Five Questions With…Dr Manal Gas
9 November 2021
Following our 2021 Annual Conference, we caught up with keynote speaker, Dr Manal Gas, Medical Coordinator at the Ministry of Health Development in Somaliland, to hear how COVID-19 has affected healthcare delivery, how the international community has responded, and what global vaccine inequity looks like for the people of Somaliland.
1. Can you give us a brief overview of how COVID-19 has affected Somaliland and the steps that have been taken to overcome these challenges?
The pandemic hit us in March 2020, before then we did not have any reported cases. While we have had our fair shares of struggles with the virus, we were able to control the death rates from 2019 to 2020. But since the emergence of the Delta variant, our death rates have multiplied, and we have been facing many challenges. COVID-19 is a new virus, at first no one knew how to handle it, we did not have the tools or knowledge to handle this crisis, but we have managed it to the best of our ability and with the support of international organisations and expert physicians from across the world, we have been able to keep the situation under control.
2. What factors have made the pandemic harder to manage?
Beyond the Covid cases themselves, a huge challenge has been widespread panic across the country caused by misinformation being shared through social media outlets about a disease that is unknown. Moreover, we were running on mechanical ventilators and were running out of supply of oxygen cylinders while treating COVID-19 patients. We only had 4 mechanical ventilators when the pandemic began for a population of 4 million people. Many patients had to be denied treatment once they reached the ventilator stage. We had only 1 oxygen plant in the whole of Somaliland, which was in the capital Hargeisa, which could roughly produce 300-400 cylinders per day. However, one patient can consume at least 20-30 cylinders per day. So, oxygen supply was the most difficult struggle we faced.
3. How has the international community responded?
Thanks to the support of the international society and the government, we now have six oxygen plants in Somaliland, one in every region, which is a great milestone for us. At the beginning of the pandemic, Hargeisa Group Hospital (HGH) – the national referral hospital for Somaliland with a capacity of 400-450 inpatients – became the COVID-19 testing centre, which compromised primary healthcare in the country. People became too scared to attend the hospital for basic check-ups, routine surgeries, pre-natal or antenatal care. Everything became delayed and the outpatient department was shut down. During this time, we received a COVID-19 response grant from THET that was co-managed by King’s College London that enabled us to set up telemedicine facilities at HGH through which patients could receive basic medical care and advice on where to access emergency healthcare. This experience is something that other countries can learn from if they are also struggling.
4. What impact has the global roll out of COVID-19 vaccines had on Somaliland?
We are reliant on the international community for access to vaccines. Only 4% of our income is allocated to the health department because we rely heavily on the international society, meaning our hands are tied because we don’t have the budget. We initially received 65,000 vaccines from the World Health Organization and UNICEF. People were worried that if they received their first dose they wouldn’t be able to receive their second. Their fears came true as we only received 30,000 doses of the second shot. Thankfully, the WHO and the international society stepped up and offered us a further 90,000 doses which are currently being administered. However, the total number of doses received (185,000) is only enough to vaccinate 4.6% of our population. Within the Government, we have had to make a decision about who takes priority. We have decided to focus on the elderly and high-risk people living in crowded cities.
5. How is vaccine inequity affecting countries like Somaliland?
Countries like Somaliland being unable to provide a first dose of the vaccine while high income countries are offering booster shots is the definition of inequality in the world. It is devastating because we are responsible for our people, and we are unable to protect them.
To catch up on Dr Manal’s conference presentation, please click here.
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