WHO Somalia/Fouzia Bano14 June 2022, Mogadishu – On 14 June 2022, Somalia rolled out the first round of a five-day campaign to vaccinate 934 511 people against cholera in nine high-risk districts that are currently facing ongoing outbreaks of cholera. The World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) are supporting the Ministry of Health and Human Services, Federal Government of Somalia, to conduct the campaign. Gavi, the Vaccine Alliance, is providing vaccines and funds to implement this life-saving intervention.

The oral cholera vaccination campaign aims to vaccinate people above one year of age, including pregnant women and internally displaced persons. It will be conducted in Hodan, Daynile, Dharkeneley, Wadajir, Jowhar, Baidoa, Afgoi, Wanlaweyne and Marka districts.

Since 2017, Somalia has witnessed several cholera outbreaks. These can be attributed to a large number of people having poor access to safe water and sanitation services, and natural hazards, including drought and floods, further exacerbated by protracted conflict and large-scale population displacement. Meanwhile, the ongoing drought in the country has had a grave impact on Somalis – while displacing over 770 000 people internally, it has dried up surface water sources and led to food insecurity in communities, which increases the risk of cholera infection as well as other waterborne diseases.

An estimated 49% of the population – 7.7 million people – require some form of humanitarian or protection assistance in Somalia, of whom 6.13 million are estimated to be affected by the current drought.

While cholera remains endemic in Somalia, and the current drought situation may have exacerbated the risk of a major outbreak across the country, vaccination against cholera with two doses given between 2 to 4 weeks apart is seen as a supplementary measure to stop the outbreak and control its spread. In addition, other proven and effective public health measures also prevent cholera transmission, such as maintaining good personal hygiene, improving access to safe water and practicing safe sanitation.

“To prevent cholera outbreaks in a sustainable way, we strongly advise affected communities to take two doses of cholera vaccine orally. In addition, we are urging our partners to assist us in improving access to water, sanitation, and hygiene facilities for vulnerable communities and the general public,” said H.E. Fawziya Abikar Nur,  Minister of Health and Human Services, Federal Government of Somalia.

“While we need to step up our collective response to cholera and other waterborne diseases, especially in the areas of case management, we have over 2100 community health workers deployed in 78 districts, including in 24 drought-affected districts. They are carrying out risk communication activities at the household level to promote safe behavioural practices and maintain basic hygiene at personal and household level even in these trying conditions. These community health workers are also ensuring that sick children with profuse diarrhoea and vomiting and other signs of dehydration are immediately cared for and referred to nearly health centres for further assessment or treatment. These public health actions are saving lives from preventable causes, as populations, especially children, are very vulnerable during these emergencies, owing to hunger, starvation and malnutrition,” added Dr Mamunur Rahman Malik, WHO Representative to Somalia.

“Parents and caregivers can take life-saving preventive measures for their children by taking them to get the cholera vaccine drops. Children are very susceptible to preventable diseases like cholera, especially with low access to water during this drought,” said Angela Kearney, UNICEF Somalia Representative.

“Together, we are ensuring that 1 869 022 doses of the cholera vaccines are readily available for the campaign while social mobilizers educate affected communities. Vaccination alone is not enough, preventive measures such as good hygiene and access to health care are important.”

As of 15 May 2022, 4887 suspected cases of cholera, with 16 associated deaths, had been reported from 21 drought-affected districts in Somalia. Around 62% of these cases were children aged below five years, while around half of the cases were females.

A second round of the oral cholera vaccination campaign will be conducted within a few weeks following completion of the first round of the oral cholera vaccination campaign. The populations that received the first dose will be targeted to receive the second dose during the next round of the campaign to boost the affected population’s immunity.

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For additional information, kindly contact:

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WHO Somalia12 June 2022 – At the busy Midnimo District Hospital in Abudwaq, a nurse and her two assistants take shifts to sit at a desk to assess the patients who come in. The nurse has been trained by WHO to deliver basic emergency care and to observe the patients and ask their caregivers or the patients themselves – if they can speak – key questions about their conditions. Dr Siyad Mohamed Abdi, a general surgeon who serves as the director of the hospital, and his medical staff come in during their shifts to oversee activities at the desk, known as the triage corner.

The hospital staff have witnessed several health emergencies in the Galgadud region, with the protracted conflict adding another layer of complexity to the mix. This means that mass casualties are a common sight.

With the ongoing drought, which has affected 6.13 million people in Somalia, and with Galgadud being a particularly arid region with no access to major rivers, additional patients are streaming in through the doors of the hospital. Every day, around 20–75 patients come in, sometimes from towns along the Somali and Ethiopian border. Many are so overwhelmed attending to their families’ dire needs due to the drought that it is often very late by the time they arrive for medical support.

