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HEALTH CLUSTER BULLETIN 1-31 December 2019 Since early December 2019, the Desert Locust situation remains extremely serious in the Horn of Africa where it threatens pastures and crops in Ethiopia, and Kenya.

Country Name: Somalia Emergency Type: Complex Conflict, Drought, Floods, Disease Outbreaks, Locusts. Reporting Period: 1-31 December 2019

There was a significant reduction of rainfall and flooding activities in areas around River Shabelle and River Juba, as well as in many districts of Bay and regions. In Punt- land, Somaliland and Central regions, there has been an improvement in terms of flood- ing, with no further risk of flash floods. Over- all, larger parts of the country have remained dry since the end of December 2019. In line with the Somalia Flood Response Plan, November 2019–January 2020 , the Health Cluster priorities were to prevent avoidable mortality and morbidity due to flood-driven environmental health hazards and displacement through access to health

There was a significant reduction of rainfall activities in Shabelle and Juba Rivers, as well as in Bay, and Bakool regions. In care and preventative measures, targeting Puntland, Somaliland and Central regions, there has been an improvement in terms of water levels, with no further risk of 200,000 people. PAGE 2. flash floods. Overall, larger parts of the country have remained dry since the end of December 2019. Photo: https://tinyurl.com/v9vyu7y

Locusts: A Threat to Public Health

A mid-December 2019 Report published by the Food 3.0M 2.4M and Agriculture Organization (https://reliefweb.int/ In need of life-saving health Targeted for health as- report/ethiopia/desert-locust-ravages-horn-africa) assistance, HRP 2019. sistance, HRP 2019. warned of the urgent need to control the Desert Lo- cust invasion in Ethiopia and Somalia. FUNDING UPDATE (as of 31 December 2019 The long term effect of locusts infestation on public health is that as they destroy acreages of farmland, the mass destruction of food crops will result in se- vere acute malnutrition (SAM) among children. US$93M US$21 US$1.6M Locusts have already destroyed 70,000 hectares REQUIREMENTS RECEIVED PLEDGED (175,000 acres) of farmland in Somalia and Ethiopia,

HRP 2019 FTS, 31/12 2019 FTS, 31/12 2019 threatening food supplies in both countries in the worst locust invasion in 70 years, reports FAO. PAGE 2. Health Cluster Bullen, December 2019 2

Health Cluster Flood Response Overview, Constraints and Lessons Learnt

Overview: The Somalia Flood Response Plan, November diseases, Strengthening/scale‐up of early warning dis‐ 2019 – January 2020 estimated the total number of people ease surveillance systems in the affected areas and De‐ affected by the floods at 547,000, of whom 370,000 were ployment of rapid response teams (RRTs) for outbreak displaced. The Health Cluster priorities were to prevent investigation and threat detection. avoidable mortality and morbidity due to flood‐driven envi‐ Summary of Results: In the midst of numerous con‐ ronmental health hazards and displacement through access straints, including access due to muddy impassable to health care and preventative measures, targeting roads, road blockages, and lack of timely supplies, the 200,000 people. Interventions also aimed to scale up the Health Cluster partners reached at least 226,655 people capacity of emergency and essential health‐care services in by the end of December 2019. Of these, 27% were wom‐ areas where IDPs were located, and through mobile and en, 15% men and 58% children (33% girls and 25% boys). outreach services to reach those in remote areas. Lessons Learnt: Flood management requires usable and How the Partners Responded: From the results of online reliable information about produced scenarios and flood survey administered with cluster partners, at least 60% of history. Without appropriate measures and systems in the life‐saving interventions of the Health Cluster partner place concerning the management of the Juba and Sha‐ were through mobile health facilities, and 35% in static belle rivers, and flooding as a hazard is viewed in isola‐ health facilities. Overall, 40% of the interventions were in tion from a holistic water management system, flooding Hiran region, 35% in Bay, 10% in and 10% will aggravate year after year with increased occurrence in and Bakool regions. and could lead to catastrophic devastations. The findings indicate that 85% of the response activities The collection, collation and reporting/escalation of included provision of primary health‐care services, estab‐ health concerns raised by the callers of Radio Ergo helps lishment of outreach services for immunization and other to flag and map out the crisis areas. Escalation consti‐ essential health care (80%), provision of essential medical tutes part of the advocacy activities and helps to draw supplies to flood affected people (60%), reduction of ma‐ the attention of partners and other stakeholders in mobi‐ ternal and child morbidity and mortality (55%) and stablish‐ lizing resources, logistics and the necessary support es‐ ment of mobile medical units (MMU) in the flood‐affected sential to respond to public health concerns in the crisis areas/areas of displacement (50%). affected areas. Other interventions included Prevention, mitigation and There is need for a long‐term strategy that will address control of water‐borne and vector‐borne diseases, Address‐ flood risk management as part of integrated multi‐hazard ing life‐threatening conditions related to communicable disaster risk management and preparedness.

