A team of 30 midwives provide free home-based health monitoring, counselling, and referrals to women in the camps and surrounding settlements, facing limited access to health facilities.

Many of the midwives held jobs at health facilities supported by humanitarian organisations until funding cuts slashed budgets in August 2024.

Fatumo Sidow, who coordinates the group, said they chose to continue serving their communities as volunteers.

The midwives frequently encounter women suffering from malnutrition and undiagnosed conditions, including high blood pressure, diabetes, and anemia that pose severe risks to the mother and unborn child.

Fatumo told Radio Ergo that since June 2025, the volunteer midwives have assisted around 200 pregnant women.

Among them is Warsan Muse Jama, 35, who lives in Hagadera refugee camp. She was unaware she was suffering from anemia and malnutrition until Fatumo took her for tests.

“The first time she took me to hospital, my blood count was seven [dangerously low]. She advised me to eat eggs, vegetables, increase my food intake, use spinach and kale, drink more fluids, and avoid stress. She kept taking me back to the hospital. Later I was told my blood count rose to nine. She helped me very well and I delivered safely. Even when I was sick and vomiting, she came to my house. She brought her notebook and kept following up on me from that time. I received very good support,” Warsan said.

When Warsan went into labour, she called Fatumo.

“When I called, she came immediately. She was the only one who accompanied me to the hospital. As we were entering the gate, the baby came out. She delivered the baby for me inside the vehicle. She had her gloves and equipment with her. I was then taken to the hospital, where she helped settle me in the bed and arranged for my relatives to join me before leaving,” Warsan said.

During a previous delivery in 2023, she nearly died due to delayed medical care, as she had believed hospital visits were only necessary once labour pains began.

Warsan’s family has lived as refugees since 2010, after leaving a rural areas in Somalia’s Lower Juba region when drought decimated their livestock. They survive on income from a small shop run by her husband, selling charcoal and vegetables in the camp.

The midwives also reach out to women living outside the camps, where health facilities are even harder to access.

Habibo Ahmed Tajir, who lives six kilometres from Hagadera camp and is nine months pregnant, said regular hospital visits are difficult, but a midwife comes to her home to monitor her.

“Now that I am in my ninth month, I have decided to give birth in hospital, and God willing, my wish will be fulfilled. The midwife advised me to avoid stress and told me that if the ambulance delays, I should call her and she would contact the hospital. I am now confident that I will deliver in hospital,” Habibo said.

It will be her first hospital delivery as she always thought hospitals would be too expensive. Guided by a midwife, she has been registered at a health facility in readiness for the delivery due in January.

Her family is poor, living off $30 cash aid that they receive every two months.

“The food we buy runs out halfway through the month. We have no support from inside or outside. I look for loans and sometimes I get them, sometimes I don’t. When I do get a loan, repaying it is another struggle. When food runs out and we cannot get loans, we go to sleep hungry,” she said.

The midwives themselves also face severe economic hardship, after losing their jobs at health facilities that were supported by International Rescue Committee (IRC).

Dahiro Malin Abdi, a senior midwife with 10 years’ experience, said the decision to continue as a volunteer was rooted in responsibility and professional commitment.

“Our purpose is that these are our people. We were trained before, and if we get an organisation to support us, that would be good. If not, we will continue serving our community. This is work we believe in and value deeply,” Dahiro told Radio Ergo.

Many maternal deaths in the camps occur at home and go unrecorded. Lack of awareness remains one of the biggest challenges.

“We discourage mothers from giving birth at home. Even when a woman insists on delivering at home, we persuade her and take her to a health facility. We provide education and awareness. Every month, we assist 10 to 15 pregnant women,” Dahiro said proudly.

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Radio Ergo was invited to participate in the health ministry’s annual review of lessons learned in 2025, aimed at strengthening health awareness efforts next year.

At the meeting held in Mogadishu, Radio Ergo’s local reporter interviewed Khadar Hussein Mohamud, Social Behaviour Change Manager in the Federal Ministry of Health and Human Services’ health promotion department.

