Statistics

Humanitarian and HIV situation

The political outlook for Somalia remains uncertain. Somalia has had no effective central government since 1991, which has lead to a deterioration of infrastructure, disintegration of basic health and social services, widespread human rights abuses and some of the worst human development indicators in the world.

The outbreak of fighting in Mogadishu in early 2007, the worst since the civil war in the early 1990s, resulted in the deaths in hundreds of civilians and a sharp rise in human rights abuses. The African Union peace support mission for Somalia (AMISOM) is only partially deployed (1,700 out of the mandated 8,000 personnel). It has secured about 5 km radius of Mogadishu, including the airport. However further violence erupted in Puntland and Somaliland, with insecurity threatening to destabilize additional zones.

Affected populations:

Around 1.5 million people are in need of assistance and protection. A total of 450,000 people have been newly displaced as of November 2007 in addition to the 400,000 protracted internally displaced persons (IDPs).

IDPs comprise over 10% of the population, with a quarter of a million IDPs living in Mogadishu alone. They lack sufficient access to sustained assistance and protection. ¹

Two-thirds of families who have fled during conflict have settled in the provinces of the Shabelles, immediately surrounding Mogadishu. Others have fled further north, including 2,600 people who have reached the town of Galkayo, 700 kms north in the region of Puntland. The town already hosts 11,000 people who fled Mogadishu between February and May. Recent arrivals, mostly women and children, reported robberies and rape by armed militiamen and thugs who set up roadblocks along the route. Galkayo has limited resources in terms of water, sanitation, education and health services. ²

Refugees:

464,253. ³ A further 25,000 Somali refugees have arrived in Kenya, and remain similarly isolated from health and education services.

Access to vulnerable populations is patchy and inconsistent due to conflict, lack of security guarantees, ongoing military air operations, and clan tension. The Government of Kenya’s closure of its border with Somalia on security grounds for several weeks from early January also hindered humanitarian access and delivery of assistance. Insecurity is often the main impediment to accessing healthcare. 

Within South/Central checkpoints, unofficial roadblocks continue to obstruct movement of supplies and cause delivery delays. The logistics cluster has recorded 238 roadblocks/ checkpoints in South/ Central. Charges per truck have reportedly increased from USD 125 to USD 520. UN Agencies and NGOs still seek clarification from the TFG regarding tax exemption procedures. Overland transport of relief supplies is difficult due to robbery.

Protection:

During the conflict, in addition to indiscriminate shelling and attacks on the civilian population, abductions, rape, and unlawful killings have been reported by human rights organizations.

Food/nutritional status:

The entire country is chronically food insecure. Acute malnutrition rates continue to exceed the emergency threshold of 15% in many districts of South/Central. Following recent flooding, food security in riverine areas of the Juba and Shabelle Valleys deteriorated.

Health status:

 Much of the population lacks access to basic healthcare and an acute shortage of trained medical personnel. Polio recurrence in 2005, with 215 confirmed cases as of November 2006 14 of 19 regions infected (WHO). Malaria, tuberculosis (TB), diarrhoeal diseases and other preventable diseases continue to kill thousands each year.

Water and sanitation systems damaged during the civil war have been somewhat rehabilitated by the international community in the past 10 years. However, extensive contamination of surface supplies remains a problem, with only 29% of the population having access to clean drinking water (UNFPA). Over half the population also lacks access to adequate sanitary facilities.

Natural hazards:

Flooding: The Deyr rains of October-December, while causing large-scale displacement (estimated at 255,000) and the destruction of homes and assets, resulted in exceptionally good crop production and continued pastoral recovery. The recently completed post-Deyr 2006/07 assessment by FAO/Food Security Analysis Unit showed many rural parts of Somalia – mainly in the north and central regions – are experiencing an improvement in livelihoods and food security. The March 2007 Climate Outlook Forum forecasts normal to above-normal rainfall in the Ethiopian highlands and coastal areas of the Juba Valley, which may result in renewed flooding in riverine areas not yet recovered from Deyr floods.

Drought:

Somalia is recovering from the worst drought in over a decade.

HIV epidemic

Somalia is approaching a generalized epidemic.  Prevalence rates differ by area. According to UNAIDS most recent data, South Central Somalia has a prevalence rate of 0.5%, Puntland 1% and Somaliland 1.4%.  The main drivers of the epidemic are sexual transmission and unsafe health care practices including blood supply.

Most at risk:

• Sex workers and their clients
• Mobile populations (truckers, returnees, nomadic population, which is 40% of Somalis
• Uniformed services
• Men who have sex with men

Most vulnerable ⁴

• Young persons
• Women (women are increasingly vulnerable, especially due to displacement and SGBV
• Orphans and vulnerable children

Response to HIV among populations of humanitarian concern

Somalis have one Strategic Framework and an Integrated Prevention, Treatment, Care and Support Plan in place in each zone. The three AIDS commissions work together and with international partners in Nairobi. Building their capacity is a focus of the current program. There is one harmonized monitoring and evaluation framework with common reporting tools and a Country Response Information System database for all entities. AIDS has been mainstreamed in a Joint Needs Assessment, Reconstruction and Development Framework, Consolidated Appeals Process and a new UN Transition Plan for 2008 - 2009.

