Floods and armed insurgents prove no match for vaccinators in Somalia’s South West State

Flash floods halted vaccination in parts of Somalia’s South West state – but only briefly. Here’s how a special, and specialised, immunisation partnership kept the show on the road.

  • 16 October 2024
  • 6 min read
  • by Chantal McGill ,   Liban Ahmed Sharif ,   George Njenga
The READO outreach team stands outside the community center at Walaag 1 IDP camp, after finishing the vaccine session of that day, From left to right: Adan Abdirahman Mohamed, Mustaf Hassan Ali, Alinur Yacqub Ibrahim, Ubah Abdulahi Ali, Fadumo Mukhtar Adan, and Abdibasid Abdisamad Mohamed.
The READO outreach team stands outside the community center at Walaag 1 IDP camp, after finishing the vaccine session of that day, From left to right: Adan Abdirahman Mohamed, Mustaf Hassan Ali, Alinur Yacqub Ibrahim, Ubah Abdulahi Ali, Fadumo Mukhtar Adan, and Abdibasid Abdisamad Mohamed.
 

 

“The floods were devastating,” recalls Mustaf Abuka Adan, a community mobiliser for vaccination in Somalia’s South West state. “I remember wading through knee-deep water just to reach some of the households.”

Drought – Somalia’s worst in decades – had left the ground parched and hard when the Deyr season rains broke in October 2023, and now the storms brought fresh disaster. By late November, flash floods had displaced 750,000 people from their homes. Fuelled by protracted conflict, food insecurity was a rampant problem countrywide already before the new crisis, and now UN OCHA projected that 1.5 million children under the age of five faced acute malnutrition by July 2024.

Both the floodwater and the malnutrition raised the risk from disease outbreaks. Getting vaccines to families was imperative. “It was exhausting, but we knew that children needed these vaccines. Despite the difficulties, seeing the relief on parents’ faces when we arrived made it all worth it,” says Adan, who works with the International Rescue Committee-led, and Gavi-funded, REACH programme.

 

Zainab Ali holds her grandchild after he received his vaccination. Credit: Gavi/2024/Mohamed Abdihakim Ali
Zainab Ali holds her grandchild after he received his vaccination. Credit: Gavi/2024/Mohamed Abdihakim Ali

Vaccinating in a polycrisis

Part of an ambitious, large-scale initiative to make sure vaccines get to communities in conflict or crisis since 2022, REACH takes a patchwork approach, drafting in local partners who have the necessary expertise to get immunisation done in some of the most complex contexts in the world.

That includes Somalia’s South West state. Long-standing conflict between armed, non-state actors has blocked the government from rolling out essential health services, including immunisation, to certain communities here. Movement is often restricted, attacks by armed groups a constant worry. In other words, the Deyr floods – far from the only natural disaster to land here in recent times – only compounded the challenges facing an already troubled setting.

But in November and December 2023, two REACH partners leading a catch-up vaccination campaign managed to get through – even exceeding immunisation targets.

WHO: REACH partner GREDO (Gargaar Relief Development Organization)
WHERE: Bardale, Burhakaba, Dinsor, Elbarde, Yeed
WHEN: November 2023
WHICH VACCINES? 4191 doses of the first dose of the pentavalent jab (containing vaccines against diphtheria, tetanus, pertussis, heptatitis B, and Hib), called Penta 1; 2987 doses of Penta 3 
3549 doses of a first dose of measles vaccine (MCV1); 1097 doses of MCV2

 

READO staff navigate through Walaag 1 IDP camp on their way to the outreach facility to begin the vaccination process. Credit: Gavi/2024/Mohamed Abdihakim Ali
READO staff navigate through Walaag 1 IDP camp on their way to the outreach facility to begin the vaccination process. Credit: Gavi/2024/Mohamed Abdihakim Ali

 

WHO: REACH Partner READO (Rural Education and Agricultural Development Organization)
WHERE: Baidoa (111% of target reached); Awdinle (198% of target reached); Hudur (125% of target reached)
WHEN: October to December 2024
WHICH VACCINES? 6,289 doses of Penta 1; 6,106 doses of Penta 3
5,809 doses of measles vaccine

How it’s done

Gathering intel: Based on weather forecasts from Somali Water and Land Information Management, a flood warning was issued to the WHO Humanitarian Health Cluster at the beginning of August 2023, anticipating a level of flood devastation not seen since 1997.