Radio Ergo asked him first to outline the ministry’s health awareness approach.

Khadar Hussein Mohamud: The health awareness programme is designed to prevent fatal diseases that are actually preventable. The prevailing global perspective, or consensus, is that if you spend one dollar on prevention today, it is equivalent to avoiding treatment costs that could reach 10 dollars. Research on the benefits of prevention confirms this. As the saying goes, prevention is better than cure.

The health awareness programme encourages people to adopt a habit of seeking health services before an illness strikes. For example, in the case of Acute Watery Diarrhea, awareness means people should wash their hands, eat clean and cooked food, avoid contamination, boil their drinking water, and if a child suffers from dehydration, administer basic medication.

Take another example of vaccination against preventable diseases. For a child to be healthy, we educate mothers to get vaccinated while the child is in the womb as part of prenatal care, and to complete the child’s vaccinations after birth. Vaccination is, by its nature, a lifesaver.

We work on vaccine uptake for recurring diseases, such as measles, which is very prevalent in certain regions like the South West State and others. Similarly, diphtheria can be prevented by vaccines. Acute Watery Diarrhea can be prevented by vaccines, as well as by drinking clean water and handwashing. These are among the practices the Health Ministry encourages, and which the world has agreed upon.

Radio Ergo: Do fake reports and misinformation have an impact on your awareness programmes?

Khadar Hussein Mohamud: Yes, fake reports such as lies about the efficacy of vaccines, or specific medicines, or incorrect statements regarding health services, do have an impact. Recently, we have been thinking about a rumour and misinformation management system to address false information reaching the public. False information can be corrected by establishing a proper system where the media has a designated place or platform to access Ministry reports. There is a need for this. Currently, it does not exist in a robust way, but we are working on building it in the coming years.

Radio Ergo: You mentioned that rumours are spread on social media. Do you feel that focusing on ethical reporting and delivering accurate information to the community would help?

Khadar Hussein Mohamud: Yes, absolutely. The ears of the community are the media. We believe there are many ways to prevent rumours. Religious scholars can participate in preventing rumours, and

traditional elders can also participate. The media can prevent the spread of rumours. So, utilising these systems can bring about positive change and help the community significantly.

Radio Ergo: How important do you think it is to share health ministry information through media, specifically radio, given that people without access to the internet might be listening?

Khadar Hussein Mohamud: For a long time, there were techniques used that became quite localised, often called house-to-house or person-to-person approaches. Today we talk about mass public awareness. Media is central to ensuring people receive correct information. Media outlets differ in power and reach. There are some media channels that certain segments of society cannot access. As a ministry, we strongly encourage vulnerable people, such as the displaced and those unable to use digital devices, to access radio stations. Therefore, we view radio as very important.

Radio Ergo: Radio Ergo and others face various challenges in accessing data and information from government agencies. Please comment on this, as radios are complaining about this issue.

Khadar Hussein Mohamud: First, I can only speak regarding health issues. We are sorry if information does not reach people correctly, but we are working on establishing good relations with the media to generally improve what we can.

Radio Ergo: What does it mean to deliver accurate information to the public during the spread of disease outbreaks?

Khadar Hussein Mohamud: When emergency health situations occur, the most important thing is for agencies, both governmental and humanitarian, to be prepared. It means delivering accurate information at the right time to the community. This means that a disease and how to prevent it should be known beforehand, and this information must be delivered in a timely manner. This can save lives and prevent potential crises.

Radio Ergo: What is your message regarding how media, specifically radios, can access data from official health agencies?

Khadar Hussein Mohamud: I suggest that they seek out and contact the Ministry of Health’s media office and the National Health Media centres. The Ministry has a Facebook page, Twitter, and contact points regarding health issues. Although the government has many branches dealing with various issues, and since we are numerous, consisting of both Federal and State level staff, I encourage the staff working with us to share accurate information at the right time with the public, especially with media working on health issues. There are many media outlets, and I thank Radio Ergo, which cares deeply about social issues like health and education.