The overall objective of the Somali HIV Response in 2007 is to scale up integrated prevention, treatment and care services in line with Universal Access and Global Fund targets. 2007 focus:

• Provide prevention services.
• Build the regional Partnership on HIV Vulnerability and Cross-border Mobility in the Horn of Africa, focusing on populations of humanitarian concern
• Prevent new HIV infections and care and
• treatment for those already living with HIV (PLHIV).

• Reduce the vulnerability associated with family networks affected by HIV.
• Prioritise actions related to HIV prevention, care, treatment and mitigation within the context of humanitarian action.

Prevention:

Priority is to change KAPB (Knowledge, Attitudes, Perceptions and Behaviour). Surveys indicate a serious lack of understanding and awareness of basic information on HIV within Somali populations, including vulnerable populations (young people, uniformed services) at high risk of infection due to mobility and lack of services.

Health cluster includes integrated action on HIV, conducting education and awareness campaigns and integrating HIV and Sexually Transmitted Infections (STIs) services into health facilities.

Protection includes work on HIV as a key element in strengthening protection mechanisms for vulnerable populations, such as the displaced, and combating sexual and gender-based violence (SGBV) against women and girls.

Food security and livelihood includes HIV prevention, treatment, home-based care, and enhancement of food security for affected people, particularly, women-headed households in southern Somalia. The Food Aid response plan also includes HIV as a priority objective, with the aim of improving the health and nutritional status of at risk groups, including PLHIV.

Care and treatment:

4,850 Somalis have been trained on integrated prevention, treatment, care and support services in Puntland (41%), South Central (30%) and Somaliland (29%). ⁵

The Somali HIV Response now has 1 TB centre, 4 functional ART sites (with another under development), 21 VCT centres, 7 sexually transmitted infection (STI) centres, 21 blood safety centres, 6 laboratories, 7 youth centres and 34 media programmes. These integrated prevention, treatment, care and support (IPTCS) centres and programmes are distributed across South Central (44%), Somaliland (28%) and Puntland (28%).

Limited data indicate a significant TB-HIV co-infection problem.

The Joint UN Team on AIDS (JUNTA) will work with partners over the next 12 months on a Joint Strategic Review of the Strategic Framework for the Prevention and Control of HIV/AIDS and STIs within Somali Populations June 2003 – June 2008. This is scheduled to be completed by June 2008 – leading to a revised strategic framework and costed action plan towards Universal Access for all Somalis who need it by 2010.

However, significantly more data and strategic information on the response is urgently required to do this. There is a lack of data and strategic information on most vulnerable/at risk populations. It may be possible that Somalia has a concentrated/low prevalence epidemic amongst vulnerable/at risk populations such as sex workers and their clients, men who have sex with men (MSM), truckers and cross border and other mobile populations.

The Joint UN plan is based on the Strategic Framework on HIV/AIDS and STIs for Somali Populations 2003–2008:

• Strengthened resource mobilization and policy
• Increased awareness and community mobilization
• Increased access to quality HIV-related health and education services
• Comprehensive care and treatment for PLHIV
• Reduction and mitigation of negative impacts of HIV
• Improved knowledge base for response planning management and implementation

UNICEF is implementing prevention of mother-to-child transmission (PMTCT) services in 10 pilot centres in Somaliland, Puntland and South Central. ⁶

Funding for HIV in humanitarian situations

The four main donors of the Somali HIV Response in 2005 and 2006 were the Global Fund, Italian Cooperation, DFID and UN agencies. The total resources mobilized on HIV through different means in 2005/2006 was USD 15 million, of which USD 12.5 million was spent in 2006.

Global Fund: USD 9,801,377 disbursed as of November 2006. Principal recipient: UNICEF. Main objectives:

• To establish and strengthen management structures for co-ordination, monitoring and evaluation
• To reduce the transmission through strengthened support of prevention services
• To ensure that PLHIV in Somalia and their families have access to high quality, affordable care and support services

PEPFAR: None

In June 2007 the World Bank and Intergovernmental Authority on Development (IGAD) signed a USD 15 million grant to support the IGAD Regional HIV/AIDS Partnership Program (IRHAPP) to mitigate the impact of HIV among cross-border and mobile populations in IGAD’s member states: Djibouti, Eritrea, Ethiopia, Kenya, Somalia, Sudan and Uganda. The four-year project will be the first financed by the Africa Catalytic Growth Fund (ACGF). ⁷

The 2008 Consolidated Appeal for Somalia (CAP) does not contain an Early Recovery pillar (as in 2007). Emergency assistance and early recovery/development will be bridged through the CAP’s complementarity with the United Nations Transition Plan. The 2008 CAP contains the following priorities:

1.     Save lives and provide assistance to 1.5 million people identified as being in a state of Humanitarian Emergency or Acute Food and Livelihood Crisis, or as internally displaced, including an estimated 400,000 protracted IDPs and approximately 450,000 newly displaced

2.     Improve the protection of, and respect for, the human rights and dignity of vulnerable populations with a special focus on IDPs, women, children, victims of trafficking, and marginalised groups through effective advocacy and the application of a rights-based approach across all sectors

3.     Strengthen local capacity for delivery of basic social services and for disaster preparedness and response

The 2008 Consolidated Appeal for Somalia seeks USD 406,235,651 for 155 projects. It will focus on the South/Central region, where the majority of the acute emergency needs lie. The 2007 CAP was 66% funded as of Nov 2007, with food security and mine action both 100% funded.

Humanitarian Response Fund for Somalia (HRF) - Administered by OCHA Somalia since early 2004 to respond to drought, the HRF supports rapid response projects. The HRF was used for a pilot project providing antiretroviral therapy (ART) drugs to refugees in Somaliland in 2005.

Central Emergency Response Fund (CERF) – CERF allocations for Somalia in 2007 under the 2 mechanisms of Rapid Response and Under-funded Emergency have, as of early Nov, totaled USD 26.1 million; this figure includes over USD 10.4 million for the flood response and USD 11 million for the IDP response (March-July 2007). Somalia also received USD 1 million in the area of security, which had not been funded under the CAP. A CERF package totaling USD 3.6 million focuses on immediate response to the IDP crisis in Mogadishu-Afgoye was approved in October 2007.

UNHCR launched an appeal for USD 48 million in July 2007 to assist 478,000 refugees and IDPs until the end of next year.

Humanitarian and HIV coordination structures

National:

IPTCS, M&E Reference Group and AIDS working group in Nairobi as well as Puntland, Somalialnd and south central Somalia

National AIDS Commissions

The Somali Support Secretariat (SSS) of the Coordination of International Support to Somalis (CISS) is a single, harmonised, transitional secretariat to support the political, planning, and technical coordination between the international community and Somalia through various joint committees. There is an HIV Working Group of the SSS.

UN:

UN Theme Group on HIV/AIDS and
UNDP Representative: Bruno Lemarquis
Chair,
Telephone: +254 2 04 18 36 40
Fax: +254 2 04 18 36 41
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UNAIDS Country Coordinator: Leo Kenny
Telephone: +254 2 04 18 36 40
Fax: +254 2 04 18 36 41
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`UNPOS, Nairobi : SRSG, Francois Fall
Tel: +254207622093  
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GFATM
Renato Corregia    
Somalia Health Sector Committee Chairperson
Email: mailto: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

Humanitarian Coordinator, Eric LaRoche
Nairobi               
Tel: +254 722 267 147           
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Head of Office, OCHA Philippe Lazzarini
Nairobi              
Tel: +254 735 339 159                       
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Head of Regional Office, Besida Tonwe
Nairobi               
Tel: +254 735 622 528                       
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OCHA contacts in Somalia

SOMALILAND
Hargeisa Sub-office - Abdulkarim Ali, - Office Tel: + 252 8283702/3 Cell: 252 24425701

PUNTLAND
Garowe Sub-office - Aminata Mansaray, Office Tel: + 252 5 846354
Bossaso/Galkayo Sub-office – Odd Einar Olsen: Office Tel: + 252 5829346 Cell: + 252 5704361

SOUTH/CENTRAL
Baidoa Sub-office - William Desbordes, Office Tel: + 252 4364143
Cell: + 252 1 528829, Sat: +882 164 333 s8242
Yusuf Ali Salah: Cell: + 252 1559007, Sat: + 882 165 112 1075
OCHA Somalia has 9 international and 15 national staff.

Key international organizations present

UN agencies: FAO, OCHA, UNAIDS, UNESCO, UNICEF, UNFPA, UNIFEM, UNHCR, WFP, WHO

Other agencies: ICRC, IOM,

Key organizations working in HIV in humanitarian situations

All the UN agencies and several local and international nongovernmental organizations.

Training on the IASC guidelines

Staff from each AIDS Commission, UNFPA, OCHA, HIV and AIDS Working Group, Handicap, World Vision International, UNICEF were trained in regional workshops in Kenya in July and November 2006 and March 2007.

Additional resources

Somalia Country Response Information System February 2007

UN Somalia

1. 2008 Somalia CAP
2. UNHCR
3. UNHCR June 2007 in Somalia Health Cluster bulletin, 27 July 2007.
4. Most at risk populations refer to persons engaging in immediate actions that can cause infection, whereas most vulnerable populations refer to persons vulnerable due to personal/ biological factors, and societal, economic, cultural factors.
5. The Global Fund, the Department for International Development (DFID) and the UN (regular budget) funded the training. It was implemented through the technical support of WHO, as well as UNAIDS, UNICEF, and international and local NGOs. CRIS February 2007.
6. CRIS February 2007.
7. World Bank June 2007.