The current assessment paper is designed to review the health care system of Somalia. The country is a part of the Eastern Mediterranean Region, which includes 20 more countries beside Somalia that are situated along the eastern coastal line of the Mediterranean Sea. According to the World Health Organization (WHO) (2020a), the other countries in the region include Afghanistan, Bahrain, Djibouti, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Qatar, Saudi Arabia, Sudan, Syrian Arab Republic, Tunisia, United Arab Emirates, and Yemen. The population of the Eastern Mediterranean region is estimated at approximately 538 million people (WHO, 2020a). The leading health issues in the region, in general, and in Somalia, in particular, include COVID-19, other infectious disease outbreaks, non-communicable disease epidemics, maternal and neonatal mortality, and the overall under-development of the health care system (Alwan, 2018). The current report identifies the areas of health disparities, social injustice, systemic drawbacks, socio-economic and environmental issues related to health in Somalia to emphasize the areas for improvement.
Demographics
The overview of a country’s health care situation must be initiated with a demographic description. The population of Somalia is estimated at 20.3 million people as of 2019 (Institute for Health Metrics and Evaluation [IHME], n. d.). Overall, the number of population is rapidly increasing, and the country is characterized by a relatively youthful population with the majority of the population younger than 54 years old. In particular, individuals aged 0-14 years constitute 45.6%, 15-24 years – 21.5%, 25-54 years – 28.9%, 55-64 years – 2.1%, and 65 years and older – 2% (United Nations Population Fund Somalia [UNPF Somalia], 2016). Thus, life expectancy in Somalia is rather low, with 60.6 years for females, and 56.5 for males, as per 2017 (IHME, n. d.).
Gender distribution of the population is represented by a sex ratio of 103 men per 100 women; therefore, the gender distribution is relatively equal, which allows for adequate marriage incidence and childbirth (UNPF Somalia, 2016). The prevailing majority of the population is Muslims; from the perspective of race, over 85% of the people are Somalians. Only 3% of household heads have a university degree, and over 79% have no education; the income level is characterized by 21% of poorest households and 18.8% of most prosperous households (UNPF Somalia, 2016). These demographic characteristics allow for identifying health disparities and vulnerable population groups.
Health Disparities and Vulnerable Populations
Due to the weakness of the health care system, the ongoing national conflict, and socio-economic disparities, the best health indicators have people from urban regions and of higher socio-economic status. In contrast, rural impoverished residents, especially women and children, are regarded to be vulnerable populations (“World Health Organization humanitarian response plans,” 2015). The social justice system’s ways of eliminating health disparities include the improvement of access to health care, implementation of universal coverage, and governmental programs for economic improvements.
Somalia’s Health Goals
These goals in the sphere of health care of Somalia have similar features with the health goals identified by the WHO region. Given the high level of maternal and child mortality in both the region of the Eastern Mediterranean and Somalia calls for improvement of the quality of health in these populations. Also, the overall improvement of access to primary health care and the prevention of communicable diseases are the goals that the region in general aims to achieve (Alwan, 2018; “World Health Organization humanitarian response plans,” 2015). However, the improvement of nutrition and access to fresh water to eliminate infectious disease outbreaks and increase the overall level of well-being are Somalia-specific goals.
Leading Cause of Death Across the Lifespan in Somalia
The leading causes of death are those related to “communicable, maternal, neonatal, and nutritional diseases,” where lower respiratory infection, tuberculosis, neonatal disorders, and diarrheal diseases are the top four causes of death (IHME, n. d., para. 7). Stroke and cardiovascular disease are the leading causes of death among non-communicable illnesses across the lifespan. Notably, the patterns in the most prevalent causes of death have not significantly changed within the past decade.
Health Indicators in Somalia
The demographic characteristics of the country predetermine the key health indicators. The leading ones for Somalia include infant mortality, maternal mortality, and life expectancy (“World Health Organization humanitarian response plans,” 2015). When comparing the identified health indicators with the ones prevailing in the WHO region, to which the country belongs, one might state that they coincide. Low life-expectancy rate and high mortality incidence in maternal and neonatal domains are the leading health indicators in the Eastern Mediterranean Region.
Health Care Priorities
The health care priorities in Somalia derive from the overall economic, social, and political situation, as well as health goals. The current outbreak of COVID-19 that has impacted the world has imposed the need for improved emergency response and better access to health. As defined by the WHO (2020b) authorities, the top priorities in health care for Somalia include universal health coverage, health emergencies, promoting healthier populations, immunization, and communicable diseases. These priorities reflect the overall direction of the health care development plan in the Eastern Mediterranean region of WHO. They include “health security and communicable diseases, the non-communicable diseases epidemic, the high burden of maternal and child mortality, emergency preparedness and response and the overarching challenge of health system strengthening and universal health coverage” (Alwan, 2018, p. 1). As the comparison shows, the regional priorities are more diverse and include specific vulnerable populations. However, the overall prioritization of key health indicators is similar, which demonstrates the alignment of the health care strategies employed by regional and state entities.
