Pressing For Progress – Somalia and Somaliland

Somalia continues to suffer from the effects of almost thirty years of civil war which has raged across all three largely autonomous zones: Somaliland, Puntland and South Central Somalia.

Whilst the health sector has seen improvements in the last five years, the country is now experiencing the devastating effects of prolonged drought and as a consequence a critical prevalence of acute malnutrition.

One of the factors that contributes to the current health sector crisis is a severe shortage of health workers where in South Central Somalia there are only 0.29 doctors, nurses and midwives per 1000 of the population compared to the 2.3 the WHO recommends.

“The civil war started in 1988 in Hargeisa where my family and I were living. I was seven years old and I remember it so vividly despite being young. It was difficult to watch the soldiers, Somali soldiers, forcing people to leave their homes, and then our turn came.

I remember my mother crying, she felt so much distress having to move out of our home with nine children and my elderly grandma. At that time my father was in the hospital with a broken leg and he couldn’t come with us.

It was very difficult – the whole city was destroyed within a few days – we were surrounded by missiles and so many different guns. We managed to leave and we moved to the countryside where we stayed for a year before going to Ethiopia as refugees. For three years we lived in camps and I can still remember how difficult that time was in particular.

Somaliland gained independence in 1991 and when we returned in 1992 we were faced with rubble. The houses had no rooves, schools were destroyed and there was no running water. The country had an unemployment rate of 100%. But we started going back to makeshift schools, we used to sit on the floor with just a couple of pens and no roof above us. It was very very difficult but bit by bit things were improving and then in 1994 there was another civil war in Somaliland which lasted for a year this time. But again we fled. We returned a year later and once again started from scratch, things moved along nicely this time, I graduated from primary school, started secondary school and finished in 2001.

By then my mother was very sick, there were so few doctors left and when she finally managed to see one they prescribed her a medicine which needed to be injected six times a day. I would go and ask someone to come to inject her, sometimes at midnight even, and often there was no one to come so she would miss having her medication. It was then that I realised I had to do something, I had to start studying healthcare and so I went to the first teaching hospital in the country founded by Edna Adan. There I studied for three years to become a nurse and then took a one year course in midwifery, it was a very good school. The training standards were high and we had lots of practical experience through visiting the government hospitals.

My mother died before I graduated as a nurse and it is hard to know that when she died there were no facilities to help her. I think she died from a stroke but there were no diagnostic machines back then and within two days of arriving at the hospital she had died. I heard from health care workers who used to work before the civil war that the system was good enough to save people like my mother, the war destroyed our health care.

As soon as I graduated I got a job and went to another region – six hours away from my home by bus. It was a great experience, although there were many challenges; the nurses at the hospital for example had graduated over ten years ago and because of the war had had no further training. Everything had been destroyed from the hospital buildings to the medical equipment but little by little I started to show them what I had learnt in Hargeisa. A year later the government decided they wanted a national nursing school and I was asked to prepare the entrance exam, in 2005 we recruited the first nursing students in years.

When I returned to Hargeisa, the city was full of NGOs working to rebuild the country. It was at this time that I came across THET and in 2008 I began working with them on a programme that supported nurse training. I was one of two tutors who over the next two years trained 29 nurse tutors. After the programme I worked for several other NGOs but ultimately returned to THET because I had seen how they were working to train health care workers, which is exactly what my country needed.

Now things are different in Hargeisa at least, the private sector has grown and the facilities are now available. It has also been great to see the number of female doctors grow from less than 3% to 15-20% since the first graduates after the civil war. It was thought women did not have the ability to learn how to be doctors and so they were prevented from learning how to do simple but life-saving procedures such as caesarean sections but now luckily women are increasingly being able to be treated by female doctors. It is a small step but considering that in 2000 when there were no female doctors in the country this is something to celebrate.

I am confident that through our work in Somaliland we will continue to further this. Our work with the Ministry of Health and the government must continue. We have done so much together, that we can surely be proud of. From the training of Community Health Workers, the development of curriculums for nurses and midwives, to the support of the National Professional Council in working to license and assess facilities and health workers throughout Somaliland. After so much destruction, I believe that through partnership we can build a healthier future for my country.”