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In November Gololey health centre, run by Somali NGO Zamzam Foundation, shut down due to a lack of funding. Qalimow centre only remains open because most of its staff are now working as unpaid volunteers.

Zamzam Foundation told Radio Ergo that the centres combined had served a population of 51,000 people for 12 years. They offered the sole reliable source of treatment, nutritional follow-up, and safe maternal health services for mothers and newborns in the area.

The closure of one centre and the threat of imminent closure of the other leaves the communities facing severe great stress over critical health issues at a time when drought, livestock losses, and failed harvests have already severely weakened household resilience.

Shukri Ahmed Hassan, 22, is eight months pregnant and has received reduced antenatal care for three months at Qalimow health centre because of the impact of funding cuts. She says her health has deteriorated and she feels weak and in pain.

The nearest alternative health centre is in Jowhar, nearly 30 kilometres away. Going there requires money for transportation, as well as money to pay for medical services on arrival.

Shukri said she had always depended on the Qalimow centre, where her two older children were born over the past nine years. This time, in her final month of pregnancy, she is anxious due to the lack of access to medical care.

Her family is struggling financially and is in debt. She owes a local pharmacy $100 for medicines bought on credit for her own malnutrition and for illnesses affecting her children, including watery diarrhoea, fever, and vomiting.

Shukri’s husband is unemployed and has no stable income. Their three-hectare farm growing maize, millet, beans, and vegetables has been unproductive for eight months due to lack of rainfall and water shortage.

The last crops they planted in October dried out before maturing, leaving them with nothing to harvest, and no money. Food is therefore short in her household, as well as in the wider community.

The two centres provided free treatment to pastoralists and farmers from 94 villages across the district of Balad. The closure of one and the threatened closure of the other comes at a time when these communities are struggling with prolonged drought that has ruined livelihoods, weakened livestock and led to failed harvests.

Maryan Gure Mohamed, 29, was among the last women to give birth at the health centre in Gololey before it shut its doors.

She is breastfeeding her baby born in September, but says her milk is not enough because she lacks adequate food and misses the nutritional support she used to receive.

She told Radio Ergo that when the centre was open, mothers and children were treated for conditions such as diarrhoea, vomiting, and malnutrition, and were provided with biscuits and supplementary food. Pregnant women were monitored and supported to gain weight.

Maryan’s family, who make a living selling milk from their livestock, have been in crisis since mid-2024, when a combination of disease and lack of pasture killed 98 of their cattle.

Only two cows remain, and they don’t get enough fodder so produce little to nothing, leaving the family with no meaningful income.

Local leaders say the health centre closures have led to many women being unable to deliver safely. Mahmoud Nur Hassan, 62, a member of the Qalimow health committee, said many women had been taken to medical facilities in Jowhar over the past three months due to childbirth complications.

He said he knows of 18 such cases in the village, including several women who required surgery. Private pharmacies often sell low-quality drugs, while the health centres used to provide reliable medicine that families depended on.

Mahmoud himself relied on the centre to support his household of four wives and 26 children. If Qalimow is forced to close completely, which is increasingly likely at the end of December, he says they will be exposed to health risks that they cannot manage on their own.

In the first eight months of 2025, 1,416 women delivered in the two health centres – an average of more than five births every day. Another 1,138 children were monitored monthly for nutritional issues.

Zamzam Foundation’s head of health and nutrition, Sugow Mohamed, said the crisis in Qalimow and Gololey is the worst in a decade. The organisation is trying to secure new funding but pledges from potential donors give no guarantee of reopening the centres.

Across southern Somalia, eight hospitals, 40 health centres and 300 nutrition treatment sites have closed this year so far, due to shrinking international aid.

Meanwhile, elders and women in the affected communities say they have raised their concerns with aid agencies and Hirshabelle authorities but have received no response.

[Note: this is a reissued report that has been corrected to reflect that Gololey health centre is closed, whilst Qalimow remains open only with staff working as unpaid volunteers for time being.]

