Sunday May 17, 2020
BY SUBBAN JAMA, AYAN ABDULLAHI
The coronavirus will ravage a resilient Somalia—with ripples far beyond its borders.
Students walk in a Mogadishu neighborhood wearing face masks as a protective measure against the coronavirus in Somalia on March 19. PHOTO BY ABDIRAZAK HUSSEIN FARAH/AFP VIA GETTY IMAGES
For close to three decades, Somalia has been spinning on a crisis carousel: war, famine, terrorism, climate stress. Now, the coronavirus pandemic is set to steer the country towards another hemorrhaging of human life. Even with a youth population above 70 percent, the virus will likely compound Somalia’s chronic medley of miseries. With each passing day, an uneasy question looms large: If the pandemic has left such death and upheaval in its wake in the world’s most powerful countries, what impact will it have on one of the world’s most fragile?
Few countries are less prepared for a COVID-19 outbreak than Somalia. And yet, paradoxically, few countries are better prepared for it—not because of health systems or prevention measures, but because of a psychological readiness for catastrophe. Extreme violence has long been a fact of daily life in Mogadishu, under siege by one of the deadliest terrorist groups in Africa, al-Shabab, which, by conservative estimates, has killed more than 3,000 people in the past five years and wounded tens of thousands in the past decade. Somalis, often touted for their resilience amid unrelenting adversity, are no strangers to mass loss of life.
“It’s business as usual here. We keep hearing about the coronavirus, but Somalis don’t take it seriously,” said Abdirisaq Aden, a local businessman. “We are used to a virus called bombs, unfortunately.”
While many are accustomed to explosive, vehicle-borne threats, COVID-19 represents an invisible, airborne threat. As of Monday, 1,054 infections—out of a miniscule testing pool—and 51 deaths have been confirmed. The true spread is doubtless far worse. Though cases were first reported in mid-March, the country only received testing equipment almost a month later. Despite testing far less than its neighbors, Somalia has the highest death toll in East Africa. On April 17 and 18, 72 people were tested, out of which 55 were confirmed positive, a staggering 76 percent infection rate. Since this revelation, the Somali government has stopped sharing the numbers of people tested with the public.
Anecdotal accounts of COVID-19 symptoms and a spike in burials abound. “There is extraordinary community transmission. Infections and deaths are out of control,” explained a Mogadishu doctor on the condition of anonymity. “And why visit a hospital if they can’t treat you?” Somalia’s health infrastructure is mere scaffolding: scarce public hospitals struggling with a lack of equipment, unaccredited doctors in private facilities offering unaffordable services, and medication that is as low-grade as it is scarce.The doctor-patient ratio in Somalia is among the worst in the world (about 0.02 per 1,000 people, compared with 2.6 in the United States). There are just 15 intensive care beds for a nation of 15 million, a fact disclosed by the federal Ministry of Health. Such figures are a damning indictment of governmental priorities in a nation that has notoriously struggled to become a state.
Somalia’s best-equipped medical institution, Erdogan Hospital in Mogadishu, was shut down in April after 3 of its doctors were infected. Martini Hospital—kitted with 76 beds—is the only medical facility in the whole country designated to treat the infected. These grim facts coupled with the cultural stigma attached to disease—fears of ostracism and a deep reverence for predestination—means that many are self-treating at home, and many are dying off the radar. Little is known about the spread of the disease among those living in al-Shabab-controlled territory.
Answers to this acute health crisis lie in part with the government’s 2020 budget, which allocated $9.4 million for health spending, a mere 2 percent of the national budget. A whopping $146.8 million was reserved for security institutions—a telling indication of a cash-strapped state facing widespread security threats.
There has been no cessation in violence amid the coronavirus. In April alone, two doctors were shot to death, a doubly tragic event given the severe shortage of medics. Reports indicate that al-Shabab claimed responsibility for one of the assassinations.
The group heralded the disease as divine punishment for the treatment of Muslims globally. Weaponizing the disease, al-Shabab ushered in Ramadan with an attempted vehicle-borne explosive attack at a military base on the first full day of the holy month.
U.S. airstrikes against the group have grown to an all-time high in recent months. Africom commander Gen. Stephen Townsend justified this by stating, “While we might like to pause our operations because of the Coronavirus, the leaders of al-Qaeda, al-Shabaab and ISIS have announced that they see the crisis as an opportunity to further their terrorist agenda so we will continue to stand with and support our African partners.”
