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Public health consequences of the civil war in Somalia |
Cahiers d'études et de recherches francophones / Santé . Volume 2, Number 6, 397-402, Novembre-Décembre 1992, Étude originale
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 Résumé
 Summary
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Author(s) : Serge Manoncourt, Brigitte Dopler, François Enten, Abdullabi Elmi Nur, Ahmed Osman Mohamed, Alain Moren, Epicentre, 8 rue St-Sabin, 75011 Paris, France, Médecins Sans Frontières, Paris, France, Ministère de la Santé, Mogadiscio, Somalie.. |
Summary : Since the worsening of the civil war in Somalia, populations have fled armed conflicts in Mogadishu to seek asylum in neighboring areas. Little was known of the health status of the displaced persons in 1991. Since January 1991, the food supply has been irregular and insufficient, and death rates are thought to have been very high inside and outside of Mogadishu. Local health infrastructure has been destroyed and several non governmental organizations (Médecins Sans Frontières, the International Committee of the Red Cross, Save the Children Fund) have provided nutritional, curative and surgical services to the population of Mogadishu since early 1991. In April 1992, in order to plan a targeted intervention, Médecins Sans Frontières requested Epicentre to conduct a rapid assessment of the health status of the displaced population in the area of Merca and Qorioley, south of Mogadishu (estimated population 100,000). A systematic random-sampling house-hold survey proportional to size of different settings was conducted between April 18 and April 28, 1992 (sampling interval of households ranged from 1/5 to 1/10). The objectives of the survey were:
1) to count the populations according to the setting (residents, displaced in towns, displaced in camps) by sex and age groups\;
2) to measure the nutritional status of children aged 6 to 59 months using the middle upper arm circumference (MUAC) with a cut-off point of 12.5 cm as a measure of severe malnutrition, and to carry out a 24-hour food consumption recall survey\;
3) to measure crude as well as age-, sex - and cause - specific mortality rates during the 12 months preceding the survey by interviewing heads of households with standard questionnaires and case definitions\;
4) to assess the daily water supply per individual and the sanitary conditions in each setting.
A total of 690 households (4,169 individuals) were surveyed. The estimated population of the area was 103,000 [73,000-116,000], (73,000 residents, 23,000 displaced in towns, 7,000 displaced in camps). During the 12 months prior to interview, 497 deaths occurred (Crude mortality rate, CMR, 106/1,000). The CMR was higher among children <\; 5 years and among displaced populations living in camps. Among the 497 deaths, 279 (56 %) occurred from January 1992 to April 1992. From February to April 1992, the average CMR was 18/1,000/month.
The proportion of children with a MUAC <\; 12.5 cm was respectively 57.0% among the 1,266 children of the entire sample, 67.8% among the 487 residents, 76.8% among those (867) displaced in towns and 89.9% (512) displaced in camps. Of the 1,266 children, 279 (22.0%) had a MUAC <\; 11 cm (12.3% among residents, 13.5% among those displaced in towns and 35.7% displaced in camps). The 24-hour food consumption recall showed that 14,2% of the population ate nothing the day prior to the survey (22% among those displaced in camps), while 31.3% had eaten Garass, a local wild seed found in the bus. Only 43.6% of the population had eaten either rice or meat or maize the day before the survey. Only small amounts of these foods were eaten. The daily food ration could not be quantified.
On average, 8.3 liters of water was available per person per day (11.6 liters for residents and 4.5 for displaced persons living in camps). This rapid assessment of the health status of displaced populations and residents of the areas of Merca and Qorioley illustrates the consequences of the civil war in Somalia. The CMR identified displaced populations as a major focus for intervention, with values similar to those observed in Ethiopia and Sudan in 1984-85. The results of the household survey showed an increased death rate since January 1992. The results of this survey were used to motivate international organisations and to increase food shipments to Somalia. However, 7 months after the survey and despite international aid, the situation has worsened. The political context of this public health disaster is described in the editorial by Marc Gastellu Etchegorry (p. 367). |
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