Dr Mamunur Malik, WHO Representative to Somalia, and H.E. Staffan Tillander, Swedish Ambassador to Somalia, sign agreement to strengthen the National Institute of Health and health information systems in Somalia

Mogadishu, 28 June 2021 – On 16 June, Dr Mamunur Malik, WHO Representative to Somalia, and H.E. Staffan Tillander, Swedish Ambassador to Somalia, signed an agreement, totalling 4 300 000 SEK (US$ 517 868), aimed at strengthening the National Institute of Health and health information systems in Somalia, through the financing of 2 senior WHO national staff positions. 

The signature of this agreement marks years of close collaboration and partnership between WHO and Sweden in Somalia. It is built upon 2 non-financial memoranda of understanding signed between WHO and the Public Health Agency of Sweden, and between WHO and the SPIDER Center (Stockholm University). The former aims to support the establishment of an independent national institute of health in Somalia, while the latter aims to strengthen the digitalization of health information and the development of an integrated disease  surveillance and response system across the country. This agreement will therefore enable the WHO Somalia country office to recruit and retain 2 senior level national staff to support the activities of the National Institute of Health and other disease surveillance functions to support SPIDER-related activities. Both staff members will act as WHO’s primary focal points for close engagement and technical collaboration with these agencies, health authorities, as well as other relevant partners. 

“This agreement marks a remarkable chapter in the history of collaboration between WHO and Sweden in Somalia. The collaboration and agreement aim at improving health information management system in Somalia by working closely with SPIDER and will provide critical human resources support to operationalize and transform the newly functioning National Institute of Health of Somalia as a premier centre in the country for public health research, front-line health workforce development, public health laboratory, emergency preparedness and outbreak response, as well as for leading disease-specific control programmes in the country. We are confident that this support of Sweden will go a long way in protecting the vulnerable and promoting health with a view to building a safer world for everyone in Somalia,” said Dr Malik, WHO Representative. 

“Access to health care touches people in their everyday life. Somalia is step by step rebuilding its health systems, around the country, in towns, villages, for girls and boys, mothers and fathers, young and old. Working with WHO to support these life-saving efforts is part of our partnership with the Somali people,” said H.E. Staffan Tillander, Swedish Ambassador to Somalia. 

This important contribution from Sweden to WHO in Somalia further consolidates the innovative partnership that already exists between the two, as well as the collective efforts of both to achieve better health outcomes for all Somalis towards universal health coverage and health for all. 

Related links

WHO and SPIDER Center sign agreement to strengthen health information management in Somalia
8 March 2021

An innovative and unique partnership: WHO, Sweden and Somalia work together to improve health outcomes for all Somalis
1 February 2021

WHO and Public Health Agency of Sweden sign MoU to support establishment of National Institute of Health for Somalia
5 January 2021

To celebrate International Nurses’ Day, marked around the world on Florence Nightingale’s birthday on 12 May, and International Midwives’ Day, which falls on 7 May, the World Health Organization (WHO) in Somalia is acknowledging the remarkable contribution of nurses and midwives in the country.

WHO spoke to 2 experts to hear about their experiences.

Omar Mohamed Abdi, a trained nurse by profession, also serves as the Head Anaesthetist at the Bosasso General Hospital. As part of his work, he prepares patients for surgery and teaches students anaesthesiology.

As a child, Omar wanted to join the health sector. He feels this was probably as, back then, many children didn’t know much about other careers. He just wanted to work hard like his father, a labourer who paints homes, and his mother, who worked at a livestock market. But most of all, Omar wanted to help his community and do as much as he could for them.

Nurses need advocates

In the last 4 years at work though, Omar was surprised to learn how tough life can be for nurses. Very few people actually value the contribution of nurses, he says.

“Being a nurse is a noble profession – nurses are a bridge between a doctor and a patient,” says Omar, “but unfortunately, nurses are yet to receive the respect they deserve in the society. Generally, managers expect nurses to do odd jobs, switch their duties abruptly from one ward to another and, on some occasions, discharge nurses very easily, which is difficult for their careers.”

Omar explains that life would be better for nurses if they had an association that could band them together and advocate for their basic rights. Without an association, it is hard to keep track of whether or not one is truly qualified as a nurse. On some occasions, people pretending to be nurses have actually neglected patients and caused them more damage, adds Omar, which gives nurses a bad reputation.

Nurses work really hard, are underpaid in Somalia, and hardly get opportunities to train and advance their skills, as not many people value them, adds Omar. He feels he was one of the lucky ones as, in January, he had the chance to participate in a training course in basic emergency care, organized by WHO. Jointly developed by WHO and the International Committee of the Red Cross (ICRC), endorsed by the International Federation for Emergency Medicine (IFEM), and certified and facilitated by the African Federation for Emergency Medicine (AFEM), this course was designed for frontline health care providers who manage acute life-threatening conditions with limited resources. However, nurses need more training like this, he adds.

