VZCZCXRO4964
RR RUEHDE RUEHROV RUEHTRO
DE RUEHNR #2214/01 1440629
ZNR UUUUU ZZH
R 240629Z MAY 07
FM AMEMBASSY NAIROBI
TO RUEHC/SECSTATE WASHDC 9912
INFO RUCNSOM/SOMALIA COLLECTIVE
RUEHRN/USMISSION UN ROME 0173
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 03 NAIROBI 002214 
 
SIPDIS 
 
AIDAC 
 
SIPDIS 
 
USAID FOR DCHA 
STATE FOR AF/E, AF/F AND PRM 
 
E.O. 12958:  N/A 
TAGS: EAID PHUM PREL PREF SO
SUBJECT: SOMALIA HUMANITARIAN UPDATE - HEALTH IN 
MOGADISHU 
 
REF:  A) Nairobi 02007 
 
NAIROBI 00002214  001.2 OF 003 
 
 
¶1.  Summary: Despite years of chaos, insecurity and 
absence of a functioning Ministry of Health, Mogadishu 
continues to benefit from a serviceable, if limited, 
health system for those with sufficient resources to 
access it.  Despite significant challenges, such as 
heavy fighting, limited access, and the withdrawal of 
international staff, health facilities were able to 
provide emergency services in response to the recent 
cholera and conflict emergencies.  UN agencies and non- 
governmental organizations supplemented local health 
facilities during the crisis period through the 
provision of supplies and, in some cases, staff. 
Ongoing challenges to the health sector include a 
limited pool of qualified technical staff and continued 
insecurity.  End summary. 
 
CURRENT HEALTH SERVICES 
 
¶2.  Five non-governmental organizations (NGOs) and 
three UN agencies are currently providing emergency 
health services in Mogadishu.  Emergency health 
facilities and services include three mobile health 
teams, two cholera treatment centers, two maternal and 
child health centers, two out-patient departments, 
support for two surgical referral hospitals, and 
essential medicine and supplies, such as oral 
rehydration treatment. 
 
¶3.  Due to ongoing insecurity, most humanitarian 
agencies have prohibited international staff from 
traveling to Mogadishu.  The one exception is the 
International Committee of the Red Cross (ICRC), which 
sent an international surgical team to assist at the 
Keysaney Hospital.  Well-trained national staff are 
currently managing most emergency health programs; 
however, agencies agree that additional oversight and 
supervision are required. 
 
¶4.  During periods of intense fighting in Mogadishu, 
health services were limited due to restricted 
movements in the city.  Several health facilities 
reported that national staff were unable to open 
clinics or staff hospitals for fear of getting caught 
in the fighting.  At the same time, many people in need 
of health care were also unable to access facilities 
due to the heavy fighting. 
 
¶5.  In addition to emergency health services, Mogadishu 
residents benefit from several public and private 
health facilities.  According to the UN World Health 
Organization (WHO) and UN Children's Fund (UNICEF), 
health services in the capital are significantly better 
than in the rest of southern and central Somalia.  WHO 
reports that there are 56 medically certified doctors 
in Mogadishu working at 28 health facilities, including 
hospitals, clinics, and maternal and child health 
centers.  Of the 56 physicians, only 14 work in public 
or NGO-managed facilities while the remaining 42 
practice in Mogadishu's thriving private health sector. 
Only two of the city's 24 hospitals are public and 
provide health care at minimal cost.  Additionally, 
there are reports of Muslim charities providing medical 
assistance and supplies in Mogadishu; however, accurate 
information regarding the staffing or treatment 
capacity of these facilities is unavailable from the UN 
and other sources. 
 
¶6.  Health agencies cite an increasing concern for the 
future availability of trained, qualified health care 
providers.  Most of the currently employed health care 
staff, including nurses, laboratory and x-ray 
technicians, and support staff were educated prior to 
the collapse of all formal training institutions nearly 
two decades ago.  Without formal technical educational 
programs functioning in Somalia since the early 1990s, 
the availability of qualified health staff is virtually 
non-existent in Somalia today.  Many of those currently 
employed were trained through informal and on-the-job 
 
NAIROBI 00002214  002.2 OF 003 
 
 
initiatives of the UN and NGOs.  The Joint Needs 
Assessment in Somalia, funded by the World Bank in 
2006, identified the lack of a technically capable pool 
of health care providers as one of the greatest 
challenges faced by the health sector country-wide for 
the foreseeable future. 
 
EMERGENCY HEALTH CONCERNS 
 
-Cholera- 
 
¶7.  An outbreak of acute watery diarrhea (AWD) surfaced 
in Hiran Region north of Mogadishu in early January and 
has spread throughout south and central Somalia 
affecting more than 30,200 people, according to WHO. 
Health facilities in Mogadishu began diagnosing cases 
of AWD and laboratories confirmed the presence of the 
cholera bacterium in early March.  A steady increase in 
new cases was reported through mid-April.  WHO reports 
that nearly 12,000 cases, representing 40 percent of 
all cases, and 161 related deaths were reported in 
Mogadishu between January 1 and May 11.  Although 
Mogadishu reported the most cases of all Somali 
regions, the overall case fatality rate of 1.35 percent 
was well below the national average of 3.2 percent. 
 