Locusts a threat to Public Health

The long term effect of locusts infestation on public health is that as they destroy acreages of farmland, the mass destruction of food crops will result in severe acute malnutrition (SAM) among children. “Locusts are pests, not vectors. Unlike mosquitoes, they are not associ- ated with disease transmission”, says Dr. Atha- nasius Mutaawe from WHO in Somalia. Chemical spraying in locust control poses a risk to human health, with pregnant women and children most vulnerable. Safety measures must be in place to ensure that communities will not be exposed to locust insecticides in areas where locust spraying is undertaken. Health Cluster Bullen, December 2019 3

Attacks on health care complicate access to life-saving health services

Aacks on health care constute any act of verbal or physical violence or obstrucon or threat of violence that interferes with the availability, ac‐ cess and delivery of curave and/or prevenve health services during emergencies. Aacks on health care could be on:  Health facilies (occupaon, bombing/ destrucon, confiscaon of supplies/ equipment, blockage of access);  Health transportaon (bombed/destroyed, confiscated, checkpoints and delays);  Health workers (shot, beaten, threatened, in‐ terrogated, kidnapped, tortured, raped, ar‐ rested); or  Paents (shot, beaten, threatened, interrogat‐ ed, kidnapped, tortured, raped, or arrested) Between 2018 and 2019, WHO’s Surveillance Sys‐ tem for Aacks on Healthcare documented at to‐ tal of 9 verified cases of aacks on healthcare in Somalia. Partners are urged to remain vigilant, and to report all cases of known aacks on health. Suc‐ wherever and whenever they occur. All reported cases are subjected to a cess on this requires vigilance. As a Health Cluster verificaon and validaon process. As the Health Cluster lead agency, WHO partner, you have the responsibility to report is providing global leadership on the methodology for collecon of infor‐ about the known cases of aacks on healthcare maon on aacks on health care and its disseminaon.

Scoping Mission Highlights ways to Improve Health Response to Gender-based Violence

From 23 November to 6 December 2019, WHO commissioned a GBV and referral opons ‐ with only a few health facilies GBV scoping mission to Somalia, facilitated by the Health Clus‐ providing CMR, health care for IPV or MHPSS services; Gaps ter. The aim was to understand the current health responses for in supplies for post‐rape care treatments (RH Kit 3 and 9); Gender‐based Violence (GBV) in Somalia, idenfy challenges lack of data and informaon on the availability and quality of and opportunies. GBV health services ‐ with no integrated system tracking the availability or quality of GBV health responses in Somalia; and The mission tool place at a me when the internaonal world lack of knowledge and capacity among health providers on observed the Internaonal Day for the Eliminaon of Violence how to respond to IPV and sexual violence. against Women, and the start of the 16 Days of Acvism Against Gender Violence. The 16 Days of Acvism Against Gender‐based The mission recommended the need to improve GBV integra‐ Violence (Internaonal Human Rights Day), highlighted 16 key on into the Health Cluster plans and strategy in 2020, with facts on inmate partner and sexual violence against women. the Health Cluster strategy for 2020 providing an opportunity to agree on priories, resources and what the different health A half day workshop was held on 26 November 2019 with part‐ programming approaches that can be adopted by health part‐ ners from the Health Cluster to discuss current GBV service pro‐ ners to increase their GBV health services. It also recom‐ vision, gaps and idenfy priories to improve responses. Two mended an ; increase coordinaon and collaboraon be‐ field visits were conducted to health facilies in Mogadishu tween the GBV sub‐Cluster and Health Cluster; provision of (Benadir Hospital and Medina Hospital) to meet with staff and training and capacity building of health partners to improve assess GBV services at the facilies. GBV services; enhancement of health informaon manage‐ ment systems to safely and ethically collect, collate and ana‐ The findings highlighted limited coordinaon between the GBV lyse GBV related health data. sub‐Cluster and the Health Cluster; limited health services for

