On 16 March 2020, Somalia’s Ministry of Health confirmed the first COVID-19 case in the country. In response, and to prevent a wide spread of the virus, the government immediately imposed restrictions including the suspension of both domestic and international flights, the closing of schools, universities and Qur’anic Madrasas, and ultimately imposed a night time curfew effective from 15th April. Despite these measures, the virus has spread in Mogadishu. The first person who died of Coronavirus on 8th April was a Somali citizen who had no travel history, clearly indicating community transmissions. Worryingly, the virus is spreading across Mogadishu and other parts of the country at a speed, and there is no institutional capacity to trace contacts.
As of May 1st, the total cases recorded countrywide are 601 with 542 active, 28 deaths and 31 people recovered. The majority of these cases (535) are in Mogadishu, while other confirmed cases are in Jubaland, Puntland, South West, Galmudug and the self-declared republic of Somaliland. Most of these cases were tested in April, which reveals the increase of the testing capacity of the government.
It is widely believed that the number is much higher than the 542, and that the possible carriers of the virus within the community are hiding it, fearing social stigma and discrimination.
COVID-19 Social Stigma
Due to the conservative nature of Somali culture, it’s hard for the people to accept quarantine and isolation, which are the primary means for preventing of the spread of the coronavirus. With a history of the segregation of people due to their occupation, clan identity, and social-economic status, people fear being discriminated against and isolated if they disclose that they have contracted the virus or notice some of its symptoms.
One of the prime factors for halting the spread of COVID-19 is quarantine. But many Somalis simply hate the idea of this. On 14th April, the Daily Nation in Kenya reported that 32 Somalis had escaped a quarantine facility in Elwak Kenya under ‘unclear circumstance’. Similarly, two people who tested positive for COVID-19 in Kismaayo, and were in mandatory quarantine escaped on 15 April.
Many people who experience the symptoms of the virus don’t disclose this to anyone just to avoid being stigmatized and quarantined. This itself has destructive psychological effects, as the Somali community life is highly social and people prioritize visiting, comforting and giving solace to those who face difficulties. If one of the family is sick because of COVID-19, it is also difficult to persuade the rest of the family to self-isolate the person. Furthermore, many Somalis simply hide the fact that they or their parents or relatives contracted the Coronavirus because if they die, they want these people to be buried according to standard Islamic funeral rituals. If these ceremonies are not performed, people fear being left with indelible shame as they will not have accorded the proper dignity to their deceased loved ones. This means the more people die of the virus, the more people may contract it through social contact at funerals. Consequently, this behavior, though perceived reckless on the face of it, will invite the virus spread uncontrollably.
All of these phenomena are testimony to the fact that we should be seriously concerned that the virus is already lurking among us to much higher degree than is being reported. The stigma associated with COVID-19 in Somalia is in line with the fact that many Somalis shun those contracted with communicable diseases like tuberculosis and HIV/AIDS, which people hitherto cannot often openly disclose.
Culturally, it’s likely impossible for a Somali person to be avoided by his family or loved ones regardless of the disease he/she has. This means that we may be unintentionally compromising their own health and the well-being of others. This might contribute to a situation of wider spread of the virus within the community. Moreover, Somalia lacks sufficient healthcare capacity and resources to contain the spread of the virus: for instance, in terms of testing kits, quarantine, hand washing/sanitation, and personal protective equipment. Also, there is no capacity to trace the contacts of infected persons.
In Mogadishu, lots of people are complaining of severe headaches, joint pain, irregular coughs, the loss of the sense of smell and taste, and a lack of appetite. Most of these signs correspond with those of COVID-19. Ominously, sometimes those who contract the coronavirus hide from the people any of these symptoms. However, this clearly indicates that people are not seeking the necessary health care and not going for testing because of the fear of experiencing a loss of self-worth if they disclose the fact that they are infected by the virus.
It is also being reported that people who are wearing face masks in the town are facing stigma and are being disparaged as ‘either carriers of the virus or not believing in predestination’. This kind of stigma and ostracism will discourage many people to take sensible steps for self- protection and may lead them to getting infected or infecting others.
According to some health practitioners, hospitals in Mogadishu are not accepting people they suspect have contracted the virus, because they fear the virus will affect patients who are already admitted. Other hospitals also hide the fact that they suspect their patients for COVID-19 because they fear losing clients.
Overcoming the Stigma
To combat this virus, it’s essential to engage the religious leaders as they are the most accepted authority to win the consent of society. They must be mobilized to counter the myth that this virus will not affect Muslims, a misconception held by some Somalis.
Health officials also need to clarify unequivocally the associated risks of the virus to the public and to debunk any medical (mis)information. To some extent, the Ministry of Health is already doing this, but its messages lack details such as the higher risk locations within Mogadishu or other regions, and their efforts to do contact tracing.
Moreover, social media influencers, intellectuals, government officials should come forward and play a crucial role in combating misinformation and the stigmatization of anyone affected by the virus. However, digital campaigns alone will not be enough, as the number of people who have access to internet in Somalia is relatively small and mostly concentered in urban settings. In addition, over half a million IDPs, who are particularly vulnerable to this epidemic, live in Mogadishu alone and they cannot be effectively reached out to through digital awareness campaigns.
A knowledgeable community will be in a strong position to fight the stigma, and this may reduce the risk of people being shunned. Amplifying messages of awareness and showing support and compassion for those most vulnerable will be the only chance to beat stigma and misinformation.
In addition to modeling good behavior, coronavirus-related stigma can be reduced by the sharing of the narratives of infected people in the community. The narration of their experiences will be useful – and appealing to other people to avoid prejudiced language and actions that make us all less safe. The message of such people needs to be amplified, so people can stringently adhere to health precautions.
Finally, to mitigate the damage of the rising epidemic curve, let’s all stay informed, countering stereotyped narratives striving to treat others with dignity. There is no shame in getting a new virus that no human on earth seems to be immune to. It is a social responsibility that we must take upon ourselves to counter this impulse by demonstrating love, support and inclusivity within and beyond our communities.