Beaming with this news, 26-year-old Omar announces he has teamed up with some of his colleagues to change the status quo. They have created a nurses’ association in Puntland State of Somalia, but need a lot of support from policy-makers and international and national organizations to be effective. For now, Omar hopes that in line with this year’s theme for International Nurses’ Day, the next generation of nurses becomes a voice to lead and a vision for future health care. 

Strong-spirited midwives and nurses need updated, standard curricula

“To be a nurse and midwife means to be of service no matter what the circumstances are. However, people forget that nurses and midwives are not just health workers – they are mothers, sisters and leaders in their communities, who need support,” says WHO’s Reproductive Health and Nursing and Midwifery Programme Officer based in Somaliland, Asia Osman Ahmed, fondly known as ‘Mama Asia’.

Mama Asia has been training midwives in Somaliland since 1996, but she emphasizes she feels like that is just a drop in the ocean. There is a need to keep training and overseeing the work of midwives, she says, and to update their curricula, so that every midwife knows exactly what she/he is doing when a mother seeks their support.

With limited resources, work has already been tough for Somali midwives, but the coronavirus disease (COVID-19) outbreak has made it even more challenging. Nurses and midwives continue to be on the front lines, trying to dodge the COVID-19 disease daily, and yet with limited personal protective equipment, they go out every day to provide essential health services. 

When discussing the challenges that Somali women face, Mama Asia’s eyes well up. In the last week, Mama Asia witnessed yet another set of unbearable incidents. Young Deqo,* who had undergone female genital mutilation (FGM) as a child waited desperately at a health facility for help, as a traditional midwife who tried to open up Deqo’s stitches so that her husband could enjoy being intimate with her had cut up part of her rectum somehow and given her second degree tears.

During her visits to mother and child health clinics, Mama Asia also came across Zahra,* who had just delivered a healthy baby boy. She watched in dismay as Zahra’s mother-in-law shamed her publicly for not being circumcised. In fact, she even named her grandchild ‘Ina Baro’, which means ‘child of one who is not circumcised.’ Mama Asia was happy to see Zahra stand strong and refuse to be circumcised after the delivery, despite the pressure her husband’s family put her through. 

“WHO is going to develop the capacity of Somali midwives so they can stop the cultural practice of FGM in communities, and encourage facility-based births,” said Dr Al-Umra Umar, WHO’s Team Lead for Reproductive, Maternal, Neonatal, Child and Adolescent Health. “WHO will work with the Government to link community midwives to qualified midwives, who have been trained by partners such as the United Nations Populations Fund.”

Three decades after Somalia’s civil war, the country is still grappling with limited skilled personnel. The Somali Health and Demographic Survey 2020 states that only around one third (32%) of births in Somalia are delivered with the assistance of skilled health personnel (a doctor or clinical officer, or a nurse, midwife or auxiliary midwife), and only 21% of women visit health facilities for child birth.

“Using skill-transfer projects like this, we can emphasize the importance of seeking health advice early in pregnancy, so childbirth is a safe experience for every mother, wherever she lives. At the same time, we will be expanding the knowledge of more people aspiring to be midwives and adding to the skilled health workforce,” adds Dr Al-Umra.  

Despite the challenges faced, in the last 2 decades, Somalia has made some progress – the maternal mortality ratio has reduced by 31%, from 1210 deaths per 100 000 live births in 2000 to 829 deaths per 100 000 live births in 2017 and the number of skilled birth attendants increased from 22% in 2010 to an estimated 29% in 2017. However, there is more work to be done to ensure every mother can access health care at all times, especially as the COVID-19 outbreak has further reduced health access in urban areas by around 42%, according to a vulnerability assessment study conducted by the Horn Population Research and Development, with support from the United Nations Children’s Fund (UNICEF).

*names changed to protect identity

MOGADISHU, 4 May 2021 – Vaccines protect us against preventable diseases, including COVID-19. They bring us closer to a healthier world and are permissible to be taken during the holy month of Ramadan – these are the main messages the Federal Ministry of Health and Human Services, World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) in Somalia are sharing this World Immunization Week, running from 24 to 30 April 2021. On this occasion, the Federal Ministry of Health, WHO and UNICEF are renewing their commitments to ensure that every child is counted for vaccination against vaccine-preventable diseases.

This year, World Immunization Week comes at a time when the country is conducting one of its largest, much needed vaccination campaigns, against COVID-19. Every year, during the last week of April, World Immunization Week is observed to encourage the use of vaccines to protect people of all ages against disease. The theme for this year is ‘vaccines bring us closer’ – to encourage greater global participation around immunization and to demonstrate to communities, politicians and other audiences that vaccines do indeed bring families, communities and countries closer together.

With support from the Federal and State Governments of Somalia, WHO, UNICEF and other agencies have been providing vaccines – while observing COVID-19 protocol since last year – to Somalis of all ages and backgrounds – against preventable diseases such as measles, pertussis, diphtheria, tetanus, hepatitis B, Haemophilus influenzae type b, cholera, tuberculosis, polio and now against COVID-19.

