Breaking the cycle: addressing recurring cholera outbreaks in Somalia

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Since the early 1990s, Somalia has suffered multiple outbreaks of cholera which, due to poor sanitary conditions, have affected a majority of the population living in internally displaced camps.

The latest outbreak occurred early in 2024 in the capital Mogadishu, with the districts of Dayniile, Dharkaynley, Wadajir, Kahda and Hamar Jajab particularly badly affected. In response, the Federal Ministry of Health and Human Services and the Banadir Health Administration, with the support of WHO, UNICEF and other partners, promptly embarked on a door-to-door cholera vaccination campaign targeting the affected districts to prevent the spread of the disease. Staff also conducted awareness-raising activities to educate residents on how to control the spread of cholera.

WHO polio programme assets and expertise were deployed to support the response activities. Hawa Abdullahi Ali, 55-years-old, who has worked on polio campaigns in Kahda since 1998, first as a vaccinator and then in her current position as District Polio Officer, was among the experienced team that WHO relied on to deliver relief to thousands of residents in the high risk district of Kahda in May 2024.

Hawa says the experience underlined the importance of delivering high quality interventions to vulnerable residents.

It is not the first time Hawa and her colleagues working in the polio programme have delivered on other public health priorities. They were also responsible for building coordination and strengthening surveillance during the COVID-19 pandemic response.

“The contribution of the polio workforce in responding to other public health emergencies is critical to the overall service delivered to vulnerable people. Protecting those most at risk, in the communities in the most at-risk areas, is key to reducing infections and saving lives,” says Hawa.

“By rapidly responding to the cholera outbreaks we were able to limit transmission, safeguard communities and prevent our health systems being overwhelmed.”

Through efforts like that of Hawa, the WHO polio programme, with the support of the Government and other partners, successfully vaccinated over 1 244 687 people aged one year and older with the oral cholera vaccine (OCV) across 12 districts in 5 states in May 2024.

“Our dedicated team, which included 244 district field assistants, 12 district polio officers, 10 regional polio officers, 5 state polio officers, state data assistants, national data managers, state SIA coordinators and over 2196 vaccinators and recorders, played a crucial role in this achievement,” said WHO Somalia’s Immunization Coordinator Dr Gedi Mohamed.

Hawa believes her team’s efforts not only protected locals from cholera but also inspired hope among vulnerable families who viewed the health workers as a lifeline during this critical time.

“As a team, we understood that every vaccine we delivered could mean the difference between life and death. The trust we’ve built within the community empowered us to reach more people than we imagined. It was incredible to see mothers lining up, knowing that together we were safeguarding the future of our children.”

Cholera remains a major public health challenge in Somalia, especially in regions affected by conflict and displacement, and with limited access to clean water and sanitation.

Over the years, cholera outbreaks have claimed many lives and placed immense pressure on Somalia’s fragile health care system. Coordinated efforts by the Government of Somalia, WHO and partners have been instrumental in reducing the impact of the disease through rapid response measures, health education and vaccination campaigns.

In the last four weeks, 768 new cholera cases have been reported from 31 districts, with a rise in cases in the areas of Kismayu, Jowhar, Marka, Burhakab, Barawe, Borama and Baidoa. Of these cases, 399 (52.0%) were female and 407 (53%) were children under 5 years.

To control cholera and prevent future outbreaks, it is crucial that all stakeholders prioritize sustainable access to clean water and improved sanitation and support the widespread delivery of cholera vaccines. Together, these actions can protect vulnerable populations and ensure that life-saving health services reach those most in need.

Distributed by APO Group on behalf of World Health Organization – Regional Office for the Eastern Mediterranean.

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