SomaliaSomalia EmergencyEmergency HealthHealth UpdateUpdate BULLETIN HIGHLIGHTS Weekly Highlights 3 - 9 Dec 2011

On 6 December 2011, a car full of explosives exploded near the former Egyptian embassy in KM4, Mogadishu. The blast killed two people and another five got injured (four men and one women). Aamin Ambulance Service rushed the wounded to Banadir and Madina Hospitals, the two largest health facilities in the city.

For further information please contact: Pieter Desloovere - Communications Officer - [email protected] - T: +254 733 410 984

Epidemiological surveillance • Acute Watery Diarrhoea Disease highlights for November 2011: • Measles Mobile clinics • Malaria • 26 mobile clinics reported a total of 48 630 consultations of which 25 055 • Acute Respiratory Infections (52%) were women and girls and 119 related deaths including 80 (67%) • Conflict Related Injuries children under the age of five years. Mobile clinics provided access to essential health services especially in underserved parts of South and Health Response Central . • Primary Health Care • Outbreak response Acute Watery Diarrhoea • Vaccination activities • a total of 6301 cases of AWD (including 4325 under the age of five years) with 155 related deaths reported for the South Central Zone. © AAMIN • The highest numbers of cases were reported in Banadir region with 3422 cases including 2327 (68%) children under five years. • Banadir hospital alone reported for the same period a total 1299 cases of AWD/cholera cases, including 915 cases under the age of five with 26 related deaths. • Cases are concentrated in Banadir and surrounding regions of , , Bay and Lower Jubba.

Measles • A total of 2803 suspected measles cases (including 1771 under the age of five) and 92 related deaths have been reported in South and Central

© Somalia. AAMIN

Malaria

• A total of 3993 suspected malaria cases were reported in South and Central Somalia, including 1980 cases under the age of five. Of these 993 (25%) were confirmed by rapid diagnostic tests.

Acute Respiratory Infections • 16 600 cases of suspected pneumonia or acute respiratory infections (including 9951 in children under the age of five years) have been reported in some regions of South and Central Somalia (Banadir, Lower Shabelle, Middle and Lower Jubba). The exact number of deaths is unknown due to challenges in death reporting in the country. The prevailing malnutrition Victims of the Mogadishu bomb blast on 6 December and environmental factors such as crowded IDP camps contribute to the are being rushed to the major hospitals high burden of acute respiratory infections in general and pneumonia cases

in particular.

Epidemiological surveillance (28 November - 4 December 2011, epi week 48)

Acute Watery Diarrhoea (source: CSR sentinel sites)

Banadir Hospital Graph 1. South and central Somalia AWD weekly Case Fatality 1 Cases trends and deaths • Since week 1 , 9146 AWD/cholera cases were reported from Rate Banadir Hospital in Mogadishu including 6243 (70%) cases in 1800 4.00 1600 3.50 children under the age of five and 324 related deaths. 1400 3.00 1200 • Women and girls account for 36% of all reported cases at the 2.50 1000 hospital. 2.00 800 2 1.50 • For this reporting week , Banadir Hospital reported 305 cases of 600 AWD, including 202 (66%) children under the age of five, with 400 1.00 6 related deaths, giving a case fatality rate (CFR) of 1.97%. Of 200 0.50 0 0.00

these cases 46% are women and girls. Last week, there was a 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 35% decrease in reported cases. This week, a 14% increase was Jan Feb Mar Apr May Jul Aug Sep Sep Oct Nov reported compared to week 47 (during week 47 a total of 262 cases were reported). Case <5 years Case >5 years Case fatality rate

Lower Shabelle • 113 AWD cases were reported from 56 health facilities (see Cases Graph 2. Lower Shabelle region weekly AWD cases 400 week 21 (2008) - week 48 (2011) graph 2), including 78 (69%) children under the age of five 350 and no related death. Women and girls accounted for 49% of 300 2008 2009 2010 2011 the reported cases. 250

200 • Merka Hospital cholera treatment centre reported 10 AWD 150 cases including 6 (30%) children under the age of five. Of all 100 10 reported cases 5 were women and girls. This compares to 50 0 the previous week. 1 2 3 4 5 6 7 8 9 10 1112 13 1415 1617 18192021222324252627282930 31323334353637383940 414243444546474849505152

