MOGADISHU, Somalia — To save the life of his severely malnourished three-year-old son, farmer Yusuf Bulla had to travel from a remote area in the south of the country. Somalia to the capital Mogadishu, where the only hope was a sparse medical facility.
After 15 days in Banadir Hospital, the child was declared out of danger.
“Where I come from, there’s no hospital,” Bulle said. “That's why I'm here.”
One of the world's poorest countries faces a health crisis worsened by the Trump administration's dismantling of the United States Agency for International Development this year. The loss of USAID funding has disheartened many Somalis who feel they cannot depend on their own government, which is largely focused on defeating the al-Qaeda-linked al-Shabab group.
Somalia's Deputy Health Minister Mohamed Hassan Bulaale told The Associated Press that U.S. cuts have led to more than 6,000 health workers losing their jobs and up to 2,000 health facilities being damaged.
The frequency and intensity of militant attacks, including on medical centers, have declined in recent months, leading some to see President Hassan Sheikh Mohamud's “all-out war” against al-Shabab as a success.
But hospital administrators, civic leaders and others say the latest step toward defeating al-Shabab has come at the expense of health care and other government services.
Somalia's health ministry has been allocated $91 million this year from a national budget of more than $1 billion, with the funds tied mainly to projects supported by outside groups. That's a significant improvement on last year's $52 million, but almost all of the increase came from donors, says Mahad Wasuge, director of the Somali Public Agenda think tank.
And as the United States has shown, donor money comes and goes.
Even with major setbacks in overall foreign support this year, including from other key benefactors such as Britain, “security remains the top priority” for Somali authorities, Wasuge told the AP.
Many areas outside Mogadishu do not have functioning public hospitals, he said, and people are forced to walk through often unsafe areas to get care at those that are still functioning.
Such facilities in the capital include Banadir Hospital, built with Chinese support in 1977, and De Martino Hospital, founded in 1922 by Italian colonialists.
During AP's visit, representatives of these hospitals said much of their work would be stopped without help from the UN and international groups.
Even at Banadir, Mogadishu's main public referral hospital, the Somali government's expectations are low. The unit, which cares for malnourished children, depends entirely on donor funds channeled through the humanitarian group Concern Worldwide, said director Dr Mohamed Haashi.
After 37 people who worked at the unit lost their jobs due to cuts in U.S. aid this year, Concern Worldwide is still paying the salaries of 13 others in addition to milk and food for mothers and children, Haashi said.
De Martino Hospital director Dr Abdirahim Omar Amin expressed concern about what will happen when contracts with two other humanitarian groups expire at the end of 2025.
The hospital was treating dozens of children suffering from diphtheria, a throat infection that can be prevented by vaccination but is now spreading in rural areas. Parents are not taking their children for routine vaccinations because they fear militant attacks, Amin said.
In the medical laboratory, Amin pointed to the equipment and said that everything was purchased with donor funds.
“Now it looks like donors are tired,” he said.
Most of the hospital's services are provided free of charge, thanks in large part to funding from the International Rescue Committee and Population Services International. Patients with conditions not considered urgent are asked to cover some costs.
“The Ministry of Health should support this hospital because this hospital belongs to the Ministry of Health,” Amin said. “I hope that even if (humanitarian groups) leave, the Ministry of Health will replace their position.”
Bulaale, the deputy health minister, said the government is working with some partners to “develop a contingency plan” following the loss of USAID funding. He didn't specify.
In some ways, the story of De Martino Hospital reflects the scars of Somalia. It once housed displaced people following the 1991 fall of Siad Barre, a dictator whose overthrow sparked fighting between warlords from different clans. Many public facilities throughout Somalia were destroyed during the civil war.
Somalia's federal government, now based in a heavily fortified area near the airport in Mogadishu, is struggling to assert itself despite support from African Union peacekeepers, US airstrikes against al-Shabab and security consultants from countries vying for influence in a country with strategic access to the Indian Ocean and Gulf of Aden.
These countries include Türkiye, which funds a hospital with intensive care units in Mogadishu.
“Even the limited number of public hospitals that have started functioning normally recently are heavily dependent on donor money,” said Wasuge, a community leader. “They don’t get direct government funding that allows them to provide better health care.”
People most in need are referred to Banadir and De Martino hospitals for help. De Martino, Mogadishu's main referral hospital for COVID-19 patients during the pandemic, is taking in “the most vulnerable” no matter where they come from, according to director Amin.
Amina Abdulkadir Mohamed, an unemployed woman who recently went to De Martino to give birth, said she went there because she knew she wouldn't be asked for money.
“They told me the medicine was free,” she added.
Mohamed Adam Dini, who represents Somalia's Puntland state in the national assembly, described the federal government's priorities as “deficient” due to its overwhelming focus on ending “anarchy.”
“A lot of diseases are spreading unchecked,” Dini said, adding: “There is no national health plan because we don’t have a national political plan.”
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