Fifteen-day-old Faadumo lies quietly with her big, dark eyes wide open. Her tiny head and dainty fists rest on a nest of blankets, starting with a black shawl. A second one adorned with white dots is layered on top. She is then tucked in a bigger, thicker blanket in a maroon and creamy colour.
In between these wrappings is one more layer that is smooth, reflective and uncharacteristically thin for a blanket. It is a black plastic shopping bag.
Faadumo was born prematurely at seven months. Her mother, who was only 15, died during childbirth. The plastic bag is to keep her warm, as is the single-bed room with no window that she is staying in.
A premature baby like her should, of course, be kept in an incubator. But here in Bosasso General Hospital in the state of Puntland, Somalia, a plastic bag and many blankets are the best doctors can do to keep her warm — and alive.
“We need incubators and our staff also need training in how to use them,” says Dr Mohamed Said, the paediatrician at the hospital.
Besides being premature, Faadumo is also malnourished. She weighed 1kg at birth, and weighs not much more — 1.1kg — now.
When asked about the challenges he faces, Abdirizak Hersi Hassan, director-general of the Ministry of Health in Puntland, sums them up in two words: “Too many.”
Poor infrastructure, shortage of personnel, equipment and inadequate training, the list goes on and on. The indicators tell the story of what Mr Abdirizak and his ministry are up against.
What makes the Somali narrative so much more distressing than anywhere else in the world is this: The struggle for a woman to survive while giving life, and for a child to survive to see his or her fifth birthday, has been going on for far too long.
Since the collapse of the government in 1991, Somalia has been in an almost constant state of war. Today, 1.1 million Somalis are displaced inside the country and another one million as refugees in the neighbouring countries.
Its health systems are mostly supported by development partners and funded by donors. Unicef alone supports 70 per cent of Somalia’s health facilities.
“Without such support, the healthy systems will collapse,” says Mr Hassan.
At the maternity ward in the mother-and-child health clinic in 100 Bush IDP camp, Malyuum Osman, 29, rests with her one-day-old newborn, Mohamed. Over the years, Ms Malyuum has suffered two miscarriages and seen two children die — a daughter from illness, and a boy in an accident.
Despite the basic conditions here, the clinic, staffed by 14 midwives and nurses, is doing wonders for the local population of 15,000 people living in the various displacement camps. It is one of the many clinics supported by Unicef under the Joint Health and Nutrition Programme, a five-year plan to save mothers and children from dying unnecessarily in Somalia.
A critical component of the programme is to ensure a core package of reproductive, maternal, newborn and child health and nutrition services to all Somali women, children and families.