Jan Feb M ar Apr M ay Jun Jul Aug Sep Oct Nov Dec

Lower and Middle Jubba Weeks • 21 health facilities reported 400 cases of AWD/cholera, of Graph 3. Lower and AWD trends and which 265 (66%) were children under the age of five (see graph He alth reporting health facilities 3). Compared to week 47 (276 reported cases), there was a Cases facilities 45% increase in the number of reported cases . 700 25 600 20 • Sakow and Kismayo districts accounted for 19% and 28% of 500 all reported AWD cases respectively. Flash floods have been 400 15 reported in areas of South central Somalia, some of which have 300 triggered population displacement. The monitoring capacity is 10 200 currently limited after the ban imposed on major health and 5 humanitarian agencies. 100 0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 Jan Feb Mar Apr May Jul Aug Sep Sep Oct Nov

Case under 5 years Case above 5 years No. Reporting Facilities

Measles (source: CSR sentinel sites)

Lower Shabelle • Health facilities in the region reported 179 suspected measles cases, including 157 (87%) children under the age of five and two related deaths under the age of five, giving a CFR of 1.1%. 53% of the cases were women and girls.

Lower and Middle Jubba • Health facilities in the region reported 19 suspected measles cases, all of them are children under the age of five. 47% of the cases were women and girls.

1Week 1: 3-9 January 2011 2Epidemiological week 48: 28 November - 4 December 2011

Malaria (source: CSR sentinel sites)

Cases Graph 4a. Trends of confirmed malaria cases in Lower Shabelle 300 of lower Shabelle region, 2011

• 653 suspected malaria cases were reported from 56 health facilities, of 250 which 593 (90%) were confirmed by rapid diagnostic test or microscopy. 200 Case >=5 years 233 (36%) of the cases were children under the age of five. There was a Case under 5 years 13% increment in reported cases compared to week 47 (567 reported 150 cases). Graph 4a indicates an increase in the cases of malaria in Afgoi 100 district of Lower Shabelle. 50 • Access to the region is limited following the ban of most implementing 0 partners from the area by local authorities. 9 7 20 23 26 2 32 Weeks35 38 41 44 4 Lower and Middle Jubba • 1371 suspected malaria cases were reported from 21 health facilities (2% Graph 4. Malaria trends in district, Low er Juba were confirmed by rapid diagnostic test or microscopy). 797 (58%) were weeks 1 - 48, 2011 Suspected 29,922; Confirmed 1198 women and girls, 562 (40%) were children under five years. 1600 Suspected malaria > 5 yrs

1400 Suspected malaria < 5 yrs • The current torrential rains observed in some of the districts with localized 1200 Conf ir med malaria > 5 y rs 1000 looding will provide ample breeding sites for mosquitoes and increases the Conf ir med malaria < 5y rs risk of malaria and other vector-borne diseases (such as dengue). 800 600 400 200 0 1 4 7 10131619222528313437404346

Acute respiratory infections (source: IDSR sentinel sites)

Lower Shabelle • 1302 cases of influenza-like illnesses were reported from 56 health facilities, of which 718 (52%) were children under the age of five and 708 (54%) are women and girls.

Lower and Middle Jubba • 669 cases of influenza-like illnesses were reported from 21 health facilities, of which 469 (70%) were children under the age of five. Women and girls accounted for 60% of the reported cases.

Bay and • 355 cases of influenza-like illnesses were reported from mobile clinics operating in those regions, of which 117 (33%) were children under the age of five. Women and girls accounted for 43% of the reported cases.

Conflict related injuries

• From 1-4 December 2011, 48 casualties from weapon-related injuries were treated at the three major hospitals in Mogadishu. No deaths were reported. • During the month November 2011, 268 casualties from weapon-related injuries were treated at the three major hospitals in Mogadishu. One death above the age of five was reported. The number of injuries reported remains stable. • Since 1 January - 30 November 2011, 7641 casual- ties from weapon-related injuries were treated at the three major hospitals in Mogadishu. 97 death above the age of five were reported.

Health Response Primary Health Care

WARDI Relief and Development Initiatives started giving free medical treat- ment and drugs to the host community and IDPs at the WARDI Health Cen- ter in Hamar Jajaab, Banadir region. The catchment population for Hamar Jajab is estimated at 47 375 families, including 33% IDPs. During the re- porting week, a total of 1550 consultations took place, including 494 children under the age of five, 433 lactating women and 200 pregnant women.

During November 2011, Aamin ambulance services transported for free 86 patients, including 37 (43%) children under the age of five, 30 (35%) women and 19 (22%) men. The major reasons for rushing them to the ma- jor hospitals were weapon-related injuries, malnutrition, skin diseases, ma- laria, diarrhea, bronchitis and pneumonia.

Since 1 December, the Somali Young Doctors Association (SOYDA), in © WARDI collaboration with the Italian Cooperation, extended their mobile clinics to two new districts of Mogadishu, namely Waberi and . The catchment population for both districts is about 21 000 people. The mobile clinics, that provide basic health services, mainly target IDPs. These two mobile clin- ics reported 1172 consultations.