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Two brothers, Ali Isaaq Ali, 40, and Mohamed Isaaq Ali, 35, both suffering from mental illnesses, are in the care of their 70-year-old mother, Adey Sagar Samow, who can’t cope.

Ali has been confined in an isolated shelter, separated from his mother and brother, after repeated violent outbursts that endangered their lives.

“The reason he’s locked up is that he tries to kill me. He can’t stand to see me or his brother. One night he attacked us, thinking his brother was someone else. If God hadn’t protected me, I’d be dead by now,” Adey told Radio Ergo’s local reporter.

Ali has never received any medical attention and his mother, who says she has no money for medical treatment, is too frail to manage him at home. She decided the only option was to isolate him, leaving him tied up under a crude shelter that provides little protection for the weather.

She wishes her sons could recover, she says, but the lack of support has left her in deep sorrow.

Before falling ill, Ali supported his wife, three children, and his elderly mother working as a porter with his handcart. However, his wife left out of fear after his mental condition worsened nine years ago.

Since then, he has been mostly left tied to a tree.

Mohamed, his younger brother, stays mostly indoors, chewing scraps of leftover khat that he collects from the market.

He, too, has never received treatment. He was once a hardworking man who earned a living transporting firewood, but after falling ill seven years ago, his wife left him with their two children.

Their mother’s hardship deepened after both sons became ill. The family depends on UN World Food Programme food rations known locally as bamba chakula, currently 24 kilos of rice, four kilos of maize, and eight litres of oil, that are distributed every two months in the camps.

Adey says the supplies last only two weeks, forcing her to beg for food from neighbours.

“We used to live on the food rations, but they’ve reduced it and giving us the cash. Now I go to the market and beg. Someone gives me 20 shillings, another 50. What else can I do? I’m old and can’t fetch firewood. I live only by God’s mercy.”

Adey’s family fled Basra village in Salagle district, Middle Juba, in 2011 after severe drought destroyed their 10-hectare farm and livelihood.

Meanwhile, 22-year-old Isse Abdullahi Abdi wanders barefoot and shirtless around Hagadera market, visibly weak from exhaustion and malnutrition.

His father, Abdullahi Abdi Hussein, says he took Isse to the mental health unit at Hagadera hospital, but the medication provided brought no improvement. He believes his son’s illness worsened due to neglect after his mother left when he was still young.

“The kids harass him. I work all day and return home in the evening. If I lock him inside, he won’t have food. Kids break the lock, and he ends up walking around naked while they mock him. That’s how he lives,” Abdullahi said.

Isse only comes home at night to sleep.

“He loved his mother deeply. Even when we were together, he trusted her more than anyone. When we separated, he began to change. Now he calls her name every night, saying ‘mother, mother.’ Even when I bring him food, he refuses it and says, give it to my mother.”

Abdullahi earns about 10,000 Kenyan shillings ($77) a month transporting water in the camp using a donkey cart. He brought the family to Dadaab from Kismayo in 2011 due to insecurity in Somalia and his son’s worsening condition.

According to Dr Hassan Aafi Malim, a general practitioner at Hagadera Hospital and private Aafi Clinic, mental illnesses among youth have risen in the camps over the past three years. He links the rise to poverty and widespread drug abuse.

He estimates that there are at least 500 people with serious disorders in need of help.

“Many people, men and women, use drugs such as hashish and khat. When used for a long time, they seriously damage the brain. The most harmful one we’re seeing now is khat,” he said.

Dr Hassan added that stigma and harsh treatment including being chained up and isolated worsened the conditions of those already with mental illness.

Mental health facilities in Dadaab provide outpatient services only and there are no facilities to handle in-patient care.

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(ERGO) – The closure due to funding cuts of 11 health centres in Baidoa have left hundreds of displaced and impoverished Somali families unable to access free health care.

Awliyo Warsame Mohamed, 38, expressed her despair over the closure of the health centre in Qaydar-cadde camp, where she and her son had been receiving free medical care three times a week. The facility provided essential medicines, nutritional supplements and biscuits, and maternity services for pregnant women, and child vaccinations.

