Because of revitalized and sustained global efforts to improve child survival, the world has succeeded in reducing global child mortality from 12 million in 1990 to 6.9 million in 2011. This success delighted some global child health leaders such as the director of the UNICEF, Anthony Lake.  What is disheartening, however, is that the child mortality rates have continued to increase in Somalia. Every 1,000 Somali children, 180 of them die before they reach the age of 5 years. Even the neighboring countries with the similar social and health determinants such as Kenya, Eretria and Ethiopia have seen significant declines in child mortality. With the lowest HIV prevalence in Sub-Saharan Africa, Somalia has escaped from the HIV/AIDS epidemics, yet child mortality rates have been higher in Somalia than any other country in Sub-Saharan Africa.

Like most other developing countries, the leading cause of child mortality in Somalia is pneumonia, which accounts for 25% of all deaths, followed by diarrhea, preterm birth complications and malaria. The environmental risk factors such as poor sanitations, contaminated drinking water, and indoor air pollution, which contribute to child mortality and morbidity in Somalia, are also present in other developing countries. Chronic malnutrition, which causes stunting and worsens the prognosis of the infectious diseases that kill children, is common in Somalia. But the chronic malnutrition is also common in South Asian and Sub-Saharan African countries. Since these determinants of health are not specific for Somalia, what is making Somalia rank the worst for child mortality?

Somalia never had the political will to promote and deliver the interventions necessary for child survival. There never has been a national action plan to end preventable child deaths. Collaboration with the global health stakeholders has been poor as the result of the two and half decades old civil war. The revitalized global campaigns for child survival such as The Millennium Development Goals, Every Women Every Child, and The Child Survival Call to Action, which enabled other countries to reduce child mortality, have passed Somalia by.

The world often tries to overcome such barriers and reach Somalia with disease-focused programs (i.e. malaria, TB, etc.) or with vertical approaches such as improving drinking water or mothers’ education. However, the widespread corruption and the lack of transparency and mutual accountability have historically disrupted such interventions. The Transparency International, a global coalition against corruption, gave Somalia a corruption perception index score of 4 in 2012; on a scale of 0 (highly corrupt) to 100 (very clean), this score ranks Somalia as the most corrupt country in the world. There are serious corruption and bribery in the most basic services such as accessing to clean water and seeing a doctor.  Millions of dollars of grants paid by donors for improving the maternal and child health services often end up misused or misdirected.

Scaling up vaccinations; reducing the indoor air pollution by introducing clean energy; and improving drinking water are some of the solutions for the root causes of child mortality. Providing individuals with the basic education and clinical skills needed to identify acute respiratory infections can also contribute to the child mortality reductions. To effectively deliver these basic services, ending conflicts and corruption through good governance and anti-corruption policies is imperative.  Not only are good governance and anti-corruption policies important for delivering key services but also for the economic growth.

The environment and stressors to which infants and children are exposed during their fist 1,000 days of their lives have enormous impact on their development and on their futures. Frequent food shortages lead to approximately 43% of the children in Somalia being underweight, which puts them at risk for stunting, a medical condition which causes irreversible brain and physical damage. In order to head off the emergency of mentally and physically thwarted generations, investing in the human capital is vital. In order to feed its malnourished children, Somalia needs an agricultural sector that can produce sufficient and sustainable food. To end the current dependence on aid and to restore self-sufficiency, the way forward for Somalia is to rely on its resources and partner with the world.

Given the prospect that Somalia has a glimpse of hope in re-emerging from isolation, the global health organizations need to move in with bold interventions. The children in Somalia have long waited for the human rights and the primary care services that have been available to children in other countries.  The good news is that complicated global epidemics such as HIV and obesity have not been issues in Somalia. This indicates that less energy would be needed for dealing with the preventable acute infectious diseases. Somalia is in a dire need for skilled healthcare workers and for a functioning healthcare system.

While the rest of the world will soon be celebrating for the attainment of all or some of the eight Millennium Development Goals, Somalia will be mourning for the loss of many children. It’s time for action.

Mohamed Abdi

Email: abdimh@uw.edu

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