Human Rights in Somalia
The military conflicts and social unrest in the country coupled with the health disparities and gender and economic inequalities display a significant challenge for the provision of human rights in Somalia. Indeed, as stated by the United Nations Human Rights Office of the Commissioner (2020), there has been a decline in human rights for the past 20 years in the country due to the incapable national authorities, armed conflicts, epidemics, and humanitarian emergencies. These issues have led to continuous violation of human rights, inequalities, and non-accountable abuses. The identified human rights violations have an adverse impact on the health care situation in Somalia.
Climate and the Environment’s Impact on Health
The environmental impact on health is vividly observable in Somalia. The tropical climate causes draughts, scarcity of water resources, and deforestation (“World Health Organization humanitarian response plans,” 2015). In addition, climate change, air pollution, and the abundance of waste cause significant challenges to the country’s ecology and ultimate health outcomes. Overall, the tropical and deserted lands are not sufficient for developed agriculture, which, combined with other adverse factors, disrupts healthy nutrition opportunities for Somalians.
Health Care System of Somalia
As a country with fragile governance and continuous economic and political instability, Somalia’s health care system is currently in a weak condition. According to the World Health Organization humanitarian response plans (2015), Somalia’s medical sector is “poorly resourced and inequitably distributed” (p. 1). One of the indicators that demonstrate the effectiveness and the level of development of the health care system is the health expenditure, which is critically low, estimated at $6 per person with $2 of out-of-pocket, $1 of government health, and $3 of development assistance for health spending (IHME, n. d.). The system critically lacks health workers, which is why “around 3.2 million women and men in Somalia are in need of emergency health services” (“World Health Organization humanitarian response plans,” 2015, p. 1). Thus, the health care system of Somalia requires assistance from international organizations to achieve their health goals.
Health Concerns of Women and Children
As defined above, maternal and child mortality and a high rate of morbidity are key health concerns in the country. According to the statistical data, the rate of maternal health reaches the point of 850 deaths per 100,000 live births, while 92 children aged under 5 and 53 children aged under 1 per 1,000 live births die (“World Health Organization humanitarian response plans,” 2015). Inadequacy of medical practices and poor quality of primary health care and maternal care lead to morbidity and under-treatment in children and women, as well as stigmatization based on mental health issues. The measures that are defined for improvement include annual monitoring of primary health care vital signs, strategies for regulating reproductive health, maternal and child mortality, and insufficient access to nutrition (WHO, 2020b). These measures are planned to be implemented within the national strategies for health service improvement.
Prevalence of Infectious and Non-Infectious Disease
Somalia has been exposed to several infectious disease outbreaks within the latest decades. The current Coronavirus epidemic puts constraints on the emergency response capability of the country. In addition to COVID-19, Somalia is highly impacted by HIV/AIDs, malaria, measles, and cholera (WHO, 2020b). As for non-infectious diseases, the most prevalent ones are stroke, ischemic heart disease, anemia, malnutrition, and neonatal disorders (IHME, n. d.). Such heterogeneity of prevalent diseases requires systematic multifaceted strategies for the overall improvement of the health status of the population of Somalia.
Natural Disaster/Humanitarian Crisis Within the Past Decade
Somalia has been affected by several humanitarian crises and natural disasters within the past decade, including armed conflicts, droughts, floods, and epidemic outbreaks. However, the military conflict remains one of the most significant factors that cause a humanitarian crisis in the country (“World Health Organization humanitarian response plans,” 2015). Combined with the rising scarcity of food and water on the background of COVID-19, the conflict does not allow for implementing adequate measures for prevention and treatment.
Conclusion
As the data demonstrates, Somalia is a particularly vulnerable country with a health care system in need of substantial development and the improvement of the population’s health indicators. The health-related interventions and initiatives should be planned with particular consideration of the demographic attributes of Somalia, the largest population segment of which is comprised of young people in their fertility and productivity phase in the lifespan. The socio-economic challenges due to the increasing population, conflict, high morbidity and mortality rates, as well as the diminished functionality of the health care system, impose difficulties on accessing to health care. Thus, long-term improvement-oriented measures should be initiated by the international community to assist Somalia in overcoming these challenges.
References
Alwan, A. (2018). Moving to action in the Eastern Mediterranean Region.International Journal of Public Health 63, 1–2. Web.
Institute for Health Metrics and Evaluation. (n. d.). Somalia [Data set]. Web.
United Nations Human Rights Office of the Commissioner. (2020). OHCHR in Somalia [Data set]. Web.
United Nations Population Fund Somalia. (2016). Population composition and demographic characteristics of the Somali people. Volume 2 [PDF document]. Web.
World Health Organization. (2020a). Regional Office for the Eastern Mediterranean [Data set]. Web.
World Health Organization. (2020b).Somalia [Data set]. Web.
World Health Organization humanitarian response plans. (2015). Web.