Operational update about current MSF activities in Somalia and the region
In this Update
- Kenya (Dadaab camp)
- Ethiopia (Liben camp)
Conflict, violence and lack of humanitarian access have been the reality for millions of Somalis over the past 20 years, and are exasperating the current nutritional crisis in Somalia. This extremely worrying nutritional crisis comes as a consequence of drought, war, high cereal prices, cattle mortality and restricted humanitarian access. Fighting and violence continues today in Mogadishu and Al Shabaab areas. Somalis are fleeing to neighbouring countries in huge numbers. Balcad district (Middle Shabelle) has been classified by FEWS/FSNAU as a famine situation. MSF operates an OPD with observation room in Balcad, but has not noted any significant increase in medical data. The team in Jowhar is monitoring the situation and planning to meet with Balcad authorities to clarify the situation and identify the areas most affected. Does MSF agree with the UN declaring this a famine? MSF cannot confirm or deny this. MSF is not present in sufficient sites to allow it to perform the kind of survey needed to establish the exact level of the crisis (such as household surveys). Therefore, MSF is not able to comment on the figures given by the UN regarding the definition. However, what MSF can say is that our teams witness continued high levels of malnutrition in its projects in Marere, Guri El, Dinsor and Galcayo. MSF is extremely worried about the situation in Somalia and the Somali population is in urgent need of more aid. MSF hopes that it will gain more access to various regions in Somalia soon. We also hope to be allowed to resupply our projects by air, and send in much needed technical staff.
- MSF is currently treating over 5,000 people in various elements of its therapeutic feeding programmes inside Somalia.
- In Hodan, Mogadishu South , the intensive therapeutic feeding centre (ITFC) is still running. Since opening, a total of 162 patients have been admitted. There are currently 46 patients and there is the potential to extend capacity to 150 beds. An ATFC has also been set up in a camp in the south of Mogadishu, so far a total of 273 patients have been treated in the ATFC. The team is screening malnourished children (for weight/height) and referring the most severe cases to the ITFC. A 50-bed cholera treatment centre opened on 22 August in which 52 patients have been admitted so far. Since 8 August, two mobile clinic teams have carried out a vaccination campaign against measles in dozens of makeshift camps where people fleeing the drought and ongoing conflict in Somalia have gathered. Relief items like soap and plastic sheeting are also being distributed. Since 8 August, 14,072 children have been vaccinated against measles.
- In Darkheley, Mogadishu South , MSF is running an OPD (361 consultations this past week), and a nutritional programme (54 children currently in the ATFC); the OPD has possibility to develop ITFC capacity.
- In Wadajir, Mogadishu South , a new health centre opened on 27 August, with SC/ITFC (25 beds), IPD/observation room (6 beds), OPD, cholera preparedness (CTU) and measles isolation. Measles vaccination (targeting IDPs) + Vit A + MUAC/oedema + deworming was completed in Halaane section of Wadajir, and is currently ongoing in Timo Xade section. So far, 3,740 children (6 months to 15 yrs) have been vaccinated against measles. Plans are to complete Wadajir district and then carry on vaccination in Dharkenley district.
- In Marere , the team has scaled up the capacity of the ITFC which is now able to accommodate 200 children. However, the number of children admitted to the ITFC has decreased from 103 two weeks ago to 84 now. The ATFC has started to admit children up to eight years. Screening of pregnant and lactating mothers will be organised.
- There has been a cholera outbreak in the concentrations of IDPs in and around Marere . So far there have been eight confirmed cases. MSF is treating cases in an isolation ward and assisting the Somali Red Crescent with preventive measures such as hygiene promotion and chlorination of wells. MSF has also treated over 60 cases of measles since an outbreak occurred among displaced populations around Marere. Current figures: ITFC: 84 ATFC: 843 (Marere + 3 locations).
- Small numbers of IDPs continue to arrive in Jilib, near Marere, so far over 1,000 families have found refuge in the town. MSF has distributed NFIs and new distributions are in the pipeline. An MSF mobile clinic and ATFC are addressing the medical needs in Jilib as well as for other displaced people and residents of surrounding areas.
- In Galcayo , malnutrition patient numbers are rising in both projects (Galcayo North and South). The ATFC is now admitting children up to eight years and screening of pregnant and lactating mothers will be organised. Two mobile ATFCs have started. Current figures: 98 in ITFC and 650 in ATFC for Galcayo North and 116 in ITFC and 229 in ATFC for Galcayo South.
- In Galgaduud , Guri El’s 80-bed Istarlin hospital is operating above full capacity, with a marked increase in the numbers of malnourished patients. Other MSF activities in this structure include outpatient services for adults and children and inpatient services including a paediatric ward, a female ward and an operating theatre. MSF also runs two health posts; one in Hindere and one in Dhusa Mareb. MSF is scaling up activities in the region through boosting the capacity of the paediatric and maternity wards of Istarlin hospital, in addition to putting in place mobile nutritional programmes in locations like Hindere, in order to address the increasing needs in the region.