Like the virus, al-Shabab transcends national borders and presents risks not only to Somalia but to its pandemic-weakened neighbors, particularly Kenya, which has weathered violent attacks from the group for years. Born out of a power vacuum itself, al-Shabab will capitalize on lapses in states’ security apparatus as governments redirect resources from preempting terror attacks to enforcing curfews. Economic hardships induced by COVID-19 have already fomented anger, which al-Shabab has historically exploited to recruit new members, sow discord, and bolster legitimacy. All of this risks reversing critical security gains in Somalia and destabilizing the region.
Kenya’s northeastern towns lying on its border with Somalia have been particularly vulnerable to devastating al-Shabab attacks. In response to the illegal smuggling of people and goods from both Somalia and Ethiopia, Kenyan security authorities have recently ramped up aerial surveillance along its borders, in part, to curtail cross-border infection. Ethiopia’s health minister announced last week that 13 of its new cases were imported via illegal migration from Djibouti and Somalia
More than 80 percent of global trade passes through the Gulf of Aden, a vital waterway cradling Somalia. As livelihoods are shuttered, the resurgence of piracy can be expected, with far-reaching impacts. In 2013, the World Bank estimated that piracy cost the global economy $18 billion a year.
Meanwhile, long before the pandemic reached its shores, Somalia had been fraught with chronic political instability. For more than a year now, the central government has been embroiled in a rancorous fight with two of its federal states. This being an election year, the fledgling Somali state finds itself at a critical juncture. It remains to be seen whether federal elections will be postponed, following in the footsteps of neighboring Ethiopia.
Undoubtedly, this health emergency will be accompanied by a humanitarian emergency. The disappearance of remittances—a lifeline for millions on the continent and estimated at $1.4 to $2 billion annually in Somalia alone—makes the situation all the more desperate. These critical cash flows have dried up as a global recession sets in and incomes of workers in the diaspora shrink. Aggravating the situation, harrowing statistics from across Europe show that Somali communities have been disproportionately affected by COVID-19. In Sweden, Somalis are dying from the virus at “an astonishing high rate” according to the BMJ despite accounting for only 0.69 percent of the population. The World Bank is calling on governments to designate remittance companies as an essential service, a crucial step to easing restrictions on these financial flows.
The populations most at risk in Somalia are those living in the densely populated camps scattered across the country. More than 2.5 million internally displaced people live in these cramped conditions, already weakened by malnutrition and compromised immune systems, and with limited access to clean water, soap, or bathrooms. Nearly 7 in 10 Somalis live in poverty, and a largely informal economy means social distancing is simply not viable. Hungry people cannot afford to hide from disease. According to the World Food Programme, the number of food-insecure people in East Africa is projected to reach up to 43 million in the next few months—more than double what it is now—sparking fears of conflict over scarce resources.
The specter of drought and famine, alongside the unforgiving plague of locusts that has ravaged crops in recent months, is worsening the situation.In just the past week, deadly flash floods have plunged several cities underwater. The attendant loss of livelihoods will force more people to move, compounding the internal displacement crisis and heightening intercommunal tensions even as it spreads the disease further.
Border closures across the region have throttled migration flows, making it ever harder for people to escape conflict or starvation. This will simply force migration into the shadows, opening up avenues for human trafficking and exploitation. Irregular movement of refugees has already been observed across the Horn of Africa’s highly porous borders.
Restrictions on movement have debilitated social life as well, stoking deep tensions. During Friday prayers at Mogadishu’s Marwazi mosque on April 10, armed forces tried to forcibly disperse a congregation of worshippers without notice. A massive demonstration broke out, and shoulder-to-shoulder prayers continue across the country today. Riots swept the streets of Mogadishu again on April 24 in response to the fatal shooting of two innocent civilians by police as they tried to enforce a curfew. Ramadan, replete with nightly rounds of public taraweeh prayers, is likely to catalyze disease spread in the absence of clear communication with communities and Islamic leaders. While efforts have been made by some religious clerics to promote awareness about COVID-19 risks, at least one has been arrested for perpetuating myths about his power to cure it.