With no labs for testing, Somalia braces for COVID-19

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A doctor and a nurse prepare a ward for COVID-19 patients at a hospital in Mogadishu, Somalia. Photo by: REUTERS / Feisal Omar

MANILA — Somalia has dealt with drought, localized displacement, heavy floods, and locust infestations in the past 9 months. But the arrival of COVID-19 could push the country into another crisis, aid workers fear.

Authorities have to date reported five confirmed cases of patients with COVID-19 as of April 3. The numbers are low. But that may be more due to gaps in the country’s health system, said Ahmed Khalif, country director of Action Against Hunger in Somalia.

“You see what’s happening in Europe, and the panic in America … so Somalia and other insecure countries may not be a priority now.”

— Aydrus Daar, executive director, Wajir South Development Association

“That's not to say there are no other cases. One because there is limitation with the testing,” Khalif told Devex earlier this week.

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To confirm the five cases, the government had to ship the specimens to the Kenya Medical Research Institute and other regional reference laboratories, Khalif said. There are a few laboratories in Somalia, including in Mogadishu and Hargeisa, that can diagnose a number of infectious diseases. But not one exists at the moment that has the capacity to diagnose COVID-19.

The Ministry of Health is currently working to procure PCR machines and train laboratory staff to build its diagnostic capacity. The World Health Organization and a health consortium led by Action Against Hunger, funded by EU humanitarian aid, are assisting the government to procure diagnostic kits and other medical supplies and equipment to boost the capacity of these laboratories. But there are still a lot of gaps that need to be filled. Health workers are in short supply. A report of a WHO mission in 2015 shows that the number and density of doctors, nurses, and midwives in the country are below 4 per 10,000 of the population.

Khalif is concerned about limited capacities in hospitals to be able to manage cases. There’s been an emphasis on investments in primary health care over the years, but not much on higher-level health care facilities to handle epidemics, he said.

And like other countries, Somalia is also experiencing a shortage of personal protective equipment and medical supplies such as antibiotics and painkillers. Khalif said they’ve reached out to several pharmaceutical companies globally, but face challenges in securing supply. The imposed curfew in Kenya has also slowed down delivery of these items, he said.

“Most of them are saying they're not able to supply the quantities we are asking for or they have restrictions in-country not to take out some of the supplies,” he said.

COVID-19 will put additional pressure on Somalia’s health system, which is already unable to meet the demands of basic health care services.

COVID-19 could also exacerbate the already dire humanitarian situation in the country, which has gone through decades of conflict and humanitarian emergencies. In 2020 alone, close to 5.2 million people, or one-third of Somalia’s population, are in need of assistance.

“A further widespread outbreak of this will be a catastrophic threat to people who are already extremely vulnerable [and] who have serious gaps in terms of basic services,” he said, adding that the locust situation remains a concern in the country. Locusts are continuing to breed in Somalia’s northeast, and new swarms may emerge in the coming days.

Aydrus Daar, executive director at Wajir South Development Association that works in Kenya and Somalia, told Devex the pandemic is already having an impact on the Somali population.

Informal workers, such as those working in construction, are having difficulty getting work as families that employ them and rely on overseas remittances are now struggling. Family members in the diaspora are also losing jobs or sources of income.

“Somalia gets $1.6 billion [a year] from the diaspora, mainly from the west. But these countries are now on lockdown, meaning people won’t be able to send to kin in Somalia,” Daar said.

Measures and rumors

One of the major concerns of aid organizations is the spread of misinformation, and how this affects how serious people take preventive measures against COVID-19. Some of the persistent rumors include that the virus doesn’t thrive in places with high temperatures. Some also felt they have experienced much worse situations, and that COVID-19 is just similar to a common cold.

There are also concerns in the enforcement of social distancing, especially among displaced communities. In Mogadishu, an estimated half a million to 800,000 people live in camps. Most of them live in cramped spaces with poor sanitary conditions.

“They live in makeshift structures [that] are not designed as COVID-19 proof, and that is a big worry,” Khalif said.

A group of Somali NGOs advocating for locally driven development in the country raised the same concern in a letter published last week. The group called Nexus, which includes WASDA, underlined the urgency of providing Somali communities, in particular those living in cramped urban spaces and IDP camps, increased access to WASH facilities, as well as more space to practice social distancing measures.

Daar said there’s “hardly 10 centimeters” separating families living in the camps. Many of these families are large households consisting of 10-12 people.

Too many families share one water tap and latrine.

There is a need for the government to identify more space to decongest these areas and add more tents, as well as to provide more space for tap construction and latrines, Daar said.

“The average is 20 person per day, per latrine. If it increases, it is an emergency situation,” he added.

Mosques and other places of worship remain open to the public. And as the month of Ramadan approaches, social gatherings will likely increase, which could accelerate the spread of infection.

Areas under the control of militant groups are also a concern, given the limited service provisions in those areas. Humanitarian NGOs received an influx of displaced people from these areas at distribution centers two to three weeks after the cholera outbreak in 2017.

“So we also anticipate significant number of populations displaced to major towns where service provision is available,” Khalif said.

Aid repercussions

Any COVID-19 response plans should involve local organizations, according to the Nexus group letter. It called for flexible funding with fewer restrictions from international NGOs and United Nations agencies. Apart from being on the frontlines, local organizations would be able to continue life-saving programs when international organizations are unable to do so due to capacity constraints, it said.

But the challenge is funding.

Apart from improving the country’s laboratory testing capacities, Khalif said the international aid community can help by increasing its funding to scale up humanitarian response on the ground.

“What we don't want is a diversion of what we have into this new crisis. We need to remain focused to continue the much needed critical life-saving interventions, but also additional funding to specifically curtail or stop further spread of this virus,” he said.

Daar shared the same need for funding, adding it will also help in the procurement of protective gear for frontline staff.

But both aid workers also recognize the challenge in their ask, as donor countries are hit hard by the outbreak.

“You see what’s happening in Europe, and the panic in America … so Somalia and other insecure countries may not be a priority now,” Daar said.

Visit our dedicated COVID-19 page for news, job opportunities, and funding insights.

About the author

  • Jenny Lei Ravelo

    Jenny Lei Ravelo is a Devex Senior Reporter based in Manila. She covers global health, with a particular focus on the World Health Organization, and other development and humanitarian aid trends in Asia Pacific. Prior to Devex, she wrote for ABS-CBN, one of the largest broadcasting networks in the Philippines, and was a copy editor for various international scientific journals. She received her journalism degree from the University of Santo Tomas.