Health Cluster Bullen, December 2019 4

eWARN Updates, December 2019

The Early Warning, Alert and Response Net‐ work (EWARN) is a network of health part‐ ners that collect and report surveillance data on selected epidemic‐prone diseases, as part of establishing an early warning system for disease outbreaks in humanitarian situa‐ ons. Termed as a ‘syndromic surveillance system’ EWARN facilitates the rapid monitoring and invesgaon of unusual events or disease occurrence. From 11‐12 December 2019, eWARN surveil‐ lance expansion training was conducted for the first me in district. A total of 28 healthcare providers ( 22 male and 6 female) from Bakool region aended the training. Priority # Sites The parcipants were trained on surveil‐ High 338 lance, case definion, use of the mobile ap‐ Medium 228 plicaon, reporng tools for the eWARN sur‐ Lower 175 veillance system. Zero Reports 479 Total 1220

Cholera (Week 50, 9-15 Dec. 2019) Measles (Week 48, 25 November —1 December 2019)

 During the period 9-15 December 2019, a total of 126 new cases of A total of 126,653 (74%) of children under one year of age out of the targeted cholera and two deaths were reported from 11 districts of Banadir 171,400 children received measles 1 vaccine (MCV1) in drought-affected dis- region. Since December 2017, a total of 9,613 cumulative cases, tricts since March 2019. During the drought monitoring period, March to October including 50 deaths (CFR 0.5%), were reported from 3 states of So- 2019, the vaccination coverage has been ranging between 61% and 83% per malia (Hirshabelle, Jubbaland and South West state) and Banadir month against a monthly target of 21 425 children under 1 year of age. region.

 Since December 2017 a cumulative attack rate of 218 cases per Polio (Week 48, 25 November—15 December 2019) 100,000 people was reported with Kismayo (Jubbaland) and Daynile (Banadir) being the most affected districts. Although the overall CFR No new cases of circulating vaccine-derived polio virus type 2 (cVDPV2) were was 0.5%, higher rates were observed in Abdilaziz, Daynile, Waberi, confirmed this week. Between epidemiological weeks 1 and 48, three new Karan and Kurtunwarey districts exceeding the WHO’s threshold of cVDPV2 cases were confirmed in Somalia. The most recent case of cVDPV2 <1% CFR. was confirmed on 8 May 2019. Similarly, no new cases of cVDPV3 were report- ed from acute flaccid paralysis cases in 2019. The last case of cVDPV3 in So-  Of the 922 stool samples tested for culture since December 2017, malia was confirmed on 7 September 2018. All environmental samples were 207 samples were tested positive for Vibrio cholerae serotype Oga- negative for both cVDPV2 and cVDPV3 in 2019. An integrated measles and wa. Culture and sensitivity tests performed at the central public polio vaccination campaign was conducted in Southwest, Jubbaland, health laboratory in Mogadishu, show that the Vibrio cholerae, O1, Hirshabelle and Galmudug states, 24-28 November. A total of 918,338 under serotype. Ogawa is sensitive to chloramphenicol and tetracycline but <5 year children received polio vaccine, 825,654 the received measles vaccine, resistant to ampicillin and nalidixic acid. 548,917 received deworming and 820,052 received Vitamin A supplementation.

