Somalia: displaced families show extraordinary strength and resilience
In Somalia, protracted war has forced millions of people to leave their homes in recent years. The Somalia Red Crescent Society offers primary health care services to many displaced families. ICRC medical officer Hawa Musse talks about some of the challenges the IDPs are facing.
What are some of the health challenges displaced people in Somalia are facing?
In Somalia, there are numerous challenges displaced families, and especially women and children, are facing. A lack of basic resources like water has created cases of infectious diseases like diarrhoea and scabies especially in the camps for displaced people (IDPs). Nutritional deficiencies for both mothers and infants are very common and communicable diseases like cholera have been on the rise. Mothers also face the challenge of high infant mortality when they are not able to access clinics where their children can get treatment and immunization. Pregnant women often do not attend antenatal clinics, which leads to complications during childbirth, because they do lack basic health education. The situation is deteriorating due to the ongoing armed conflict, scarcity of medical personnel and harsh climatic conditions.
How do displaced families who no longer have the support of their male breadwinner cope with the situation?
Many Somali women have lost their husbands and eldest sons who either died or left home to become fighters. Often they find themselves alone with several children and relatives to look after. Traditionally, women are not used to being the breadwinners of the family. Many women struggle to provide for the physical needs of the family, but some are also running businesses selling ba sic commodities. In the camps, women collect firewood, do laundry and carry water for others who have a little money to spare. A few of the displaced families are fortunate enough to collect remittances from relatives abroad, but these are the minority and even then, they have to share their meagre income with other relatives.
Despite the hardships, many displaced women heading households work very hard to provide for their relatives and ensure they get at least one meal a day. Many of them are grandmothers who remain the sole caregivers in families. They are often overworked and suffer from nutritional deficiencies, as only on rare occasions do they get sufficient and balanced meals for the whole family. When they do, the children take priority and it is common for mothers to go hungry. Life is especially difficult for those who have no work and have to rely on neighbours for support.
What support can the Somali Red Crescent (SRCS) give these displaced families in terms of health?
The SRCS runs 36 health clinics in southern and central Somalia, which are supported by the ICRC. These clinics offer free primary health care programmes in the area of Mother and Child Health (MCH), outpatient departments (OPD) or curative services. In Mogadishu south, in the area of Afgoy and Daynile, there are 6 MCH and outpatient clinics for displaced families. Each of the clinics has a mobile outreach team. The mobile teams can reach the sick in the villages who do not have the money to pay for transport or private clinics. Further, accessibility to the clinics can be an issue, as there are many roadblocks on the way that can prevent patients from coming to get help. However, the people in the area know where to find the nearest clinics. Many new patients are those who were referred to the main clinics when the mobile unit visited their area.
Two new h ealth posts were opened in north Mogadishu in response to population displacement and subsequent lack of access to health care. Both have reported an increase in the number of patients seeking treatment. Currently there is no MCH component, but this could change if needed.
The ICRC provides drugs for the clinics, financial support and staff training for the volunteers. We train and support midwives and traditional birth attendants (TBA's) in the detection of pregnancy related risks. The focus is on regular antenatal care and clean, safe deliveries. Post-natal visits are conducted by the mobile teams to ensure continuation of care for the mother and infant with focus on breastfeeding and immunization.
Has there been a change in community practices following the intervention of the SRCS?
There has been a huge change, which is a combination of the work achieved by the health workers within the communities. Before, for example, Somali women did not see the need to bring their children for vaccinations as clinics and health workers were foreign concepts. However, there are those who understood the benefits of health care and had their children immunized. In their interactions within the villages, the mothers whose children were healthy and surviving began telling the others about the benefits of taking children for vaccinations. With time, they urged the others to come to the clinics and seek treatment. We worked with these women encouraging direct interaction and building trust. Infant mortality rates are going down because of the women in the community who advocate for proper health practices. In addition, the SRCS clinic staff, who are mainly volunteers, are reaching even those displaced families living in remote villages and getting them to go to the clinics for treatment.