In Somalia and Somaliland, drought is worsening multiple health crises


Responding to massive displacement, malnutrition, measles, and other challenges

People living in Somalia and Somaliland are facing one of the worst droughts in decades after four consecutive poor rainy seasons. Failing crops and rising food prices, combined with ongoing insecurity and a massive invasion of locusts that swept across the Horn of Africa, have forced hundreds of thousands of people to move from rural areas to urban centers. They leave their homes with the hope of finding food, clean water, shelter, and health care. Many have sought refuge in camps for internally displaced people, yet these sites often have a lack of toilets, hand washing stations, and clean drinking water.

At the Doctors Without Borders/Médecins Sans Frontières (MSF) projects in Baidoa, Mudug, Jubaland, Hargeisa, and Las Anod, patients tell us that they need humanitarian assistance to survive. Many people describe their challenging journeys in search of help, with some walking for weeks, and losing family members while on the move.

“For 20 days we walked while carrying our children,” said a 75-year-old man who recently arrived at a camp in the Lower Juba region with his extended family. “We did not have a donkey to carry our children, so it took us 20 days to reach here. Our donkeys died because of the drought, and we had no money for a car. We came to Lower Juba because we heard that families who lost their livestock could get assistance.”

For many people, getting to a camp has not guaranteed that they receive food, water, or shelter. MSF staff spoke to 60 people in several camps, and most described not having access to safe drinking water.

“We walked for eight days, around 120 to 150 kilometers [about 75 to 93 miles],” said a 65-year-old woman currently living in a camp for displaced families in Afmadow. “Our livestock had died in the drought. We heard that an organization is distributing food in the camps in Afmadow. I was registered but have not received anything. I am waiting—everyone is waiting.”

“A series of crises, one after another”

The current drought comes on top of decades of conflict, recurrent climate shocks, frequent disease outbreaks, and increasing poverty in Somalia and Somaliland. And while the drought worsens, the country is also experiencing a massive outbreak of measles. Common and preventable diseases like measles and diarrhea have been leading causes of death among children here, and widespread water scarcity and food insecurity are creating the conditions needed for such diseases to spread fast.

“Somalis are facing a series of crises, one after another,” said Djoen Besselink, MSF’s country representative in Somalia. “Already we are hearing stories of desperation, with some people telling us they have faced the impossible choice of leaving one child to die to save others.”

MSF teams have seen close to 6,000 suspected measles cases from the beginning of the year to mid-May in multiple hospitals across Somalia and Somaliland. Vaccination rates among children in Somalia are among the lowest in the world, and the COVID-19 pandemic and widespread insecurity have hampered efforts to provide routine vaccination to children under five.

“In February, the hospital we support in Baidoa already treated more than 2,500 children with measles since the start of the outbreak,” said Bakri Abubakr, MSF’s program manager in Somalia. “Our 20 outpatient therapeutic feeding centers around Baidoa admit between 700 to 1,000 children per week.”

Baidoa also recorded its first cholera cases in April 2022. Malnourished children are three times more likely to die from the waterborne disease, and poor conditions in the overcrowded informal settlements across the city are creating the opportunity for its rapid spread. Baidoa's population used to be around 130,000 people. The city is currently hosting more than double that number of displaced people, with many families living in overcrowded settlements.

As the drought drags on and food insecurity worsens, our teams are already seeing extremely distressing signs of acute malnutrition among children. A lack of health care services and insecurity have made it difficult to evaluate the overall nutritional status of people in the region. But in February, our teams in Baidoa screened 81,706 children under the age of five. They found severe acute malnutrition rates of 3 percent, and global acute malnutrition rates of 17 percent.

“In one week alone, we admitted almost 1,000 children to our outpatient therapeutic feeding program in 20 different centers around Baidoa city,” said Bakri. “Thirty percent of the children were severe acute malnourished, indicating that we are far into an acute emergency.”

As more people move to urban areas to seek assistance, the limited public services available are overstretched. In Baidoa, the arrival of huge numbers of displaced families and the rising cases of cholera and malnutrition are straining the already struggling health care facilities in city.

“People find themselves caught in a downward spiral, which without a swift and sustained response will continue to exact a heavy toll on Somalis,” said Besselink.