Since the resumption of mass vaccination campaigns, which had been paused due to the COVID-19 epidemic in 2020, Somali authorities, with support from WHO, UNICEF and other partners, have conducted 5 targeted campaigns and one nationwide campaign, where approximately 3 million children were offered vaccines to protect them from polio. In addition, 514 567 (83% of the target) and 450 983 (73% of the target) children aged under one year received pentavalent 1 and pentavalent 3 vaccines respectively. Overall, 433 863 (70% of the target) children aged under one year received their first doses of measles vaccines to protect them against this highly infectious disease.

“Smallpox's last resting place was in Somalia. But, thanks to concerted and collaborative efforts, we were able to eliminate the disease. Polio is on the verge of being eradicated. In reality, with the help of partners, Somalia's circulating poliovirus type 3 (cVDPV3) outbreak was successfully stopped this year, 28 months after it was reported, with no further international spread from our country. That should suffice to convince us that we can do it again. If we act now and together, we will stop the spread of all vaccine-preventable diseases,” said HE Dr Fawziya Abikar Nur, Minister of Health and Human Services, Federal Government of Somalia. “However, politicians, our foreign and national partners, societies, parents, women, youth, scholars, the private sector, nongovernmental organizations and donors all have a role to play. We should all play a role in ensuring that Somalis receive vaccines appropriate for their age groups. Since the rollout of the COVID-19 vaccine on 16 March 2021, and until 28 April 2021, 121 743 people in Somalia had received their first doses of the Oxford Astra-Zeneca vaccine to protect them from COVID-19. The uptake remains considerably low (at 40.6%) though. There is a need to increase the uptake of vaccinations, by health workers, frontline workers, elderly populations and people suffering from chronic illnesses, with the first batch of 300 000 vaccines – which arrived in the country on 15 March 2021.”       

“We are at a critical time, where we can save humanity from the COVID-19 pandemic, especially as we have tools like vaccines to protect people. In Somalia, we remain concerned that the current uptake of the vaccine is not optimal. The pandemic will not end if it doesn’t end in Somalia and other conflict-affected countries with very weak and fragile health systems,” said Dr Mamunur Malik, WHO Representative for Somalia.

Addressing people’s concerns regarding the uptake of the COVID-19 vaccine during Ramadan, Dr Malik explained, “I want to assure people that 2 fatwas have been issued by the Al-Azhar Al-Sharif and the International Islamic Fiqh Academy (IIFA), the co-chairs of the Islamic Advisory Group. The fatwas offer advice that it is permissible to take COVID-19 vaccinations, as this vaccine goes into the muscles, not bloodstream. We must share information with our loved ones and friends about the benefits of vaccination. In the last decade, at least 10 million deaths have been prevented by vaccines, and more lives have been saved by vaccines in the history of medicine. Vaccines are the most cost-effective health technology ever invested in, during the history of our civilization. We are responsible for our health and that of our children. We should support them in accessing vaccines for their age too. No one is safe until everyone is safe.”

Since March 2020, when the first case of COVID-19 pandemic was confirmed, this had an impact on all health programmes, including routine immunization. An estimated,186 000 children missed their first doses of the measles vaccine in 2020 and around half a million are missing out on polio vaccines, also due to limited access and insecurity. 

However, the Government, WHO, UNICEF and partners are working to ensure health facilities and personnel use all precautions possible while delivering services.

“The devastating COVID-19 pandemic has reminded the world how important and effective vaccines are,” said Mohamed Ayoya, UNICEF Somalia Representative. “Vaccines protect us from life-threatening diseases and safeguard our future health. It is critical that we accelerate COVID-19 vaccinations and scale up routine immunization especially for children in hard to reach areas. Reaching and protecting these children is a priority.”  

In last quarter of 2021, the Somali Federal Government, WHO and UNICEF and other partners have plans to introduce a second dose of inactivated polio vaccine (IPV) and measles vaccines as part of the routine immunization programme, now being extended to children older than one year of age. This will boost their immunity, particularly in the event they may have missed one dose of measles or polio vaccines when younger.    

For additional information, please contact:

Khadar Hussein
Coordination and Communication Office
Ministry of Health and Human Services
Federal Government of Somalia
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+252 615 602 637

Fouzia Bano
Chief of Staff ai, Communications Officer
WHO Somalia
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+252 619 235 880 

Dheepa Pandian
Communication Chief
UNICEF Somalia
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+252 613 375 885

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Note to editors

A statement from the International Islamic Fiqh Academy (IIFA) covers both the permissibility of all COVID-19 vaccines and of using Zakat to procure and distribute the vaccine among poor countries/communities. It can be found here:

Arabic  | English | French 

A fatwa statement from the Al Azhar reaffirms the permissibility of getting vaccinated while fasting in Ramadan

Messages from the WHO Regional Office for the Eastern Mediterranean on Ramadan 2021, citing both fatwas, can be found here:  

English | Arabic