Somalia Health Insurance

In the eastern-most part of the continent, on the horn of Africa, Somalia fronts the Indian Ocean and the Gulf of Aden, sharing land borders with Kenya, Ethiopia and Djibouti. Ancient cities and pyramidal structures have been discovered in the country, attributed to a sophisticated civilization which previously thrived on the Somali peninsula and which had a lucrative trading relationship with Ancient Egypt. Peace and prosperity are unknown in modern Somalia, which is now one of the most violent and poorest countries in the world. Despite decades of war and lack of effective government however, a healthy informal economy has been maintained, based primarily on telecommunications, livestock and fund transfer companies, the latter facilitating up to 1.6 billion dollars in remittances annually in the absence of a formalized banking sector. Some of the most competitively priced and technologically advanced internet and telecommunications services are offered in Somalia, which now boasts a higher density of telephone lines than neighboring countries and affordable internet services unavailable in many parts of the continent.

Population count is difficult for Somalia, as the last official census by the Government was taken in 1975. Refugee movements and the large number of nomads in the country compound the challenge. The estimated population of 9.9 million inhabitants is therefore largely variable however nomads and semi-pastoralists make up a large portion of the overall population. Livestock is both an important domestic product and export item, accounting for approximately 40 percent of GDP and in excess of 50 percent export earnings. Principal exports also include charcoal, fish, bananas and hides. Prior to independence in 1960, the country’s major language was Italian; however, its influence has significantly diminished and is now generally used by older generations. Somali and Arabic have been designated official languages, and Italian and English, the latter widely used and taught, as second languages. A number of local dialects and minority languages are also spoken. Given the security situation in Somalia, those travelling to the country should ensure their health insurance coverage extends to acts of war and terrorism and includes air evacuation for medical emergencies.

Somalia Health Care and Insurance

Local and regional bodies have controlled various regions of Somalia since the collapse of central government in 1991. An internationally recognized Transitional Federal Government controls the south, the self-proclaimed, and relatively stable Republic of Somaliland controls the northwest, and the semi-autonomous Puntland, controls the northeast corner. All three zones face insecurity, human rights violations and weak governance. Though rudimentary, Somalia had a reasonable public health system by African standards prior to government collapse. Since then, political instability, a worsening humanitarian crisis and civil war have significantly impacted the availability and quality of health services, leaving many of the poor and vulnerable without access to basic care, and facilitating deterioration in health indicators and outcomes. The public health system is, however, in the process of being rebuilt, overseen by Somalia’s Ministry of Health. Both Puntland and Somaliland maintain their own health ministries.

As with other nationalized industries in Somalia, informal providers have filled a void. Consequently healthcare is now concentrated in the private sector, which has improved access through establishing clinics, health posts, health centers, hospitals and pharmacies. The growth of this industry however has highlighted a number of issues, most importantly the sector being unregulated, leading to inadequately trained staff, misdiagnosis, and the importation and dispensing of poor quality and uncertified drugs. The World Health Organization has estimated the cost of outpatient treatment in Somalia between US$1.89-$3.97 per visit, and at health centers US$5.72. Primary through tertiary care at hospitals was estimated between US$7.83-13.95 per day. Given a significant portion of the population lives in extreme poverty, and on less than $1 per day, healthcare is price prohibitive for many. Rural and nomadic populations are even less likely to have access to healthcare. Problems also exist in shortages of appropriate medical equipment, and the use of unhygienic facilities. Should one suffer an illness or injury requiring treatment, facilities are unlikely to supply anything more than basic care. Serious cases would involve medical evacuation, which would require confirmation of Somalia health insurance, including a clause for air ambulance services.

The capital, Mogadishu, now described as a ‘bombed paradise’ has general hospitals which by and large focus on emergency maternal medicine and trauma care, treating significant numbers of war-wounded patients. Despite this care being available, facilities throughout the country are extremely limited by western standards. Somalia is second in the world, behind Afghanistan, for maternal mortality rates at 1,200 deaths for every 100,000 live births, where only a small percentage of births are attended by a midwife or trained medical professional. Shortages of the most basic medical supplies are common and a lack of proper sanitation and safe drinking water are also public health concerns. Reflective of the low social and health indicators in the country, life expectancy is only 48 years for males and 52 years for females. To mitigate the risk of being forced to remain in the country to receive healthcare, expatriates require comprehensive health insurance with an evacuation clause.

After four years of below-average rainfall, the country is experiencing severe drought, resulting in famine and the displacement of thousands of Somali’s. Hot conditions prevail throughout the year, with the country recording some of the world’s top mean annual temperatures. Daily temperatures can range from 30 to 40 °C in the hottest months. The UN Office for the Coordination of Humanitarian Affairs has, since July 2011, declared six regions in the south to be officially in famine. Foreign aid agencies and NGO’s continue to deliver humanitarian assistance and subsidize public health services, however intensified fighting in the south has adversely affected humanitarian efforts. In January 2010, the World Food Programme was forced to partially suspend its operations due to armed attacks and threat to the safety of aid workers. In November 2011, sixteen non-government and UN organisations, including UNICEF and the WHO were reportedly banned in areas under the control of al-Shabaab, an Islamist militant organization in Somalia.

Somalia Travel Insurance Concerns

Pervasive and violent crime reflects the general state of insecurity and instability of Somalia. Travel advisories warn there is ‘extreme risk’ to personal security due to widespread armed conflict, lawlessness and a high threat of terrorism. Violent clashes occur frequently, including in the capital, where the Mogadishu International Airport is regularly closed at short notice. Foreigners are actively targeted by bandits and kidnappers. Road conditions are poor, illegal road blocks common, and landmine detonations present a significant danger throughout the country. Travel advice notes that those already in the country, should depart. Those deciding to stay or embarking on travel to Somalia should seek advice on security arrangements from a security company experienced in Somali conflict situations. Considering there is substantial risk to personal safety and therefore one’s health in Somalia, a comprehensive medical insurance plan which includes cover for acts of war or terrorism should also be purchased.

Listed by the WHO as endemic for Yellow Fever, a vaccination certificate may be required for both entry and exit of Somalia. Some airlines will request passengers to present proof of having had the vaccination before being permitted to board departing flights destined for specific countries. Malaria also occurs in all parts of Somalia throughout the year, and is endemic in many areas. Other insect-borne diseases such as Dengue Fever, Leishmaniasis and Filariasis also present a risk to travellers. The degree of risk for contracting a major infectious disease in Somalia is ‘high’. An outbreak of Measles resulting in approximately 9,000 cases and 31 deaths was reported in August 2011. Other diseases such as Hepatitis, Tuberculosis and Meningococcus are prevalent also. The number of Cholera cases peaks each year from December to May, declining at the start of the rainy season. Outbreaks of Polio, Typhoid and Rift Valley Fever also occur periodically. Before travelling to Somalia, the CDC recommends routine childhood inoculations should be administered if not already up-to-date and vaccinations for Hepatitis A & B, Typhoid, Yellow Fever, Meningococcus, Polio and Rabies.

Somalia Expat Health Insurance

There is inherent risk involved in travel to Somalia, where acts of violence are frequent and medical facilities limited. Evacuation will be necessary in the event of illness or injury, which can be costly and difficult to arrange in the country. An international health insurance policy which includes cover for acts of terrorism and war is required. Not all providers will cover these acts and obtaining such a policy can be challenging, however as a leading insurance provider, Expat Medical Insurance can assist you in finding appropriate comprehensive cover for your specific travel and medical needs. Contact one of our consultants to discuss a range of worldwide and globally transferable medical insurance plans available.