5.1. Mental health
Mental health disorders are estimated to be on the rise in Somalia according to a baseline study of the health system in Somalia. The reasons for this increase have been explained as a combination of …the longstanding conflict, unemployment, sedentary lifestyles, socio-economic stress, high khat consumption a d i ade uate s ee i g s ste s at the p i a le el .183
It is estimated that the country has 0.05 psychiatrists per 100,000 population (2017).184
5.1.1. Psychotic disorders, depression, PTSD
Several of the interviewed health sector actors stated that there are no available specialised treatments for mental diseases which meet international standards, nor any hospital with a specialisation in mental health problems.185 One source mentioned that if any treatment was to be found it would be in the private
sector.186
By contrast, the interviewed FMoH official mentioned that the Forlanini Hospital in Mogadishu offers specialised treatment to mentally ill patients.187 The consultant team found that this public hospital has a ward for mental health patients; however, this ward does not admit women as patients. Women are only treated at the outpatient department. The staff working at this ward comprises one psychiatrist, one psychologist, one general practitioner and four nurses out of whom two are qualified. The hospital receives its medicines from WHO.188 Regarding treatment, the interviewed representative of the hospital advised that the staff use sedati es a d edi i es to t eat patie ts, ot ough t eat e t su h as ph si al fo e . The hospital has no written guidelines on the use of physical force in the interaction between health workers and patients.189
People suffering from mental health diseases are being stigmatised and looked down upon and therefore belong to the most vulnerable of patient groups according to the interviewed FMoH consultant and according to a report by ACCORD.190 Previously people with mental illnesses have been subjected to rough treatment in Somalia, e.g. chained to a tree, but according to a Finnish fact finding report this kind of mistreatment has diminished.191 An interviewed UN source stated that this kind of abuse still exists and cited the example of patients who experience a psychotic episode may be chained to prevent them from harming themselves or others. Traditional forms of treatment, such as reciting the Quran at home or beating still exist.192
183HIPS & City University of Mogadishu, So alia’s Health are Syste : A Baseli e Study & Hu a Capital De elop e t, May 2020, url, p. 19
184HIPS & City University of Mogadishu, So alia’s Health are Syste : A Baseli e Study & Human Capital Development, May 2020, url, p. 19
185FMoH: 17, WHO: 15,UNFPA: 29, Swedish Embassy: 15, A Western Embassy: 10, A development NGO: 21,
186A UN Organisation: 13
187FMoH: 17
188 Tana Sub-Study: Mogadishu. Read o e a out this hospital i the se tio Mogadishu of this epo t
189Tana Sub-Study: Mogadishu, pp. 5-6,
190 FMoH: 17,ACCORD, Anfragebeantwortung zu Somalia: Lage von Personen mit psychischen Erkrankungen, 30 April 2020, url
191Finnish Immigration Service, Somalia: Fact-Finding Mission to Mogadishu and Nairobi, January 2018, 5 October 2018, url, p. 37
192UNFPA: 30
5.2. HIV/AIDS
The prevalence of HIV in Somalia is low; by 2018 the prevalence was estimated to be 0.1 percent. The number of people (all ages) living with HIV is estimated to have dropped from 17,000 in 2010 to 11,000 in 2018.193 The prevalence among TB-infected patients is considerably higher and is estimated to be 6.8 percent.194
Treatment for eligible HIV positive patient exists, including test, counselling and ART treatment, but it is limited.195 There are two HIV/AIDS centers in Mogadishu,196 one being the Banadir Hospital which has since 2011 run an HIV/AIDS treatment program. In 2018 that program offered ART treatment to 700 patients;197 eligible patients are treated free of charge at the Banadir Hospital.198 It is also possible to receive HIV treatment in Kismayo at the Kismayo General Hospital although the hospital has no specialised doctor for HIV/AIDS treatment. There are trained counsellors and department supervisor for medical prescription and counselling HIV/AIDS patients.199
In 2016, only 18 percent of all health facilities advised that they offered HIV/AIDS testing and counselling, and only five percent of facilities offered ART treatment.200
5.3. Chronic diseases
The last Somali Health and Demography Survey notes that 5.7 percent of all Somalis suffer from a chronic disease.201 The most prevalent of these chronic and non-communicable conditions as diagnosed by a physician is blood pressure (33.3 percent) and diabetes (20.4 percent) as illustrated by the table below.
