the main health agencies
providing casualty assistance to 11 hospitals
throughout south and central Somalia by providing
medicine, health kits, surgical supplies, as well as
technical and logistical staff.


17. According to WHO, more than 1,000 conflict-related
fatalities have been reported to date, mostly occurring
between Mogadishu and Baidoa. The ICRC reports
approximately 800 people have been wounded in conflict,
although local reports suggest the number of wounded to
be between 2,500 and 3,000 people. The major problems
are reportedly bullet wounds, fractures, and post-
trauma complications such as sepsis and osteomyelitis.


18. As of January 11, WHO reports that approximately
120 war-wounded remain in area hospitals, mostly in
Baidoa and Galkayo. Accurate estimates of the total
number of casualties from the ongoing fighting in the
southern Ras Kamboni area are unavailable, although the
fighting is reportedly fierce.

RIFT VALLEY FEVER

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19. With the recent outbreak of RVF in northern Kenya,
it was inevitable that the disease would surface in
Somalia. According to the UN Food and Agriculture
Organization (FAO),the UN cluster lead for livestock
and agriculture, reports of abortions in animals, which
is a strong indicator of the presence of RVF in the
animal population, were received from Afmadow District
in Lower Juba Region the first week of January. WHO
received unconfirmed reports that seven people died of
possible RVF in Afmadow District and one person was
admitted to Kismayo Hospital on January 11, with
symptoms similar to RVF and died a short time later.


20. The week of January 8, WHO convened an emergency
meeting of all operational health and veterinary
agencies in Kismayo to monitor the situation and
distribute health education materials. However,
increased insecurity limited NGO staff movement,
although, as of January 14, WHO reports improved access
in the region. WHO has also assembled an outbreak
response team to investigate the reports and collect
the samples for confirmation. However, the flight
scheduled to transport the team to Kismayo on January
10, was canceled due to military activity in the
region. WHO is now arranging for biological samples to
be sent to Kenya for testing using local polio testing
networks. WHO and FAO have provided personal
protective equipment to health facilities in the region
as well as to teams collecting animal and human
samples.


21. On January 14, WHO received reports from Bardera
town, Gedo Region, that one person died with symptoms
suggestive of RVF. The patient was from Barowdindle, a
village about 35 km from Bardera. Three additional
suspected cases have been reported in Baraka village
outside Bardera municipality. These are the first
reported cases outside of Lower Juba Region. FAO has
received reports that up to 80 percent of small
ruminants in Bardera District are aborting.


22. FAO and WHO are expanding health education and
prevention activities to Gedo Region. WHO and FAO have
provided personal protective equipment to health
facilities in both regions as well as to teams
collecting animal and human samples. Radio networks,
including BBC Somalia, are broadcasting health
education messages on RVF, and clergy and local leaders
in all flood-affected regions are also providing
information to communities with high risk. UNICEF and
WHO have mobilized vaccination staff to engage in
surveillance and support prevention education campaigns
for RVF as well as record and forward field reports of
animal abortions to FAO.

CONCLUSIONS


23. Recent events in Somalia have not led to any
significant changes to the humanitarian priorities
identified in the 2007 CAP (REFTEL); the number of
beneficiaries and critical needs by sector remain
unchanged. Internal displacement as a result of recent
conflict was small-scale, localized, and short lived.
Interventions calling for non-food items, increasing
national and international staff, and purchase of
medical and trauma supplies are planned in the recent
UN appeals for Somalia. New and ongoing interventions

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in the health sector will focus on flood and drought
recovery and respond to emerging health crises such as
RVF.


24. Coordination among health and livestock sectors is
impressive, with multiple agencies communicating
through established networks, sharing resources and
staff, and establishing and implementing multi-agency
response plans to meet humanitarian health needs in
Somalia. While most coordination occurs in Nairobi, on
the ground communication and networking is also taking
place.


25. The DART will continue to monitor the health
impacts of the recent fighting and work with OCHA, WHO,
UNICEF, FAO, ICRC, and current USAID health sector
partners to report on the status of the suspected RVF
and other emerging health problems. Support to the
health sector remains a priority for all humanitarian
stakeholders in Somalia, in particular because an
already impoverished and vulnerable population has
little or no resilience left after repeated shocks.

RANNEBERGER