Triage corners help staff to give urgent attention to those patients with emergency health conditions who need it first and the most. With assistance from WHO, the Federal Ministry of Health and Human Services and other partners, Midnimo District Hospital has been able to set up the triage corner to sort and prioritize patients with emergency health conditions that require urgent medical intervention. Progress is underway to set up similar efficient and effective triage corners in another 71 health facilities in drought-affected districts of Somalia, with equipment already delivered to most of the facilities.

One of the biggest lessons of the COVID-19 pandemic has been that safe access to health care that is close to home for early diagnosis and intervention, including targeted referral to higher levels of care for severe illness, is as important as specialized care at the higher levels of the health service delivery system. In this way, the resources of both the primary and secondary levels of care are optimized as a continuum of care within an integrated health service delivery system. This approach has been essential for maintaining essential health services during the recent drought.

The triage corners being set up within district hospitals will help to build the foundations for introducing emergency and critical care services at the primary health care level across Somalia. Emergency health conditions form a substantial proportion of the overall disease burden in the country and the drought may be exacerbating many of these conditions. WHO is supporting health facility preparedness and the building of a strong and resilient health system through the emergency response to the COVID-19 pandemic and the current drought.

Using triage corners to prioritize patients

While describing how things used to work before at the emergency ward at Midnimo District Hospital, Dr Mohamed explains, “Before, we would take in patients on a first-come, first-served basis, which meant those in need would wait unnecessarily for more casual cases to receive attention. These delays were sometimes dangerous.”

However, since WHO, the Federal Ministry of Health and Human Services and other partners intervened, Dr Mohamed and his team feel much better prepared to manage patients with emergency conditions. Between December 2020 and 2021, Dr Mohamed and two of his colleagues participated in capacity-development in mass casualty management organized by WHO with the support of the World Bank. Through this support, nurses, doctors and anaesthetists from around Somalia learnt how to organize and support patients as they arrive at health facilities through the establishment of a triage system.

Now, at Midnimo District Hospital, at the triage corner, the patients with the most serious conditions, or ‘red’ patients are admitted to the emergency ward. The ones who are able to wait — the ‘orange’ or ‘yellow’ patients — are escorted to the casualty ward.

“We are careful to screen and treat children, especially the under-5s, who are experiencing medical complications as a result of severe acute malnutrition and serious levels of diarrhoea, without delay. At the triage corner, we are ensuring they receive immediate attention, as they are so delicate and a few minutes can mean a matter of life or death,” added Dr Mohamed. He explained that children with these conditions were treated as ‘red’ patients.

The triage corner has helped Dr Mohamed and his team to be more efficient and organized, saving both time and lives, and limited resources. After seeing its benefits, he feels every hospital, particularly in an under-resourced country like Somalia, which has recurring health emergencies, should have triage corners.

Triage corners save lives

A few weeks ago, a family of eight rushed to Midnimo District Hospital with three young girls who were severely dehydrated. After assessing their dehydration status, the team at the triage corner informed Dr Mohamed about their serious condition, and they were admitted to the paediatric ward immediately. The doctor set up intravenous drips for each of them to receive infusions for rehydration, since they were severely dehydrated (category C). When he saw their condition, Dr Mohamed was not sure if they would survive but, as always, he tried his best to manage their conditions, keeping alive the hope he always has for his patients.

After a few days of managing their condition, the three girls were discharged. A few days later, their father returned with a goat. He explained that he did not have much to offer Dr Mohamed but insisted he accept the goat as a token of his appreciation for saving his daughters’ lives, despite Dr Mohamed attempts to persuade him that this was not required.

Dr Mohamed and his team were really touched with this kind gesture. He decided to sell the goat and bought supplies for other patients with urgent needs at the hospital.

Setting up triage corners in more hospitals

So far, WHO has collaborated with the Ministry of Health and Human Services to set up triage corners in two hospitals in the Galmudug State – in Abudwaq and Dhushamareb. WHO and the Federal and State ministries of health are working together to equip Midnimo District Hospital and other triage corners and emergency wards in hospitals with biomedical equipment. This includes oxygen concentrators, oximeters, stethoscopes, nasal cannulas and oxygen masks.

Progress is underway to set up similar triage corners in other health facilities in drought-affected districts of Somalia, and equipment has already been delivered to most of the facilities. Instruction in the use of biomedical equipment is currently underway.

“Thanks to support from the Central Emergency Response Fund (CERF), the European Union and WHO’s Contingency Fund for Emergencies (CFE), and other partners, WHO and the Ministry of Health have been able to save many lives by addressing the needs of patients who require life-saving, timely support. We are helping health facilities and their workforce to use efficient ways of working, such as triage corners, which have a high impact on saving lives. However, we still need additional support to scale up the capacity of more hospitals across Somalia to offer the same efficient services,” said Dr Mamunur Malik, WHO Representative to Somalia and Head of Mission.