193UNAIDS, Data 2019, url, pp. 324-325
194HIPS & City University of Mogadishu, So alia’s Health are Syste : A Baseli e Study & Hu a Capital Development, May 2020, url, p. 24
195FMoH: 18, WHO: 13, UNFPA: 27,UN Organisation: 10, Swedish Embassy: 13, Western Embassy: 8, A Development NGO: 20
196Tana Sub-Study: Mogadishu, p. 4
197Finnish Immigration Service, Somalia: Fact-Finding Mission to Mogadishu and Nairobi, January 2018, 5 October 2018, url, p. 37
198Tana Sub-Study: Mogadishu, p. 8
199Tana Sub-Study: Kismayo, p. 5
200WHO,Somali Service Availability and Readiness Assessment (SARA): 2016 Report, p. 21
201Directorate of National Statistics, The Somali Health and Demographic Survey 2020, url, p. 261
Figure 6. Overview of chronic diseases202
5.3.1. Cancer
No cancer treatment is available in Somalia according to the findings from the Finnish fact-finding mission conducted in 2018.203 By contrast, a WHO report from 2016 has assessed that two percent of all health facilities in Somalia offered cervical cancer treatment. Out of the two percent, it was NGO-run facilities, primarily in urban areas, which were most likely to offer cervical cancer services.204
According to the interviewed sources, specialised cancer treatment is deficient in South Central Somalia;
patients with financial means must seek treatment abroad; the interviewed WHO source was not even aware that there are oncologists in Somalia.205 There is no oncologist at the Somali Turkish Recep Tayyip Erdogan Training and Research Hospital; patients who show up may be seen by an internal medicines doctor or a general surgeon according to findings from the sub-study.206 By contrast, there is one oncologist at the Hilaal Speciality Hospital in Beled Weyne, but this doctor does also treat other patients within
202Directorate of National Statistics: The Somali Health and Demographic Survey 2020, url, p. 263
203 Finnish Immigration Service, Somalia: Fact-Finding Mission to Mogadishu and Nairobi, January 2018, 5 October 2018, url, p. 35
204 WHO, Somali Service Availability and Readiness Assessment (SARA): 2016 Report, p. 22
205 FMoH: 19, WHO: 14, UNFPA: 28, UN Organisation: 11, Swedish Embassy: 14, Western Embassy: 9, A development NGO: 23
206Tana Sub-Study: Mogadishu, p. 32
general medicine.207 One source assessed that in the whole country there is a maximum of five oncologists.208
5.3.2. Kidney diseases (including dialysis)
In 2016, it was only nine percent of health facilities across the country which offered diabetes diagnosis and treatment. Hospitals were more likely to offer diabetes services than other health facilities and urban facilities were more likely than rural facilities to offer diabetes services.209
Dialysis treatment is available in Mogadishu.210 According to interviews with hospital managers the only functioning dialysis centre in Mogadishu is located inside the Somali Turkish Recep Tayyip Erdogan Training and Research Hospital, and it is equipped with 35 machines and patients from public hospitals are referred to the Turkish hospital (also referred to as the Erdogan Hospital or the Turkish Hospital).211.
5.3.3. Surgery, including spine surgery
Surgery is only available to a limited extent in Somalia.212 The interviewed sources stated that spine surgery and treatment is not available in the country.213
The Somali Turkish Recep Tayyip Erdogan Training and Research Hospital in Mogadishu has general surgery, thoracic surgery, neurosurgery, paediatric surgery and cardiovascular surgery. According to interviews with hospital managers, neurosurgeons at this hospital may conduct spine surgery operations, except for endoscopic spine surgery and cases that require advanced experience and equipment.214
5.3.4. Pre- and aftercare for patients who have had a transplantation
No specialised treatment is available inside Somalia.215
5.3.5. Cardiac complications and hypertension
There is no specialised treatment available inside Somalia.216 Some diagnostics may be available.217
According to interviews with hospital managers, cardiac complications and hypertension may be treated by an internal specialist (internist) or a cardiologist at the Somali Turkish Recep Tayyip Erdogan Training and Research Hospital and the Ladnan Hospital, both in Mogadishu.218
207Tana Sub-Study: Beled Weyne, p. 15
208A development NGO: 23
209 WHO, Somali Service Availability and Readiness Assessment (SARA): 2016 Report, url, p. 22
210 FMoH: 20, Finnish Immigration Service, Somalia: Fact-Finding Mission to Mogadishu and Nairobi, January 2018, 5 October 2018, url, p. 35
211Tana Sub-Study: Mogadishu, pp. 27, 31
212 Finnish Immigration Service, Somalia: Fact-Finding Mission to Mogadishu and Nairobi, January 2018, 5 October 2018, url, p. 35
213 FMoH: 22, WHO: 19, UNFPA: 36, A UN organisation: 16
214Tana Sub-Study: Mogadishu, pp. 4, 21
215 FMoH: 23, WHO: 17, UNFPA: 33, A UN organisation: 15
216 WHO: 18, UNFPA: 33, A UN organisation: 15
217FMoH: 21
218Tana Sub-Study: Mogadishu, p. 25
5.3.6. Chronic obstructive lung disease
Chronic lung diseases such as TB are common in Somalia. TB treatment is free of charge funded by the Global Fund. 219
According to interviews with hospital managers, patients may receive treatment by a pulmonologist at the Somali Turkish Recep Tayyip Erdogan Training and Research Hospital in Mogadishu (also known as the Turkish Hospital or the Erdogan Hospital).220