Somalia Polio Emergency Policy Briefing

Situation overview: A polio case in Mogadishu was reported in May 2013. Polio then spread to 10 regions in Somalia and into Kenya and Ethiopia. The number of reported cases now stands at 1,74[1]: 160 in Somalia, 1 in Ethiopia, and 13 in Kenya. New cases are being reported in South Sudan. In its July report, the Global Polio Eradication Initiative predictedthat the outbreak wouldlikely be explosive, large,long lasting, and spread more quickly than the 2005-2007outbreak. The Initiativecalledfor continued, urgent, and coordinated joint action by countries of the Horn of Africa.Somalia is considered a root of polio pathways throughout the Horn and believedto have more children unvaccinated from, and at risk of, polio than anywhere else in the world. UNICEF estimates 1 million Somali children were never vaccinated 2008-2012.

Because there areno early symptoms, one confirmedcase is considered evidence of an outbreak. With 500,000 or more children inaccessible in South Somalia, there is risk of an outbreak that could cause acute and permanent paralysis ofthousands of children: During the previous polio outbreak in Somalia in 2005,more than228 children under 5 years of age were paralyzed.Adults rarely get polio. However, they carry and contribute to the transmission of the virus. Adults also have higher rates of mortality from polio than children.The combined effect of susceptible adults and poor sanitation significantly increases the risk ofa sustained period of high transmission, leading to more and more infected children. Health facilities are poorly equipped and often under-staffed. The majority of health workers are semi-skilled or haveno formal professional training

Due to the upheavals of the past decades and continued insecurity and hunger Somalis oftenmigrateto different parts of the country.The situationin parts of Somalia is worsening and some international organisations have left. Public rhetoric and prognoses from some donors have sometimesseemed disconnected from realities on-the-ground. The central government has so far been unable to extend health infrastructure and services throughout Somalia. There is high risk of uncontained outbreak undoing concerted international action to eradicate the virus.

Recommendations

There is immediate need for access to emergency health services and immunisations and long-term need for community-level health infrastructure.Relevant government and non-governmental actors should collaborate to address immediate needs and risks and lay the foundation for enduring, resilient health systems in Somalia. We recommend:

DONORS

  • Urgently prioritise funding access to emergency health care and immunisations – especially for children – including support for logistics and effective coordination, vaccine delivery, pre-positioning, and cold chain systems and related training for staff to ensure vaccines are preserved and still effective when administered.
  • Prioritise health systems strengthening including as part of the New Deal process, including strengthening routine immunisations,developing community health models and infrastructure, and awareness and mobilisation campaigns.
  • Earmark sufficient funding, ideally as a percentage, for child-focused polio initiatives.
  • Make decisions based on context and do-no-harm analysis, health needs, and best practices from other relevant contexts and initiatives, like the Global Fund to Fight AIDS, Tuberculosis and Malaria and CORE Group Polio Eradication Initiative.

GOVERNMENT OF SOMALIA

  • Identify what it requires to address polio nationally and what it will do to ensure resources are requested and used based on health needs and best practices for accountability and effectiveness.
  • Collaborate and consult closely with local government, national and international civil society, donors, and the United Nations.

NON-GOVERNMENTAL ACTORS

  • Prioritise immunising high-risk Somalis, especially children, filling gaps in national and local health care systems, and coordination with the full range of relevant health actors, including national and local authorities, other NGOs, donors, and the UN. Ensure relevant staff are adequately trained in cold chain systems.
  • Link polio response to efforts to strengthen health systems in Somalia. Mobilise relevant actors to develop and implement community health models and infrastructure.
  • Contribute to relevant context and do-no-harm analysis.Invest in functional & effective context monitoring mechanisms that provide reliable information on conflict and security dynamics to enable health teams to have safe access.
  • Contribute to ongoing monitoring and information sharing by health actors, and mobilisation and public awareness campaigns related to polio.
  • Engage religious and clan leaders, local authorities, local NGOs, and others in civil society, to increase access to high-risk areas and consolidate and strengthen efforts of local communities.

Signatory Agencies:

ACF – Action Contre la Faim
DRC – Danish Refugee Council
COSV
NCA – Norwegian Church Aid
OXFAM
WORLD VISION

[1] Global Polio Eradication Initiative report update, October 2nd 2011