Health Cluster Bullen, December 2019 5 National/Sub-national Updates National: Mogadishu, 10 December 2019

Presented an update on survey results was presented. It provided the foundaon the flood response mission for group discussions to idenfy areas in of improvement to Beletweyne during the in the following year.

last week of November Humanity Inclusion (formerly HI) planned a series of 2019 where the mission training acvies on MHPSS in Dec. 2019/early 2020. met with different health cluster partners operaon‐ Key AcƟon Points al in Hiran region, visited Partners not aending Cluster meengs for three con‐ health facilies and IDP sites. During an ad hoc health clus‐ secuve months to be eliminated, have their Cluster ter meeng held in Beletwyne on 28 Novermber, partners membership revoked, with room to reapply. discussed ongoing response acvies, gaps and challenges. Effecve January 2020, only partners reporng through An integrated polio and measles immunizaon campaign ReportHub to appear on Cluster 3W Operaonal Pres‐ (POPV, VitA, Albendazole) was conducted from 24 to 28 ence maps and informaon products. Nov 2019, and fogging/space spraying exercise (Naonal Malaria Control Program) started as of 27 Nov and is ex‐ Partners with updates asked to forward them to the pected to end on 10 Dec 2019. Cluster Coordinaon team. Health Cluster Workplan for 2020 to be presented to partners for comment, once CCPM Survey—Partners received briefing on the CCPM pro‐ draed. Minutes at hƩps://Ɵnyurl.com/qvequuh cess, background, and purpose. An overview of the CCPM

National: Somalia Stakeholders Meeting, 18 December 2019

Convened by OCHA, a stakeholders meeng took place at wards standardizaon of tools, templates, and methods the AMISOM VIP Conference Center in Mogadishu, 18 De‐ across the different states and regions to collect analyze cember 2019. In aendance were representaves from and use such informaon to provide the needed evidence Government, the Donor Community, United Naons to support informed programming/acon. A Country Hu‐ (including UNDP), and Non‐governmental Organizaons. manitarian Forum was established by MHADMA to strengthen coordinaon at the local level and avoid over‐ Main Highlights laps. Challenged by capacity gaps for local authories. The discussions centered on the nexus (sequencing vs. concurrent mainstreaming of the nexus) in humanitarian, Discussion along the need for capacity building for local recovery and development intervenons. authories. It is an area that is grossly lacking. There is urgent need to build and strengthen the capacity of local Nature and ming of funding steams—with a focus on authories in basic informaon management, conduct of single‐year vs. mul‐year planning (a mul‐year HRP), or needs assessments, and reporng, among other aspects. shorter‐term planning, with a call for the availability of ready funding (besides SHF, CERF) that can be tapped into Somalians in the diaspora a very important source of to address immediate humanitarian needs. funding. Key challenge is lack of accountability for such funds. Appealed for UN involvement – as an observer on Opons for effecve decentralizaon of coordinaon. how funding from the diaspora is ulized. OCHA made a presentaon highlighng the ongoing coor‐ dinaon and associated challenges at the sub‐naonal Protecon Cluster made presentaon on the Centrality of level. Coordinaon focal points (from NGOs, and with de‐ Protecon, highlighng the progress in geng key Clus‐ manding job roles) volunteer to call and chair coordina‐ ters mainstream protecon in programming. Announced a on meengs. A lot of informaon exists, but is not struc‐ scheduled meeng on 16 January 2020 providing a forum tured, and there lacks a coherent mechanism to collate it, to discuss the issue at greater detail. use it to inform decision. Appealed for a mechanism to‐

Health Cluster Bullen, December 2019 6

Puntland: Garowe, 26 December 2019 Key AcƟon Points EWARN presentaon for Epidemiological week 50 and 51 World Vision Internaonal to share highlighted 24 Suspected AWD cases; 8 Bloody diarrhoeal Bemoc Survey assessment report cases; 972 cases of Other Acute Diarrhoeal infecons; 254 conducted in Health facilies Ga‐ Chikungunya virus cases and 65 confirmed Malaria cases. rowe district to the Health Cluster.