¶8.  As fighting escalated in Mogadishu in April, 
thousands of people fled the city and health facilities 
suspended or limited activities.  As reported reftel, 
the number of new cases reported in Mogadishu dropped 
dramatically in the second half of April.  WHO 
cautioned that the sharp decrease was not a sign of 
improving conditions but rather a result of limited 
reporting from health agencies and the outflow of 
people from the city.  As access and security improved 
in May, health facilities resumed reporting into WHO's 
surveillance system.  The initial trend of decreasing 
cases continued into early May. 
 
¶9.  Humanitarian agencies are responding to the 
outbreak through prevention and treatment activities. 
A cholera task force meets regularly to coordinate 
response operations.  Action Contre la Faim (ACF) and 
Medecins Sans Frontieres-Spain (MSF/S) manage two 
cholera treatment centers; ICRC and the Somali Red 
Crescent Society (SRCS) run five temporary rehydration 
treatment centers; Muslim Aid/UK operates four mobile 
teams throughout the city; and WHO and UNICEF are 
providing essential medical supplies and drugs to 
health facilities.  In addition, UNICEF and partners 
are increasing access to safe water through 
chlorination activities at the water source and 
household levels. 
 
¶10.  The treatment of cholera in Somalia is complicated 
by strong cultural beliefs that the only effective 
treatment for acute diarrhea is with intravenous 
fluids.  Many people do not appreciate the value of 
using oral rehydration salts and large volumes of oral 
fluids in the early stages, but wait until severe 
dehydration occurs, making recovery even more difficult. 
Health education messages on hydration and water 
treatment are critical adjuncts to cholera treatment. 
WHO has been taking the lead on health education 
programs in the media, but has been limited by the 
recent insecurity. 
 
-War-Wounded- 
 
¶11.  Fighting in and around Mogadishu, including 
indiscriminate mortar and rocket-propelled grenade 
attacks, resulted in civilian injuries and deaths. 
More than 2,250 people received treatment for weapon 
wounds in Mogadishu between January and May, according 
to ICRC. 
 
¶12.  The Medina Hospital, run by SRCS and supported by 
ICRC, has the capacity to accommodate 67 in-patients. 
However, at the height of the fighting in Mogadishu in 
April, the hospital admitted more than 200 patients by 
 
NAIROBI 00002214  003.2 OF 003 
 
 
increasing beds per room, setting up beds in the 
hallways, and erecting tents in the outside garden. 
 
¶13.  ICRC provides Keysaney and Medina surgical referral 
hospitals with monthly consignments of surgical and other 
supplies, salaries for staff, and support for maintenance. 
In addition, ICRC is enhancing the capacity of the 
hospitals' local staff through technical and medical 
training.  ICRC has deployed a cadre of international staff 
to Mogadishu to assist overworked local surgeons to treat 
the high volume of war-wounded.  ICRC also supports other 
medical facilities treating war-wounded patients on an 
ad hoc basis. 
 
USAID/OFDA-FUNDED ACTIVITIES 
 
¶14.  In FY 2007, USAID's Office of US Foreign Disaster 
Assistance (OFDA) has provided more than USD 5.6 
million to UNICEF and WHO to carry out health, 
nutrition, water, sanitation, and hygiene activities in 
throughout Somalia.  OFDA is supporting WHO to 
coordinate emergency preparedness and response 
mechanisms in southern and central Somalia, with a 
particular focus on Mogadishu.  This includes 
coordinating the provision of health kits, cholera 
kits, and essential medicines for clinics, cholera 
treatment centers and laboratories.  WHO also provides 
technical staff who assist in direct health care 
services and the training of local counterparts. 
 
¶15.  USAID/OFDA is supporting UNICEF to implement 
water, sanitation, and hygiene programs in Mogadishu 
and surrounding regions.  UNICEF is providing safe 
water, water purification equipment, water storage 
supplies, and other non-food items for people displaced 
both in Mogadishu and in other regions in southern and 
central Somalia.  UNICEF is supporting the health 
sector through the distribution of health kits for 
maternal and child health clinics and mobile health 
service programs.  With OFDA support, UNICEF is also 
addressing the nutritional needs of underweight 
children under five years of age, as well as lactating 
and pregnant women in conflict-affected areas. 
 
CONCLUSION 
 
¶16.  Compared to other urban centers in Africa, the 
situation in Mogadishu is far from adequate.  However, 
health services are distinctly better in Mogadishu than 
in areas outside of the capital.  While national staffs 
provide most of the hands on treatment, international 
staff provide essential supervision, monitoring of 
treatment protocols, and guide appropriate treatment 
interventions when needed.  The continued commitment 
from international health organizations and the 
dedication of the national staff allowed health 
facilities to respond adequately to recent crisis 
conditions.  Long-term support to the health sector is 
needed not only in Mogadishu, but throughout the country. 
 
RANNEBERGER