VZCZCXRO8764
RR RUEHDE RUEHROV RUEHTRO
DE RUEHNR #0255/01 0161420
ZNR UUUUU ZZH
R 161420Z JAN 07
FM AMEMBASSY NAIROBI
TO RUEHC/SECSTATE WASHDC 6671
INFO RUCNSOM/SOMALIA COLLECTIVE
RUEHRN/USMISSION UN ROME 0031
RHEHNSC/NSC WASHDC
RHMFIUU/CJTF HOA
RHMFIUU/CDR USCENTCOM MACDILL AFB FL
RUEKJCS/SECDEF WASHINGTON DC
RUEKJCS/JOINT STAFF WASHINGTON DC

UNCLAS SECTION 01 OF 05 NAIROBI 000255 
 
SIPDIS 
 
AIDAC 
 
AID/DCHA FOR MHESS, WGARVELINK, LROGERS 
DCHA/OFDA FOR KLUU, GGOTTLIEB, AFERRARA, ACONVERY, 
CGOTTSCHALK, KCHANNELL 
DCHA/FFP FOR WHAMMINK, JDWORKEN 
AFR/AFR/EA FOR JBORNS 
STATE FOR AF/E AND PRM 
STATE/AF/E FOR NGARY 
STATE/PRM FOR AWENDT, MMCKELVEY 
NSC FOR TSHORTLEY 
USUN FOR TMALY 
BRUSSELS FOR PLERNER 
GENEVA FOR NKYLOH 
USMISSION UN ROME FODAG FOR RNEWBERG 
 
SIPDIS 
 
E.O. 12958:  N/A 
TAGS: EAID PREF PHUM PREL SO
 
SUBJECT:  SOMALIA DART SITUATION REPORT 3 - HEALTH 
UPDATE 
 
REF:  NAIROBI 00206 
 
NAIROBI 00000255  001.2 OF 005 
 
 
SUMMARY 
 
¶1.  The November-December floods raised concern that 
Somalia would see an increase in cases of water-borne 
diseases, malaria, and respiratory infections. 
Additionally, recent outbreaks of cholera and Rift 
Valley fever (RVF) have prompted Somalia health sector 
agencies to coordinate response plans for a difficult 
operating environment with limited access to vulnerable 
regions, particularly southern Somalia.  End Summary. 
 
BACKGROUND 
 
¶2.  The UN Office for the Coordination of Humanitarian 
Affairs (OCHA) estimates that there are currently as 
many as 1.8 million vulnerable Somalis.  The USG 
Disaster Assistance Response Team (DART) is monitoring 
the impact of recent flooding and conflict on this 
population.  This cable is an update on current and 
emerging health care concerns in Somalia. 
 
¶3.  According to the 2007 UN Consolidated Appeals 
Process (CAP) for Somalia, there are only 39 trained 
doctors per one million people in Somalia, and the 
doctors are unevenly distributed throughout the 
country, largely concentrated in major cities.  There 
are as few as 141 qualified midwives, a contributing 
factor to the high rates of infant and child mortality, 
and the lack of certified and credentialed health 
workers as well as literate Somalis to train in medical 
skills remains a challenge.  Since the collapse of 
formal government health care services in the early 
1990's, health care activities in south and central 
Somalia have been implemented by a variety of 
international and local non-governmental organizations 
(NGOs), UN agencies, and international organizations. 
 
¶4.  The Somali Support Secretariat (SSS), formerly 
functioning as the Somalia Aid Coordination Body 
(SACB), coordinates agencies operational in the health 
sector in Somalia, and supports the burgeoning 
ministries of health in Somaliland and the semi- 
autonomous region of Puntland.  The SSS also 
spearheaded the formation of health care policies and 
treatment guidelines as well as leading various working 
groups and task forces that monitor, assess, and 
oversee health related issues. 
 
¶5.  With the formation of the UN "cluster system" to 
enhance coordination, program quality, and 
accountability, the UN World Health Organization (WHO) 
has been designated as the lead agency for the health 
sector.  WHO is currently expanding its in-country 
capacity to assist with acute health care 
interventions.  WHO assists health facilities by 
providing supplies and equipment for hospitals and 
coordinates the implementation of the health 
information, disease surveillance, and communicable 
disease response initiatives. 
 
¶6.  The UN Children's Fund (UNICEF) is the lead agency 
for primary health care and nutrition support services 
including assistance to NGOs implementing community- 
based health care, maternal and child health clinics, 
reproductive health initiatives, and supplementary and 
therapeutic feeding programs.  WHO and UNICEF both 
 
NAIROBI 00000255  002.2 OF 005 
 
 
facilitate vaccination services. 
 
