Woman feeding her baby in a maternal and child feeding
center, Mogadishu, 1991
Courtesy Hiram A. Ruiz
The collapse of the government in January 1991 with the fall
of Siad Barre led to further deterioration of Somalia's health
situation. The high incidence of disease that persisted into the
early 1990s reflected a difficult environment, inadequate
nutrition, and insufficient medical care. In the years since the
revolutionary regime had come to power, drought, flood, warfare
(and the refugee problem resulting from the latter) had, if
anything, left diets more inadequate than before. Massive changes
that would make the environment less hostile, such as the
elimination of disease-transmitting organisms, had yet to take
place. The numbers of medical personnel and health facilities had
increased, but they did not meet Somali needs in the early 1990s
and seemed unlikely to do so for some time.
The major maladies prevalent in Somalia included pulmonary
tuberculosis, malaria, and infectious and parasitic diseases. In
addition, schistosomiasis (bilharzia), tetanus, venereal disease
(especially in the port towns), leprosy, and a variety of skin
and eye ailments severely impaired health and productivity. As
elsewhere, smallpox had been virtually wiped out, but occasional
epidemics of measles could have devastating effects. In early
1992, Somalia had a human immunovirus (HIV) incidence of less
than 1 percent of its population.
Environmental, economic, and social conditions were conducive
to a high incidence of tuberculosis among young males who grazed
camels under severe conditions and transmitted the disease in
their nomadic wanderings. Efforts to deal with tuberculosis had
some success in urban centers, but control measures were
difficult to apply to the nomadic and seminomadic population.
Malaria was prevalent in the southern regions, particularly
those traversed by the country's two major rivers. By the mid1970s , a malaria eradication program had been extended from
Mogadishu to other regions; good results were then reported, but
there were no useful statistics for the early 1990s.
Approximately 75 percent of the population was affected by
one or more kinds of intestinal parasites; this problem would
persist as long as contaminated water sources were used and the
way of life of most rural Somalis remained unchanged.
Schistosomiasis was particularly prevalent in the marshy and
irrigated areas along the rivers in the south. Parasites
contributed to general debilitation and made the population
susceptible to other diseases.
Underlying Somali susceptibility to disease was widespread
malnutrition, exacerbated from time to time by drought and since
the late 1970s by the refugee burden
, this ch.).
Although reliable statistics were not available, the high child
mortality rate was attributed to inadequate nutrition.
Until the collapse of the national government in 1991, the
organization and administration of health services were the
responsibility of the Ministry of Health, although regional
medical officers had some authority. The Siad Barre regime had
ended private medical practice in 1972, but in the late 1980s
private practice returned as Somalis became dissatisfied with the
quality of government health care.
From 1973 to 1978, there was a substantial increase in the
number of physicians, and a far greater proportion of them were
Somalis. Of 198 physicians in 1978, a total of 118 were Somalis,
whereas only 37 of 96 had been Somalis in 1973.
In the 1970s, an effort was made to increase the number of
other health personnel and to foster the construction of health
facilities. To that end, two nursing schools opened and several
other health-related educational programs were instituted. Of
equal importance was the countrywide distribution of medical
personnel and facilities. In the early 1970s, most personnel and
facilities were concentrated in Mogadishu and a few other towns.
The situation had improved somewhat by the late 1970s, but the
distribution of health care remained unsatisfactory.