- In Guri El MSF teams continue to distribute relief items and clean water to to around 2,500 families of Internally displaced people in the area. Six different mobile feeding programmes have been launched, following an assessment that revealed humanitarian needs among the community of displaced people in the town. We are currently treating 201 patients in the six new ATFCs and 293 patients in the existing ATFC.
- In Dinsor admissions to the nutrition programmes are decreasing. However, admission figures are still much higher than compared to last year. The movement of population in the area may explain this reduction.
- In Belet-Weyne admissions to the nutrition programme are increasing.
- In Jowhar, MSF runs its regular maternity programme (Jowhar) plus four health centres (Jowhar, Mahaday, Gololey, Balcad). Activities include: CEMOC (Comprehensive Emergency Obstetric Care), TB, OPD and nutritional programmes (ATFC and SFP). There were 2,127 consultations carried out this week and over 600 children in the nutritional programme at the end of the week (including ATFC, SFP and ITFC). Nutritional figures remain high but stable. Measles trend is on the increase (approx. 60/month), and vaccination campaigns are still being denied by Al Shabaab. AWD cases are on the normal trends (average <5 300/month), with no cholera cases confirmed.
In Daynile hospital, in the outskirts of Mogadishu , activities continue. The area is in an Al Shabaab zone and the project has received more than 1,200 war-wounded patients since the beginning of 2011. This week MSF has received 13 war-wounded patients. Measles and AWD admissions are increasing on a weekly basis. Current figures: 62 AWD and 30 measles admissions.
- In Jasiira and Rajo camps , MSF continues to do measles vaccinations in the two camps (located south of the international airport). The target population is children between 9 months and 15 years. MSF have also began to offer outpatient consultations at Jasiira and also itinerant nutritional activities, which appear to have got off to a satisfactory start. Current figures: more than 1000 children have been vaccinated; 746 consultations have been done (mainly respiratory infections, skin infections and anemia); 73 SAM in ATFC + 12 in ITFC.
- In central Mogadishu, OCG teams have setup a 60 bed capacity ITFC which currently has 41 patients. The ATFC has 840 and teams have vaccinated more than 7000 children against Measles.
Since July approximately 50,000 people have arrived in Dadaab in search of humanitarian assistance and safety. As the camps were already full, most of the newly arrived refugees have been forced to settle in the outlying areas of Dagahaley, Ifo and Hagadera camps. These families, camped out in the desert, are living in very difficult conditions with limited access to water, shelter and food and with poor hygiene. MSF has responded by increasing its activities in order to cope with the rising needs. The trend of daily arrivals has now reduced from a maximum of 1,800 people per day to an average of 1,200 people per day (UNHCR, Health sector update, 19 August). The capacity to register new arrivals at the camps keep increasing which is beginning to reduce the backlog in registration accumulated since June, before the sudden influx of new arrivals began. By 28 August the registration capacity rose to 8,500 people per week. As the government of Kenya lifts the ban placed on the relocation of refugees to the Ifo extension camps, the UNHCR continues to relocate refugees from the Ifo and Dagahaley camp outskirts into the Ifo extension camp. By 23 August the Ifo camp extensions hosted 24,574 people (19,719 in Ifo 3 and 4,855 in Ifo 2).
The almost 417,000 people living in the camps and their outskirts are experiencing an ever-shrinking access to essential services such as water, sanitation, food and shelter, exacerbated by the fact that many have been sharing their rations with the new arrivals. At the current pace of new arrivals MSF estimates that the camp’s population will total 500,000 before the end of 2011, and living conditions are only expected to deteriorate further. Without a long-term solution in sight, MSF is deeply concerned about the fate of the hundreds of thousands of people who have sought refuge in Kenya due to the ongoing conflict in Somalia combined with a looming nutritional crisis after several years of drought.
- In Dagahaley MSF is currently treating over 12,000 patients in various components of its nutritional programmes (2,800 in ATFC; 200 in ITFC; 9200 in SFP) and there are plans to begin a measles vaccination campaign. MSF water trucking is continuing to provide around 143 000 litres per day to refugees in Dagahaley.
- MSF teams are currently providing primary health care to refugees settled in the Ifo camp outskirts (estimated population figure above 20,000 people) as well as inside the newly opened Ifo extension camps. This consists of: 1 health centre in Ifo outksirts; 2 mobile clinics in Ifo extension camps; 1 consultation post at the reception site for relocated refugees in Ifo extension camps.