At least 36 cases of suspected AWD/Cholera in Yaka vil‐ Health cluster to conduct communi‐ lage reported. Noted confirmed cases of pneumonia in ty awareness on prevenon and Xaabo IDP, Bossaso, with 3 deaths reported. control of Water born diseases in main towns and IDPs in Puntland in An ongoing malaria response in Arta, Armo district of Bari first week of January 2019. region with 30 confirmed cases reported from Bari region. On‐job training on Infecon prevenon control for health Suspected Chikungunya in North Galkayo where 254 workers at Yaka Health facility by the Health facility manag‐ Chikungunya virus cases were reported from Public ing Partner and RHO in January 2019. Somali Red Cross Socie‐ Health facilies in north Galkayo. ty (SRCS) to conduct water chlorinaon in Bossaso in first week of January 2019. Also highlighted the need for partners to update the ma‐ Save the children to support incenves teams and transpor‐ trix of ongoing and planned intervenons for flash floods taon for WASH Mobile teams in Yaka region in order to con‐ in Puntland, and a discussion on Jowle IDP and Health duct WASH response of the AWD/Cholera Outbreak in Yaka Center – Hygiene and sanitaon issues to prevent AWD / Village. Call for ad hoc meeng between Health, Nutrion Cholera outbreak. and WASH at MOH, 29 December 2019 to discuss soluons Partner updates were received from World Vision interna‐ for Hygiene and sanitaon issues in Jowle IDPs in Garowe. onal, Save the Children internaonal, World Health Or‐ ganizaon, UNICEF, IOM, , Somali Red Cross Society, Care Details online at hps://www.humanitarianresponse.info/en/ internaonal, TASS and NODO. operaons/somalia/document/ somaliapuntlandhealthclustermeengminutes26december2019

South West State: Bay and Lower Shabelle, 31 December 2019, Baidoa.

NWO intervenons on course in Lower Shabelle, specifically IMC operated one MCH in Suqa Hoolaha secon and a mo‐ in Qoryoley, Marka, Barawe. In Bay they were in Baidoa, Bar‐ bile team covering 5 IDP camps in Baidoa town. Offering BE‐ dale and Awdinle. All health care facilies were reported MONC services and free ambulance services with toll‐free acve from November 2019 to October 2020. In Afgooye, calling in Baidoa. Also providing mental neurological sub‐ VCT for HIV was ongoing. SHF projects scheduled to end on stances for referral mechanisms. 31st December 2019. SAMA conducted a 5‐day psychosocial support training, De‐ URRO was acve in Qasaxdhere, intervening in Nutrion, cember 2019 in Baidoa, benefing 20 GBV staff from the WASH and Health. Reported confirmed malaria cases out of SAMA GBV Support Center in Baidoa with funding from SHF. 25 tests in December 2019, and 3 suspected measles cases Faced a gap related to essenal medical supplies and hospi‐ from Korimbowd, and Abaay. tal equipment.

DMO acve in Baidoa and Awdinle village in Bay, Elberde in Key Points Bakol region as well as Barwaqo IDP in Baidoa, with funding  Partners unanimously agreed work in coordinaon to from SHF, UNICEF, WFP and WV. As of December 2019, the avoid overlapping during acvity implementaon. SHF project benefited 5,233 female (1,899 over five females,  Partners agreed on cooperaon in supplies sharing 1,665 under five females, 932 PNC and 737 ANC). among to avoid stock out and expiry of drugs through health cluster and MoH‐SWS. WVI conducted a training on TIME TARGETED CANCELLING,  Agreed mely updates to the HC focal point on key benefing 31 people in . Received 18 metric emergencies in health in Bay and Lower Shabelle . tons of medical supplies from Nairobi for its health facilies in different regions of South West State. Conducted an as‐ Details online at hps://www.humanitarianresponse.info/ sessment on the health situaon in Baidoa. WVI visited IDP en/operaons/somalia/document/ camps, the Mental Health Hospital and the Prison. Planning somaliabayandlowershabellehealthclustermeeng‐ to establish new ten health posts in Baidoa. minutes31dec2019 Health Cluster Bullen, December 2019 7

