There are now more than 142,000 cases of COVID-19 in 122 countries, and 5,393 people have died according to the World Health Organization (WHO). While the number of cases have surged in Asia, Europe, and the Americas, to-date only 105 cases have been recorded in Africa according to the Centre for Disease Control Africa. However, it is highly likely that in an interconnected world the virus will spread to low and middle-income countries (LMIC) in Africa but with potentially a far deadlier impact.
The first case of coronavirus was recorded in Somalia as confirmed by the Federal Minister of Health on March 16, 2020. The person is a Somali citizen who has recently returned from China. This makes the total number of cases in Africa 106. The Council of Ministers have also banned all international flights coming to Somalia starting from 18th March 2020 for two weeks.
Somalia, like other countries with porous borders, mixed migration, displacement, regional trade, the presence of international staff and armed forces from across the world, the probability of an outbreak is almost inevitable according to epidemiologists and infectious disease experts.
Considered one of the poorest nations in the world, Somalia’s health system infrastructure is weak and cannot mount an adequate response to manage a crisis of the scale of the Covid-19 pandemic.
Absence of vital resources and services
For various reasons, a pandemic of this magnitude will usher in new frontiers of anxiety for an embattled national health system and a nightmare for public health practitioners in Somalia.
Three decades of conflict and the ongoing security challenges have left the health system infrastructure broken and unable to respond. Dilapidated facilities, under-resourced public health programs and the dismal numbers of qualified health professionals make access to basic health services nearly impossible even in the best of times.
One fifth of Somalia’s population are internally displaced and are dependent on international aid for basic life necessities. About seventy percent of Somalia’s households earn less than two dollars per day. Poor access to basic services, low literacy rates and nomadic nature of population places large number of Somalis at high risk from Covid-19.
The lack of water, sanitation, hygiene services, and overcrowding are of serious concern. Traditional public health infection control practices of good hygiene, social distancing and staying home will simply be impossible to implement in overcrowded displacement camps.
Chronic poor health resulting from decades of war increases vulnerability to disease across age groups. High rates of multidrug-resistant tuberculosis, diarrheal, cholera, and malaria diseases are all are risk factors for a weakened immune system, and this would further exacerbate vulnerability to the coronavirus.
In large dense urban settings such as Mogadishu, hospitals do not have bed capacity, expertise and resources to manage a pandemic of this size. Furthermore, Somalia does not have national laboratory facilities to test and confirm Covid-19, hampering efforts of health authorities to respond timely and effectively.
We have seen many cases across Africa in which Covid-19 cases have been reported among foreign nationals. Somalia hosts thousands of international staff that are part of various military, political and humanitarian missions including AMISOM, UNSOM, a large diplomatic core, international contractors, both civilian and military, to name but a few. These personnel travel in and out of the country frequently posing great public health risks, which are difficult to minimize.
Responding to Covid-19 without proper planning will be impossible given the fragility of Somalia’s country system. Consistent with global best practices, the Federal Government of Somalia should consider instituting the following measures to curb Covid-19 spread.
- Convene a taskforce consisting of multidisciplinary international and local experts to prepare the nation for the spread of Covid-19.
- Introduce travel bans/restrictions where necessary among international staff living in the country both in Aden Adde International Airport and other parts of the country. In addition, coordinate with international organizations on protocols for how to limit contact between their internationally mobile staff and local communities.
- Allocate additional government resources to support emergency preparedness, surveillance, management protocols, public education and outreach.
- Setup a Covid-19 emergency coordination center and quarantine sites in major cities.
- Designate one hospital as primary hospital in each region to treat and manage suspect cases locally.
- Provide federal states and local governments materials and knowledge support to provide preventative and containment measures.
- Ensure availability of in-country diagnostic capacity especially in urban settings along with personal protective equipment required for patient care.
- Strengthen surveillance and contact tracing as per WHO protocols.
- Engage the private sector in healthcare and other sectors to support pandemic response and resources.
- Increase public education and outreach. Setup a national hotline to support citizens to call in for accurate information. This is crucial to ensuring that the public is abreast and panic is avoided in the event of an outbreak. This must be done at community level.
To its credit, Somalia’s Ministry of Health has begun preparatory work and outreach programs aimed at public education. However, the reality on the ground is far more critical, and there is a need for an immediate multi-tiered and interdisciplinary approach led by local and international experts.
The public needs to be aware of the potential threat in a manner that does not incite panic. An awareness needs to be conveyed about the facts of Covid-19 and how it will affect people’s daily lives, so they can be a partner in stopping the spread of the virus through reasonable prevention measures (i.e. washing hands, social distancing etc.).
The social, political and economic impact of Covid-19 globally is massive as we are witnessing. Economic impact should be mitigated by encouraging stronger public and private partnerships to address immediate and long-term economic fallouts.
Dr. Hodan Ali is Family Nurse Practitioner and Benadir Regional Administration Humanitarian and Durable Solutions Coordinator.