- In Liboi, located at the Somali border, 80 km from Dadaab, MSF continues to work in a health centre based in a reception camp for new Somali refugees, which also provides healthcare for Kenyans. The teams are doing consultations for new arrivals who cross the border before reaching Dadaab.
The influx of Somali refugees is due to an extremely worrying nutritional situation in Somalia as a consequence of drought, war, high cereal prices, cattle mortality and restricted humanitarian access. Somalis are fleeing to neighbouring countries in great numbers. The roots of the crisis are related more to a neglected failed state than to the El Niña/rain shortfall effects. Refugees mostly arrive through the town of Dolo Ado in Liben region where there are now four refugee camps; Bokolmayo, Malkadida, Kobe, and Hiloweyn. After arrival, refugees first go to the pre-registration camp and then to a transit camp. Initial MSF nutritional surveys suggest very high numbers of malnutrition in Kobe, Hiloweyn and the transit camp. According to UNHCR, more than 78,000 Somalis have arrived in Ethiopia since the start of 2011, with new arrivals peaking during the summer months. Today, a total of 160,000 Somalis are seeking refuge in Ethiopia. Overcrowding and insufficient humanitarian assistance worsen their situation. Until the opening of the fourth camp, people were waiting in the transit camp for weeks rather than days. The transit camp was hosting far more people than it was meant for; instead of hundreds, it hosted up to 15,000. The delays in the construction of new camps led to bottlenecks in the transit camp, which led to limited access to humanitarian assistance: food, shelter and water. The situation should improve with the transfer of refugees to Hiloweyn camp.
- MSF is screening the new arrivals at the registration centre and in the transit camp, where medical assistance is most urgently needed at present.
- Most camps are overcrowded (originally designed for 45,000 people and now hosting 160,000) and humanitarian organisations are struggling to meet the needs of the tens of thousands of people who have arrived over the last months. Malnutrition is a serious issue and a number of cases of measles have been reported in the camps. MSF has carried out a mass vaccination campaign (14,000 people vaccinated) in Kobe camp and the transit camp in order to reduce the risk of infection. The precarious situation of water and sanitation and insufficient shelter over past months has contributed to the deterioration of the health status of the population. Many children have died of severe dehydration and severe respiratory infections. MSF provides curative and preventive health services in Kobe and Hiloweyn camp health centres and continues carrying out nutritional programmes in all refugee camps as well as supporting a health centre in Dolo Ado town.
- The UN recently issued a press release saying that every day 10 children under five dies of measles in Kobe camp. MSF cannot confirm or deny this figure. This is the result of a UN assessment. What MSF can say is that the situation in the camps of Dolo Ado is critica and measles infections remain a huge concern to MSF, and to fight the potential risk of measles spreading MSF has begun vaccinating children at the transit centre.
- At Bokolmayo, Malkadida, Kobe and Dolo Ado MSF continues to provide primary healthcare to the refugees, exhausted on arrival and affected by respiratory diseases and diarrhoea. Protective and discharge rations were distributed to the families as well as blankets (on admission) and soap (weekly). MSF is delivering an average of 200,000 litres of good quality water per day through the water plant in Malkadida. Apart from supplying MSF health structures, the water plant is also contributing to water supply in Bokolmayo, Malkadida, Kobe and Hiloweyn camps.
- It is estimated that in the past six weeks the population of the Hiloweyn camp has grown from 0 to 17,000 refugees and there are still 3,000 people waiting to be transferred, which should be complete in the coming days. The people who have been transferred from the transit camp to Hiloweyn camp are in a dire condition, particularly those who were waiting in the transit camp the longest. Since activities started in Hiloweyn camp on 5 August, MSF has been monitoring the nutritional situation. From the refugees who have already been transferred from the transit camp to Hiloweyn camp, one out of every three children is severely malnourished and is being admitted to the programme. These are extremely high malnutrition rates. Currently there are over 1,600 children in MSF’s ATFC. The inpatient facility of the health centre and the stabilisation centre is up and running with 24-hour care since 17 August. Two weeks ago the team started up the ITFC and IPD. Current figures: ITFC 10; measles isolation: 4.
- Other MSF activities in Hiloweyn camp include OPD for emergency cases only (around 450 consultations per week); IPD where some 40 children are currently being nursed; reproductive health services; a mental health project; and a measles outbreak response (measles infection remains a huge concern, with over 20 suspected cases identified in Hiloweyn camp this week). However, the measles epidemic that hit the Liben camps, of which Hiloweyn is one, is subsiding since MSF started vaccinating refugees before they are transported by bus from a transit camp to Hiloweyn. Every day, 200 to 300 children are being vaccinated against measles while before being transferred from the transit camp to the new camp. The main morbidity seems to be chest and upper respiratory infections, diarrhoea and eye infections; also some suspected measles cases have been isolated.