Hiiraan Online

by Samira Sawlani
Friday, August 16, 2013

"We are ending our programmes in Somalia because the situation in the country has created an untenable imbalance between the risks and compromises our staff must make and our ability to provide assistance to the Somali people."

These words of Dr Unni Karunakara, President of Doctors of Borders, have gone on to make headlines across the world, particularly because MSF has always been known as an organisation which has stayed committed to vulnerable populations regardless of adversities.

The decision to leave Somalia has resulted in three areas of concern forming discussion points; first, the power which terrorist groups continue to have in the country, secondly, the implication this has for the image of the Hassan Sheikh Mohamoud government and thirdly, what will become of the millions of civilians who have been dependent upon MSF.

The Organisation had been providing free medical care in Somalia since 1991. Throughout the years of war, famine and health crisis it was one of the few organisations which remained during the troubled times of the country. It also continued to operate in areas of the country which were under the control of Al- Shabab who had allowed them to remain despite expelling almost all other international aid agencies.

Some of its successes include the rapid set up of a cholera treatment centre in Balcad in 2012 where 75 of 77 patients were cured and the spread contained.  The creation of a Measles Vaccination campaign in Daynile where over 60,000 people were given the vaccine before conflict in the region meant the project had to be suspended. In fact according to statistics released by the organisation in 2012 alone, MSF teams provided more than 624,000 medical consultations, admitted 41,100 patients to hospitals, cared for 30,090 malnourished children, vaccinated 58,620 people, and delivered 7,300 babies.

Through mobile and fixed clinics, staff offered general healthcare, mother and childcare and nutrition and immunisation programmes both in Mogadishu and in other parts of the country including Balad, Kismayo Jowhar and beyond.  Furthermore MSF recruited a number of local staff in the country all of whom will now be left unemployed.

To some MSF’s decision to pull out of Somalia will not be a shock. Since 1991, fourteen members of MSF staff have been killed in the country, its medical facilities have been targets of attack and employees have been most vulnerable to abductions. In January 2008 three MSF employees, one local and two international, were killed by a roadside bomb in Kismayo. Following this in December 2011 two MSF staff were killed in Mogadishu and then of course came the kidnapping of employees Montserrat Serra and Blanca Thiebaut who were released after 644 days captive.

Over the years research has shown that often aid workers and organisations are seen as having ‘Western agendas’ and so automatically not cooperated with due to the perception that they are the ‘enemy’.  For those targeting MSF workers or not assisting in their protection, there is perhaps an association between them and Western powers who are seen to back the Somali government. These attacks also allow rebel groups to exercise and display their strength and power to the world, and in this case questions are naturally being raised around how strong the current ruling party is.

Regarding its suspension of operations in the country MSF stated "The armed groups' targeting of humanitarian aid, and civilians leaders' tolerance of these abuses, has effectively taken away what little access to medical care is available to the Somali people."

Of primary concern is the implication which MSF’s decision will have upon civilians, Dr Omar Saleh of the World Health Organisation (WHO) recently said ”Malnutrition rates in Somalia are still among the highest in the world, with one in seven children under five acutely malnourished. Two thirds of these children are in southern Somalia and need medical assistance.”

This also illustrates the dependency that the country has had upon MSF in terms of healthcare and should serve as a wake-up call to the Government to prioritise spending on health services. Furthermore, if more focus and finances is put towards the health sector then those medical professionals that had left Somalia due to the conflict may be tempted to return home and take up jobs. With MSF no longer offering services in Somalia many parts of the country where it was the sole provider will now have no medical facilities whatsoever. As the job of the Government is to serve its people, this needs to be addressed immediately.

MSF argued that some local leaders and authorities, particularly in those areas outside of Government control, did not cooperate with the organisation which also contributed to increasing insecurity. Again this is a reminder of how essential it is for those sitting in Parliament to continue to push for unity in the country.

Currently the Government is putting much focus upon attracting investors, particularly to Mogadishu in order to lay the foundation of economic recovery in Somalia. As important as this is, the fact that MSF leaving the country will mean that a number of regions outside of Mogadishu will also not have any or limited healthcare services at all should ring alarm bells for the central Government, which perhaps is having to face up to its lack of control outside of the capital city.

Above all this situation highlights the on-going battle with insecurity and those dark forces who continue to destroy the lives of civilians. Previously during the famine in Southern Somalia, Al- Shabaab blocked all aid from reaching those starving and suffering. It seems that the organisation or organisations like it, continue to illustrate their leverage by taking destructive actions which have now led to what can only be described as a tragedy.

At a time when Somalia finding its feet, the pulling out of an internationally acclaimed NGO like MSF will only harm the reputation of the country. Potential investors are unlikely to be filled with confidence after these events and in terms of security it is a blow to the image of the country.

MSF pulling out of Somalia shows the long road ahead in re-birth of the country. Healthcare is a basic right of every human being and it is essential that it be prioritised by the Government. The action of one organisation has also brought to light the very many challenges which the country continues to face. The lack of connection between central government and certain regions, the continued domination in some parts of groups who resort to terror and the absence of certain infrastructure mechanisms along with medical facilities are all very real issues.