Are aid groups honest about the barriers to helping Somalia?

By Megan Rowling

British medical charity Merlin has just announced it's planning to expand its health care services in famine-hit Somalia, despite the challenges of operating amid ongoing conflict in the Horn of Africa nation.

The aid group will increase its number of health facilities there from 24 to 47, and the number of mobile clinics from four to 35.

"There is no doubt that the situation is critical, and escalating armed conflict between rival groups has made expanding our services in both the South Central and Puntland regions particularly difficult," Merlin's Chief Executive Carolyn Miller said in a statement.

"Yet, despite the increased security risks, Merlin's medical teams are committed to reaching more people and are working around the clock to address the unmet health needs."

Since the start of the year, Merlin's medical experts have screened over 20,000 children, pregnant women and young mothers, finding nearly a third to be severely or moderately malnourished. They have also vaccinated more than 3,000 children for measles, diphtheria, whooping cough and tetanus, conditions that could be fatal for those already weak with hunger.

Having operated in Somalia since 2004, Merlin’s network of strong relations with local communities has enabled it to deliver medical expertise in demanding conditions, it says. In the last few weeks, teams have held meetings with community leaders in the south-central region to enlist support for Merlin's plans, and communities have been asked to help with activities, including staff recruitment.

"We are committed to stay on, undaunted and determined," Miller added.

DROP IN THE OCEAN?

Four million Somalis are said to be in crisis. Given that insecurity is limiting international aid groups’ activities and some have been banned from territory controlled by Islamist rebels, to what extent are they actually able to help?

"We know we are not yet fully meeting the enormous needs the Somali people are facing," the U.N. humanitarian coordinator for Somalia, Mark Bowden, said in Nairobi this week, while stressing that additional funds are now enabling international and local agencies to scale up their work in famine-hit regions.

Around 1.2 million people received food assistance in August, for example. That's up from 750,000 in July, but still only covers just over a quarter of those who are going hungry.

Merlin's move to expand its clinics follows comments from a top official at another medical aid group, Medecins Sans Frontieres (MSF), who accused other agencies of "glossing over the man-made causes of hunger and starvation in the region and the difficulties in addressing them."

Unni Karunakara, president of MSF's International Council, wrote in the UK’s Guardian newspaper last Friday that many aid and media organisations have portrayed Somalia’s emergency in "one-dimensional terms," ascribing it largely to the severe drought affecting large parts of East Africa.

"But only blaming natural causes ignores the complex geopolitical realities exacerbating the situation and suggests that the solution lies in merely finding funds and shipping enough food," he said.

He added that it's the war between hardline Islamist rebels and the transitional government, backed by the international community, "that has kept independent international assistance away from many communities."

In large parts of the country there is virtually no access to health care, and the conflict makes it hard for medical humanitarian organisations to ramp up their activities and make an impact, Karunakara said.

Nonetheless, MSF – which has been working in Somalia for two decades – has projects in nine locations, some inside rebel-held territory, and is feeding 8,000 acutely malnourished children.

"Providing aid in Somalia today is about as grim as it gets," Karunakara wrote. "Our staff are at constant risk of being shot or abducted. And we may never be able to reach the communities most in need of help, or have to compromise some of our independence when we do reach them."

With the pressure on to raise more money for the emergency response, he suggested that not all aid agencies seem to agree honesty is the best policy.