After around two months of watching the global spread of the coronavirus (COVID-19), on 31 March 2020, Somalia had five confirmed cases of the virus. Any interventions to stop the spread of the virus in Somalia will, without a doubt, be deterred by cracks in the health system that will now deepen further unless swift action is taken by Somalia’s partners.

Laboratories across Somalia do not have the capacity to test for COVID-19, which will inevitably lead to missed opportunities for the early detection of cases and exacerbate further spread by undiagnosed cases. Even if they did have tests, a majority of Somalis find it difficult to access laboratories due to limited and poor quality of public transportation.

With two health care workers per 100,000 people, compared to the global standard of 25 per 100,000, most existing health facilities are understaffed. Facilities already lack regular stocks of essential health supplies. The impact of COVID-19 on the supply chain could be significant, with lockdowns, closure of production plants, exhaustion of existing stocks, closure of ports, and the ensuing impact on access to markets.

Somalia scored 6 out of 100 in 2016 on the Health Emergency Preparedness Index, a global report card on a country’s capacities to prevent, detect and respond to any global health security threat.

The country already has one of the highest maternal mortality rates in the world and an estimated one out of every 22 women is likely to die due to pregnancy or childbirth-related causes. The maternal mortality ratio stood at 732 deaths per 100,000 live births in 2018. Access to both information and services about maternal health is low, with only around two out of ten women delivering being assisted by any skilled personnel, according to the Population Estimation Survey for Somalia (2014).

There is limited data on the effects of COVID-19, but recommendations that any febrile respiratory illness in pregnancy should be treated seriously with immediate diagnosis, appropriate care and precautions to avert infections.

“We all have to ensure prevention of the spread of COVID-19 by observing social distancing, frequently washing hands, wearing surgical masks and other personal protection equipment,” states the Maternal and Reproductive Health Manager at the Federal Ministry of Health and Human Services, Dr. Naima Abdulkadir.

“This is really a challenging and difficult task because of the Somali traditions of staying together in close contact and greeting each other by hugging and shaking hands. So, one could expect to see things get only worse for pregnant women in Somalia. However, we need to work to ensure their compliance with COVID-19 requirements and safe delivery,’’ she said.

Dr. Abdulkadir advises that specific attention should be given towards raising awareness among and protecting midwives and health care workers who are in close contact with women delivering babies, to reduce infection, and ensure prevention and control of the virus in all health facilities. She emphasized that efforts should be made to continue outreach of maternal and reproductive health services, particularly for vulnerable groups such as internally displaced persons and people in informal settlements.

“We should not lose sight of our fight to reduce the exceptionally high maternal mortality in the country and, after all, mothers and their babies will always be supported in giving birth during this highly sensitive COVID-19 pandemic period,’’ stressed Dr. Abdulkadir.

Fay Osman Gabow, a senior midwife with over 35 years of assisting women with delivering babies, is worried that fears caused by the coronavirus may stop pregnant women from visiting hospitals for antenatal care. Already, not as many women seek antenatal care in Somalia.

“Clear and tailored messages should be shared, directed at pregnant mothers and health care workers. Pregnant women should be aware of the availability and accessibility of important services and measures that can be taken to protect them from infection,” said Ms. Gabow.   

Even before the news of the first COVID-19 case was confirmed in Somalia, UNFPA sprang into action, developing internal plans to respond to the pandemic and continuing to develop the capacity of national institutions. UNFPA works closely with governments, UN agencies, community-based organizations and other partners, to ensure that reproductive health is integrated into common COVID-19 responses. The agency also supports the procurement and supplies of Personal Protective Equipment (PPE), sanitizers, N95 masks, soap, and gowns/goggles for health professionals, including midwives for both infection prevention and control (IPC) at Emergency Obstetric Care and Neonatal Care (EmONCs) facilities. UNFPA also supports the training of health care workers on IPC and risk communication and supports facilities with obstetric and family planning supplies. Support is provided to vulnerable populations and to address the needs of women and young people, both at emergency and reconstruction phases.

More can be done in Somalia to respond to this pandemic that is taking a toll on health systems across the globe

                                                                                                                                                                                                                                                                                              -----Ridwan Abdi