Fifteen-day-old Faadumo lies quietly with her big, dark eyes wide open. Her tiny head and dainty fists rest on a nest of blankets, starting with a black shawl. A second one adorned with white dots is layered on top. She is then tucked in a bigger, thicker blanket in a maroon and cream color. In between these wrappings is one more layer that is smooth, reflective and uncharacteristically thin for a blanket. It is a black plastic shopping bag.
Faadumo was born prematurely at seven months. Her mother, who was only 15, died during childbirth. The plastic bag is to keep Faadumo warm, as is the single-bed room with no window that she is staying in.
A premature baby like her should, of course, be kept in an incubator. But here in Bosaso General Hospital in the state of Puntland, Somalia, a plastic bag and many blankets are the best doctors can do to keep her warm – and alive.
“We need incubators and our staff also need training on how to use them,” says Dr. Mohamed Said, the pediatrician at the hospital.
Besides being premature, Faadumo is also malnourished. She weighed 1 kg at birth, and weighs not much more – 1.1 kg – now.
“Too many” challenges
When asked about the challenges his Ministry faces, Abdirizak Hersi Hassan, Director General of the Ministry of Health in Puntland, sums them up in two words: “Too many.”
Poor infrastructure, shortages of personnel and equipment, and inadequate training – the list goes on and on. The indicators tell the story of what Mr. Abdirizak and his Ministry are up against.
- The risk that a Somali woman will die in childbirth: third highest in the world (1 in 22).
- Under-five child mortality: third highest in the world (137 per 1,000 live births).
- Immunization coverage: less than 50 per cent.
- Female genital mutilation: highest in the world (98 per cent).
What makes the Somali narrative so much more distressing than anywhere else in the world is this: the struggle for a woman to survive while giving life, and for a child to survive to see his or her fifth birthday, has been going on for far too long.
Since the collapse of the central government in 1991, Somalia has been in an almost constant state of war. Today, 1.1 million Somalis are displaced inside the country and another 1 million as refugees in neighbouring countries. Somalia’s health systems are mostly supported by development partners and funded by donors. UNICEF alone supports 70 per cent of the country’s health facilities. “Without such support,” says the Director General, “the health systems will collapse.”
An essential health package for all
At the maternity ward in the mother and child health clinic in 100 Bush Internally Displaced Persons Camp, Malyuum Osman, 29, rests with her one-day-old newborn, Mohamed. Over the years she has suffered two miscarriages and seen two children die – a daughter from illness, and a boy in an accident.
“I was carrying a bottle of water, and it was too heavy – I tripped and fell and lost the baby,” she says of how she miscarried last time. “The daughter died from diarrhoea. She was not even two years old.” Malyuum weeps when she thinks of them.
Despite the basic conditions here, the clinic, staffed by 14 midwives and nurses, is doing wonders for the local population of 15,000 people living in the various displacement camps. It is one of the many clinics supported by UNICEF under the Joint Health and Nutrition Programme, an ambitious five-year plan to save mothers and children from dying unnecessarily in Somalia.
A critical component of the programme is to ensure a core package of reproductive, maternal, newborn and child health and nutrition services to all Somali women, children and families. Since 2012, 5.7 million people, out of a total population of 12.3 million, have had access to such services, offered free of charge in public health facilities like the 100 Bush Mother and Child Health Clinic.
Under the scheme, more women are being assisted at birth by skilled birth attendants; more children are receiving treatment for major childhood killer diseases, especially diarrhoea, pneumonia and malaria, and are protected with immunization; and the treatment and prevention of malnutrition is on the rise.
However, there are currently no firm plans for the continuation of the programme in 2017 and beyond. UNICEF, along with partners, is mobilizing resources to keep the health services open, and the 2000 health workers covered under the programme – out of 3000 in the entire country – paid.
“A good life for us all”
Soon Malyuum and her baby will be able to go home to her three other children. Life has been hard and will continue to be hard for the single mother. The family of five, now including baby Mohamed, survives on the US$2 a day she makes by cooking for workers at construction sites. But she remains optimistic.
“I pray to Allah to grant my children health,” she says. “I want a good life – a beautiful life – for us all.”
To find out about the fate of Faadumo and learn more about UNICEF’s work for mothers and babies in Somalia, write to us at firstname.lastname@example.org.
Kun Li is Communication Specialist for UNICEF Somalia.