¶7.  The International Committee of the Red Cross (ICRC) 
is a strong agency in the Somalia health care sector 
that provides assistance to war-wounded, casualties of 
conflict, internally displaced persons (IDPs), and 
responds to large-scale communicable disease outbreaks 
such as cholera. 
 
RESPONSE TO FLOODS AND CONFLICT 
 
¶8.  The recent November-December floods raised concern 
that Somalia would see an increase in cases of water- 
borne diseases, malaria, and respiratory infections. 
While reports provided by WHO indicate a decrease in 
the number of cases of malaria, kala-azar, and measles 
over the past two months, most agencies agree that the 
apparent reduction is actually due to limited 
surveillance and reporting as well as a drop in client 
attendance at health facilities during the height of 
the floods. 
 
¶9.  In early January, health facilities in Lower Juba 
Region started reporting increased numbers of malaria 
cases, according to WHO.  In anticipation of increased 
incidence of malaria due to heavy rains, WHO and 
UNICEF, along with implementing partners, distributed 
100,000 insecticide-treated mosquito nets, to 
vulnerable populations in the flood planes and riverine 
areas in Juba and Shabelle regions over the past 
several months. 
 
¶10.  WHO supports 12 mobile health teams to deliver 
basic health care to IDPs and residents cut off from 
routine health services due to floods and conflict in 
the south and central regions.  However, the conflict 
between the Council of Islamic Courts (CIC) and the 
Transitional Federal Government (TFG) have disrupted 
mobile health services in Lower and Middle Juba regions 
since early January.  WHO anticipates the teams will 
recommence medical services the week of January 15. 
WHO is currently exploring options to expand the number 
of mobile health clinics to areas of south and central 
Somalia, which have few functioning health facilities, 
especially in the Lower and Middle Juba regions. 
 
¶11.  WHO facilitates the local purchase of medicine and 
supplies to fill gaps and maintain buffer stocks in 
Wajid and Mogadishu.  WHO, UNICEF, ICRC, and Medecins 
Sans Frontieres (MSF) support hospitals and clinics in 
south and central regions and all report having 
adequate supplies and staff, according to WHO's recent 
assessment of medical and surgical stocks.  ICRC, 
UNICEF, and WHO are waiting for airlift services to 
resume and the Kenya-Somalia border to re-open to allow 
overland transit to restock storage facilities in 
Mogadishu, Wajid, Kismayo, Belet Weyne, and Galkayo 
with essential drugs, health kits, and supplies that 
have been depleted. 
 
¶12.  WHO has commenced operation of a Health Emergency 
Operations Center in Nairobi, and is supporting an 
emergency coordinator, communications officer, 
logistician, information officer, public health 
officer, epidemiologist, and security officer.  The 
staff will coordinate with OCHA as well as key UNICEF 
staff to ensure all ongoing health services and 
emerging health crises are adequately addressed. 
 
NAIROBI 00000255  003.2 OF 005 
 
 
 
CHOLERA 
 
¶13.  In late December, WHO confirmed cholera in Kismayo 
District, Lower Juba Region, followed by an outbreak in 
Jilib District, Middle Juba Region.  According to WHO, 
both outbreaks are under control.  A total of 90 cases 
were treated at Kismayo Hospital with three deaths 
reported.  In Jilib, 120 cases were reported with three 
deaths.  WHO reports that both cholera treatment 
facilities were closed the week of January 8, and that 
both outbreaks have been contained.  Health agencies 
operational in these districts (Muslim Aid and MSF- 
Holland) attribute the outbreak to contaminated water 
sources and sanitation facilities destroyed by the 
recent flooding.  It is unusual for cholera to appear 
during the rainy season in Somalia (although it is 
endemic in the country). 
 
¶14.  On January 14, WHO reported an outbreak of cholera 
(yet to be confirmed by biological test, but symptoms 
are consistent with cholera) in Belet Weyne town, 
Hiraan Region.  WHO is sending cholera treatment 
supplies, and the NGO International Medical Corps (IMC) 
is coordinating specimen collection for testing and 
plans to open a cholera treatment facility in Belet 
Weyne town.  MSF-Swiss, Save the Children-UK, and local 
NGOs are also assisting in the region's cholera 
response.  A task force has been formed to organize 
community mobilization, health education on cholera 
prevention, early treatment, logistics, and 
chlorination of water points. 
 
¶15.  WHO also reported 23 cases of suspected cholera in 
northwestern Somaliland as well as in Saylac area 
bordering Djibouti.  UNICEF and WHO are sending 
supplies and a joint response team to further 
investigate. 
 
CONFLICT CASUALTIES 
 
¶16.  WHO and ICRC are tracking the number of injured 
seeking care at major hospitals in conflict areas as 
well as monitoring the number of tetanus cases, which 
are associated with trauma and combat injuries.  WHO, 
the ICRC, and MSF are the main health agencies 
providing casualty assistance to 11 hospitals 
throughout south and central Somalia by providing 
medicine, health kits, surgical supplies, as well as 
technical and logistical staff. 
 
