Somaliland is one of three distinct areas which make up Somalia. South and central Somalia is ruled by the Transitional Federal Government, with large areas controlled by militant Islamist groups. The north-eastern region of Puntland is home to a third of Somalia’s population and was declared an autonomous state in 1998. And in the north, there is Somaliland, an autonomous state since 1991. Unlike Puntland, this region would like to become independent as the Republic of Somaliland.
With its peace and functioning democracy (three parliamentary elections have been held since 1991), Somaliland is home to many refugees from the southern and central parts of the country. Around half a million displaced Somalis have fled there, putting extra strain on public services such as education. Somaliland’s Education Ministry estimates one in ten of the state’s primary school children come from south-central Somalia.
Health services are also struggling to cope with the influx, especially since the healthcare system was already in desperate need of investment and trained staff. According to the office head of the UN Children’s Fund (UNICEF) in the capital Hargeisa, there are barely more than 100 doctors working in the state and only around the same number of qualified midwives. This severe shortage of medical personnel is a key reason why Somaliland has one of the worst maternal mortality rates in the world, as well as extremely high infant and child mortality rates.
73 infants (less than 1 year) die for every 1,000 live births in Somaliland. Over a quarter of infant deaths in Africa occur within the first 28 days of a child’s life. Many of these deaths can be avoided when mothers and newborns are cared for by trained midwives. Skilled attendants can also drastically reduce the number of deaths among mothers from complications such as haemorrhaging, eclampsia and obstructed labour. According to the UNICEF representative, Somaliland’s women have a 1 in 15 risk of dying through maternity-related causes.
With poor health services and widespread poverty, 117 children out of every 1,000 die before they reach the age of five. In a recent report by IRIN, the head of Somaliland’s National Health Management Information System (NHMIS) within the Ministry of Health explained that children in the state were particularly prone to respiratory infections, which accounted for two-fifths of child deaths. He estimated another two-fifths were caused by malnutrition and acute watery diarrhoea. Illnesses due to poor hygiene and infected water are particularly common, since little more than 40% of the state’s population have access to safe water and proper sanitation facilities. Somaliland’s government is committed to doing all they can to reduce infant and maternal deaths and tackle communicable diseases. But health officials admit more action is needed and as soon as possible.