Working with the Health Cluster, the Somali Office of Humanitarian Affairs, the Ministry of Health and community leaders, REACH performed a situational assessment and developed a risk management plan with their local partners READO, GREDO, and SHACDO (Shabelle Community Development Organization) to enable the continuation of immunisation services.

Fail to prepare, prepare to fail: Coordination, prepositioning of supplies, and community mobilisation were all key to bolstering immunisation services against disruption.

A number of readiness activities enabled REACH to continue immunisation services, even in the most challenging locations:

  • Coordinating with the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) and the World Food Programme (WFP) to acquire supplies for additional mobile clinics.
  • Prepositioning immunisation and essential medical supplies at strategic, high elevation locations.
  • Strengthening the cold chain infrastructure by procuring and incorporating solar direct-drive refrigerators/freezers to maintain the viability of vaccines during storage and transportation, in coordination with the Somali cold chain managing agencies.
  • Deploying additional four-wheel drive vehicles capable of navigating flooded terrain, and transporting supplies and vulnerable community members.
  • Conducting community outreach activities, such as health education sessions, community meetings, door-to-door campaigns, and radio messages targeting parents and caregivers, informing them of flood risk and planned locations of mobile clinics where they could access health services and continue immunisation once flooding began.  As community mobiliser Adan recalls it, "it was essential to keep the communities informed, especially since we had to change the usual vaccination sites. We relied heavily on local leaders and radio broadcasts to get the word out. This way, families knew where and when to bring their children for vaccination."

Activating the plan: Flooding in REACH’s intervention areas caused extensive destruction to infrastructure, including roads, bridges, and sanitation facilities. It compounded the already dire situation following a prolonged drought, leading to severe food insecurity and displacement. "When the floods started, we received directives to alter our usual routes and schedules because many roads were inaccessible,” said Adan. “We had to quickly adapt and find alternative routes, sometimes even using boats to reach the isolated areas."

 

A child, held by his mother Amino Sidow, watches as the vaccinator prepares a dose. Credit: Gavi/2024/Mohamed Abdihakim Ali
A child, held by his mother Amino Sidow, watches as the vaccinator prepares a dose. Credit: Gavi/2024/Mohamed Abdihakim Ali

Safety was a major concern during this period. “In some places, we had to get special permission from the local authorities to enter, as they were concerned about our safety and the potential for disease spread. We also made sure to coordinate closely with other humanitarian organisations to avoid duplication of efforts. The floodwaters brought additional risks, such as waterborne diseases and unstable structures." The contamination of water sources further exacerbated the situation. Outbreaks of acute watery diarrhoea and malaria sprang up.

In some cases, the safest course of action was to pause. In October, when the flash floods started, REACH immunisation activities were put on hold for two weeks in some locations, while they continued throughout the crisis in other locations. REACH attributes its ability to maintain full immunisation services in its intervention areas to the following efforts: 

  • Ongoing coordination with the WHO Health Cluster and UNICEF provided access to immunisation supplies.
  • Deployment of a classified protocol system for safe sites and places – identifying routes, paths, and distances to the nearest safe locations and listing the various types of assistance available – connected REACH staff and communities to safety and essential services.
  • Distribution of unconditional cash assistance and hygiene kits in combination with immunisation reached the most vulnerable households.
  • Provision of primary health care alongside immunisation improved overall health service delivery. In some locations, REACH frontline staff delivered essential medical services through local partner SHACDO, and in other areas, they coordinated with other NGOs to offer services in the same location through local partner READO.

This experience within ZIP, Gavi’s Humanitarian Partnerships, offers a model for full immunisation service continuity in other humanitarian crises, even when additional shocks occur, and demonstrates the feasibility of full immunisation in emergencies, said Liban Ahmed Sharif, REACH Project Coordinator for Somalia.


Authors

Chantal McGill 
Learning and Project Manager, CORE Group

Liban Ahmed Sharif 
REACH Somalia Project Coordinator, International Rescue Committee

George Njenga
REACH Senior Communication, Advocacy, and Policy Coordinator, International Rescue Committee