¶17.  According to WHO, more than 1,000 conflict-related 
fatalities have been reported to date, mostly occurring 
between Mogadishu and Baidoa.  The ICRC reports 
approximately 800 people have been wounded in conflict, 
although local reports suggest the number of wounded to 
be between 2,500 and 3,000 people.  The major problems 
are reportedly bullet wounds, fractures, and post- 
trauma complications such as sepsis and osteomyelitis. 
 
¶18.  As of January 11, WHO reports that approximately 
120 war-wounded remain in area hospitals, mostly in 
Baidoa and Galkayo.  Accurate estimates of the total 
number of casualties from the ongoing fighting in the 
southern Ras Kamboni area are unavailable, although the 
fighting is reportedly fierce. 
 
RIFT VALLEY FEVER 
 
NAIROBI 00000255  004.2 OF 005 
 
 
 
¶19.  With the recent outbreak of RVF in northern Kenya, 
it was inevitable that the disease would surface in 
Somalia.  According to the UN Food and Agriculture 
Organization (FAO), the UN cluster lead for livestock 
and agriculture, reports of abortions in animals, which 
is a strong indicator of the presence of RVF in the 
animal population, were received from Afmadow District 
in Lower Juba Region the first week of January.  WHO 
received unconfirmed reports that seven people died of 
possible RVF in Afmadow District and one person was 
admitted to Kismayo Hospital on January 11, with 
symptoms similar to RVF and died a short time later. 
 
¶20.  The week of January 8, WHO convened an emergency 
meeting of all operational health and veterinary 
agencies in Kismayo to monitor the situation and 
distribute health education materials.  However, 
increased insecurity limited NGO staff movement, 
although, as of January 14, WHO reports improved access 
in the region.  WHO has also assembled an outbreak 
response team to investigate the reports and collect 
the samples for confirmation.  However, the flight 
scheduled to transport the team to Kismayo on January 
10, was canceled due to military activity in the 
region.  WHO is now arranging for biological samples to 
be sent to Kenya for testing using local polio testing 
networks.  WHO and FAO have provided personal 
protective equipment to health facilities in the region 
as well as to teams collecting animal and human 
samples. 
 
¶21.  On January 14, WHO received reports from Bardera 
town, Gedo Region, that one person died with symptoms 
suggestive of RVF.  The patient was from Barowdindle, a 
village about 35 km from Bardera.  Three additional 
suspected cases have been reported in Baraka village 
outside Bardera municipality.  These are the first 
reported cases outside of Lower Juba Region.  FAO has 
received reports that up to 80 percent of small 
ruminants in Bardera District are aborting. 
 
¶22.  FAO and WHO are expanding health education and 
prevention activities to Gedo Region.  WHO and FAO have 
provided personal protective equipment to health 
facilities in both regions as well as to teams 
collecting animal and human samples.  Radio networks, 
including BBC Somalia, are broadcasting health 
education messages on RVF, and clergy and local leaders 
in all flood-affected regions are also providing 
information to communities with high risk.  UNICEF and 
WHO have mobilized vaccination staff to engage in 
surveillance and support prevention education campaigns 
for RVF as well as record and forward field reports of 
animal abortions to FAO. 
 
CONCLUSIONS 
 
¶23.  Recent events in Somalia have not led to any 
significant changes to the humanitarian priorities 
identified in the 2007 CAP (REFTEL); the number of 
beneficiaries and critical needs by sector remain 
unchanged.  Internal displacement as a result of recent 
conflict was small-scale, localized, and short lived. 
Interventions calling for non-food items, increasing 
national and international staff, and purchase of 
medical and trauma supplies are planned in the recent 
UN appeals for Somalia.  New and ongoing interventions 
 
NAIROBI 00000255  005.2 OF 005 
 
 
in the health sector will focus on flood and drought 
recovery and respond to emerging health crises such as 
RVF. 
 
¶24.  Coordination among health and livestock sectors is 
impressive, with multiple agencies communicating 
through established networks, sharing resources and 
staff, and establishing and implementing multi-agency 
response plans to meet humanitarian health needs in 
Somalia.  While most coordination occurs in Nairobi, on 
the ground communication and networking is also taking 
place. 
 
¶25.  The DART will continue to monitor the health 
impacts of the recent fighting and work with OCHA, WHO, 
UNICEF, FAO, ICRC, and current USAID health sector 
partners to report on the status of the suspected RVF 
and other emerging health problems.  Support to the 
health sector remains a priority for all humanitarian 
stakeholders in Somalia, in particular because an 
already impoverished and vulnerable population has 
little or no resilience left after repeated shocks. 
 
RANNEBERGER