For additional information on WHO’s response to the drought, please see:

WHO scales up operations to save lives from cholera and other waterborne diseases

Stepping up humanitarian operations for drought: WHO’s support to the stabilization centres is saving lives

A public health officer discussing supplies at the oral rehydration therapy corner at the Bayhow cholera treatment centre. Credit: WHO Somalia/Dhal Hassan9 June 2022 – At the cholera treatment centre in the Bayhow General Hospital in Baidoa, Dr Abdirahman Isack Mohamed sighs when he explains some of the gruelling effects of the lingering drought. Between March and April 2022, the hospital was attending to 40–50 cases of cholera a week. Even though the number is down to 5–10 per week this month, the situation is still very severe. 

A few weeks ago, late one night, a young man rushed in and admitted a 60-year-old woman with severe dehydration from a camp for internally displaced persons to the hospital. Her caregiver explained she had had a serious bout of diarrhoea and vomiting, and then fainted. He also added that the old lady had been using water from an unprotected shallow well to cook and for hygiene. With the ongoing drought, around 3.5 million people lack sufficient access to water and risk contracting waterborne diseases.       

At the cholera treatment centre, after a quick diagnosis and assessment of the dehydration status, Dr Mohamed and his team gave her immediate support, which helped her to gain consciousness. She recovered within a few days, after receiving intravenous (IV) fluids through the bloodstream and then oral rehydration salts (ORS) that she could drink. 

WHO supports cholera treatment centres to manage patients with cholera infection  

“WHO, the Ministry of Health and other partners have helped us to strengthen and refresh our skills for case management of cholera infections. They trained us to assess dehydration and manage cholera infections, as well as other waterborne diseases. They have also helped us in infection prevention and control, which has enabled us to protect patients and health workers,” said Dr Mohamed.  

With support from WHO and partners, medical staff at 3 hospitals – the Bayhow General Hospital in Baidoa and Marka Hospital and Afgoye cholera treatment centres — are able to provide the right treatment and support to patients suffering from acute watery diarrhoea and cholera. The health workers are managing cholera cases and demonstrating to patients proper hygiene practices, including hand washing and safe sanitation practices. They also teach patients how to manage domestic waste within their households, sanitize latrines and use water purification tablets to purify and preserve safe drinking-water at home. All these measures have significantly reduced the spread of waterborne diseases like cholera in the South West state, which has the highest number of cholera infections reported from the country thus far.  

Since 2021, WHO has developed the technical capacity through training 45 health workers, including 12 medical staff, such as Dr Mohamed, at these 3 centres in the South West State. WHO has also equipped these major hospitals with essential supplies and medicines for case management of cholera and other waterborne diseases. 

Oral rehydration treatment corners offering life-saving measures 

Access to clean water is limited during the ongoing drought in Somalia, which increases the risk of cholera and other waterborne infections in camps for internally displaced persons. Credit: WHO Somalia/Mukhtar Sudani Oral rehydration therapy (ORT) corners are an important life-saving strategy that prevent mortality in children due to dehydration from diarrhoeal diseases. WHO is collaborating with health facilities to set up 63 ORT corners across 24 drought-affected districts that WHO is currently supporting for drought response. In Baidoa, so far, WHO has set up ORT corners in 6 health centres to offer life-saving treatment for children with diarrhoea. 

ORT corners are equipped with ORS and other useful equipment to assess the dehydration status of children presenting symptoms of diarrhoeal diseases. The early treatment, and follow up offered by trained health workers, is saving children from dying due to severe dehydration. Trained health workers in each corner provide ORS and treatment for children with moderate dehydration, while keeping a watchful eye over them to prevent severe dehydration. When the affected children’s conditions improve, the health workers give their mothers ORS and teach them how to prepare home-made ORS. They advise mothers to visit a health facility nearby if the child’s condition deteriorates and encourage mothers to continue breastfeeding if children are young. 

Time is of the essence in curbing cholera spread 

“Time is of the essence in our response to the ongoing drought, including in managing diseases like cholera,” said Dr Mamunur Rahman Malik, WHO Representative to Somalia. “WHO has been providing urgent, life-saving support to cholera treatment centres around Somalia to save the lives of patients infected with cholera. We have over 452 community health workers explaining to communities in 6 affected districts of South West State how to prevent the spread of acute diarrhoeal diseases and suspected cholera.”

The Head of Mission at WHO Somalia added, “Furthermore, we are teaming up with the Ministry of Health and Human Services and partners to conduct a cholera vaccination campaign to protect over 900 000 people from cholera. As of May 2022, Somalia has had 4887 suspected cholera cases, including 16 deaths, reported in 21 of 74 drought-affected districts in Somalia. Cholera remains endemic in Somalia with repeated outbreaks occurring in localized areas. Approximately 62% of the cholera cases were among children under 5, while around half of the cases were females.”   

An estimated 49% of the population – 7.7 million people – require some form of humanitarian or protection assistance in Somalia. Overall, 6.13 million of these people are estimated to be affected by the current drought. 

WHO’s current drought response operations, including its critical life-saving support, is funded by the Central Emergency Response Fund (CERF), the European Union (EU) Delegation to Somalia, and WHO’s Contingency Fund for Emergencies (CFE).