Berbera - The socio-economic situation

Berbera, a coastal town, was hit hard by the civil war in Somaliland between 1988 and 1991, in which nearly 60,000 people were killed and half a million became refugees. The infrastructure was virtually destroyed and many cities were completely razed to the ground.

Berbera is characterised by a comparatively high HIV/AIDS rate (2.6% in Berbera compared to 1.4% countrywide average), extreme poverty and a high unemployment rate. On average, eight to nine children live in one household, which is far above the national average of six children. This number is a result of a high birth rate (4.46 children) as well as the fact that a lot of families are taking in orphans.

There is one overcrowded TB (tuberculosis) hospital in Berbera which also serves as a general hospital. The other hospital (formerly a hospital for the mentally impaired) is rundown and not used. Therefore the 300,000 plus residents of Berbera have to seek alternative medical care, through private clinics, pharmacies or traditional healers.

As in other major towns in Somaliland, the spread of HIV/AIDS is increasing in Berbera day by day. There are a number of factors that are thought to be accelerating the spread of the disease, among them the location of Berbera itself i.e. on the coast. Travellers come from countries with a high prevalence of the disease while foreign sailors dock in Berbera port, and truck drivers from as far as Djibouti and Ethiopia travel to Berbera constantly. There are also young men from the neighbouring towns of Hargeisa and Burao who come to Berbera in search of casual labour at the port. All these people have contributed to the spread of the diseases in the town.

Diarrheal disease-related dehydration, respiratory infections and malaria are the main killers of infants and young children, together accounting for more than half of all child deaths in Berbera. Cholera is endemic in Somaliland, with the threat of outbreaks recurring annually during the “season” from December to May, when in crowded communities  the pre-conditions emerge as a result of a critical  water shortage. The major underlying causes of diarrhea are the lack of access to safe water, and poor food and domestic hygiene.

Malnutrition is also a chronic problem in Berbera due to poverty, low quality diet, poor feeding practices and inadequate home management practices.

Berbera’s weather has contributed greatly to poverty in the area. During the summer the temperatures may reach as high as 50°c making it impossible for people to engage in any economic activity. The few able people migrate to cooler areas leaving behind the poor, many of whom are former refugees who settled here with the hope of gaining some income from the port.

The population of Berbera relies heavily on imported food like rice and spaghetti but regular price increases (due to devaluation of currency and the recent world food crisis) affect the ability of an average household to rely solely on market purchase and in many households, cases of malnutrition and underweight children are evident.

The SOS Medical Centre Berbera

Given the above scenario, SOS Children’s Villages Somaliland opened a medical centre in Berbera in March 2008 to assist the population by providing the most basic and necessary support to enable them to cope with the many health challenges.

The medical centre is staffed by one full time doctor, a midwife, a clinic nurse (for under-fives), a pharmacist, a laboratory technician, a receptionist, a visiting gynaecologist and four support staff.

The services provided

Out-patient services for mothers and children

Maternal and Child Health / Reproductive Health services offered include:

• Antenatal care (ANC): Visiting pregnant mothers are provided with ferrous sulphate and folic acid tablets during each visit. They also receive two doses of tetanus toxoid if not previously vaccinated. Early detection of risk factors during pregnancy is made and treated if necessary. If treatment is not available, or not possible at the health centre, the mother is referred to hospitals.

• Postnatal care (PNC): During the 6 weeks following delivery, mothers receive a physical examination, and may receive counselling on breast-feeding and family planning. Complications of childbirth are detected and treated. If treatment is not available or not possible, the mother is referred to postnatal clinics in hospitals.

• Growth monitoring of under fives (U5s): Children under the age of five years are periodically weighed to monitor their growth. The routine immunization visits are utilized to monitor growth.

Other services

• Management of acute respiratory infections (ARIs) and diarrhoea using the standard case management charts.

• Promotion of breast-feeding through health education.

• Immunization according to the Somaliland national schedule.

• Curative services to mothers, adults and children.

• Laboratory/ diagnostic services.

• Gynecological services.

On average, the medical centre serves 30 patients each day.

Common illnesses

The medical centre has witnessed an increasing number of malnourished and underweight children, approx 30% of cases

Other common child illnesses include:

• Respiratory tract infections - 38.4%

• Gastrointestinal enteritis/ diarrhoea- 32%

In adults, the following are common:

• Urinary tract infections – 42%

• Anaemia – 15%

The future

It is envisioned that within the course of 2010, a family strengthening programme will be started in Berbera to support 200 beneficiaries.

HIV/AIDS prevention and treatment of opportunistic infection services will also be offered at the centre within the course of the year. This activity includes the establishment of a VCT (voluntary counselling and testing centre) and prevention of mother to child transmission services (PMTCT).