Somalia Team attends HeRAMS Training in Amman, Jordan

cost and time‐efficient tool primarily designed to help key stakeholders and decision makers to overcome access, security, time and resource constraints. Hand in hand with the Ministry of Health of the Federal Republic of Somalia, and WHO (the Health Cluster Lead Agency), the Health Cluster is is working on an ambi‐ tious exercise to avail the necessary geographical data During the week of 15‐19 December 2019, a team from So‐ on Somalia’s administrative structure, and comprehen‐ malia attended the HeRAMS training in Jordan‐Aman. sive questionnaire that will enable data givers to seam‐ lessly provide data at the health facility level. HeRAMS is an electronic system for monitoring service availability to the population, optimized and standardized HeRAMS is powered by an online applicaon (hps:// for emergency and crisis contexts. It allows for self‐ primewho.org/) that maximizes data entry and data reporting to monitoring of the status of health facilities and management processes to provide real‐me analysis of the availability of health services; and tracking of the main the situaon. A key benefit of the system is that it will constraints and factors limiting services. bridge the humanitarian – development (NEXUS) health system information needs for immediate and It is a collaborative process involving all health [cluster] ac‐ longer‐term planning. tors, adaptable to any emergency or country context. It is a

CRISIS WATCH

Disease Outbreak in Yaka, Karkaar Region Radio Ergo: Health Concerns

During the first week of January 2020, the main health issues Ad hoc emergency Health Cluster meeng was conducted raised by the callers of Radio Ergo were on neglect at maternal in Garowe at the Ministry of Health conference room on 31 ” centers, chikungunya outbreak with nine people reported December 2019 to discuss the current disease outbreak dead, locust infestaon, skin diseases and diarrhea. reported from Yaka village in Karkaar region (Suspected AWD/Cholera out region (Pneumonia/Malaria Outbreak) I share this message with a heavy heart. There was a woman

and Galkayo (Suspected Chikungunya/Hemorrhagic fever). who gave birth to twins outside Do'oley but she died aer los- The meeng was aended by H.E. Minister of Health, the ing blood profusely. This mother could not get necessary medi-

Director General, all Directors from the MOH, technical cal aenon. There are many others who are rushed to Adado,

staff, representaves from the United Naons, Internaon‐ as the hospitals here don't have facilies. So, that is the situa-

al and Local NGOs. ” on. I wish the family and relaves all the best but there is ne-

glect and lack of proper health care here.”

Caller from Do'oley, Galgadud. For immediate acƟon:

 Ministry of Health to lead the response and Surveil- ” “We have the Chikugunya disease here. We are a whole family lance intervenons to control the outbreak; who have been affected. We would like to know how we can

 SRCS to send a mobile team to Yaka village to conduct treat this disease.” Female caller from Abudwak, Galgadud.

community awareness raising on Hygiene and sanita- “There are huge numbers of locusts that have swarmed over

on and Chlorinaon of water sources by 1 Jan. 2020; the area. There is some disease that is affecng the people,  WHO to deploy a disease outbreak invesgaon team ” forming rashes over their bodies, and we would like to know to Galkayo and Widh Widh towns to confirm the re- more about this disease.” Caller from Haarhaar, . ports by 1 Jan. 2020; “This area has been invaded by locusts which are destroying  MOH & SRCS to send Medical supplies to WIDHWIDH - the vegetaon. There are also diarrhea cases in the area”. the affected health facility by 1 Jan. 2020. Caller from Bakool. 8 Health Cluster Bullen, December 2019 People reached with life-saving health services, December 2019 Monthly reporng analysis indicates that at least 334,824 people were reached with health care services in December 2019. The number includes services delivered with both HRP and non‐HRP or other funding modalies.

Funding progress (US$ ’000’000) with relation to key Clusters (FTS—https://fts.unocha.org/appeals/667/clusters)

As at the end of December 2019, Health Cluster funding received was US$21,236,329 (22.8% funded) out of US$93,203,762 appealed in the Somalia HRP 2019, with a pledge of US$1,633,359.

Required (US$ ’000’000)

Funded (US$ ’000’000)

Cluster Coordination Contacts

Craig Stuart Hampton, Cluster Coordinator, Matilda Kirui, Cluster Coordination Support Officer, [email protected], +252612488306 [email protected], +254721665362

Farhan Bashir Hassan, Cluster Co-Coordinator, Richard Baker Sennoga, Information Management [email protected], +252618648 666 Officer, [email protected], +252614381315