“Since this centre was closed, we have suffered greatly from the loss of medicines and the Plumpy’nut given to children. Even the biscuits were a lifeline, and we struggled without them. One of my children developed an ear infection with constant discharge and severe pain, but I couldn’t get the treatment he needed. It’s been very difficult,” she said.

Awliyo, a mother of seven, said for two years they had relied on the clinic for their healthcare, but now she has no option but to walk five kilometres into Baidoa town to seek medicine on credit from pharmacies. She has already accumulated $20 in debt trying to treat her children, and worries constantly about their health and survival.

“The burden I feel is immense. The medicine has run out and even simple injections are unavailable. I cannot afford a tuk-tuk ride, so I walk into town. Sometimes, I stand outside the closed health centre until midday prayers, still hoping for help,” she explained.

Awliyo said she is the family’s sole breadwinner, as her elderly husband is too weak to work. She earns less than a dollar on the days she finds casual jobs, barely enough to buy one inadequate meal for the household.

None of her children are in school due to the family’s financial struggles. They were displaced in 2023 from Ruwey-gadud, 30 kilometres from Baidoa, after drought wiped out their small herd of livestock.

Another mother, Marin Abdullahi Madker, 43, with 10 children, also relied heavily on the Qaydar-cadde clinic. She and her two-year-old son used to receive weekly treatment and nutritional support there. The closure in February came as she was still recovering from postnatal complications after giving birth. Her son was also malnourished and had been receiving Plumpy’nut and other supplements at the clinic.

“Every morning I still go to the closed health centre, holding onto hope that it will reopen. It was vital for us. We could get everything there without having to travel far for healthcare,” Marin said.

She added that her family was now in a desperate situation, depending on cooked food shared by neighbours, which was rarely enough for everyone.

At times, the children go to bed hungry when no food is available. The family fetches water from a well 30 minutes away, carrying it home on their backs. A single jerrycan costs 1,000 Somali shillings.

“There are no free wells anymore. If you don’t have money, your jerrycan will not be filled. Even paying 3,000 or 4,000 shillings is sometimes not enough – they demand more. Without cash, you get nothing,” she said.

Marin’s family was displaced in 2023 from Busley in Bay region, after drought destroyed their five-hectare farm.

The health centres had been managed by the local Deeg-roor Medical Organisation (DMO), which reported a sharp decline in funding from agencies including USAID and UNHCR.

Dr Mustaf Hassan Mohamed, from DMO’s management team, said the financial shortfalls set in in February, leading to the complete closure of 11 centres. Seven other centres run by DMO remained operational under severely limited conditions.

He explained that the few remaining staff were working voluntarily. Many staff had been laid off and there were acute shortages of staff and supplies. The centres, once supported by agencies such as Health International, were located in Baidoa town, in displacement camps, and in villages including Awdinle, Goof Gadud and Burey.

“The worst impact has fallen on the people who depended on these facilities as their only source of healthcare. Many young staff were also dismissed when donors announced they could no longer sustain funding. Out of 18 centres we once operated- some fixed, some mobile – only six are still functioning.

The outlook is bleak if urgent support is not secured, because we cannot meet the needs without resources,” he warned.

He cautioned that other remaining facilities in Awdinle, Goof Gadud, and Burey were also at risk of imminent complete closure.

For thousands of displaced and poor families, the free health centres were lifelines. Their restoration would offer critical relief and ease the daily hardships of communities already struggling with displacement, hunger, and poverty.

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The conflict led to the closure of 26 health centres that were supported by organisations including Save the Children and had been providing free medical care. Their closure in July has left displaced families with no access to treatment.

Halima Abdulle Jimale fled the conflict to Bukuri village with her elderly mother, aged 100. Her mother suffers from diabetes and high blood pressure and can no longer receive the regular check-ups and medication she depended on.

“She is very sick, and we do not sleep at night. All the medical equipment I was using to monitor her condition was left behind. I can’t afford to buy medicine. We are new here, and there isn’t even a single pill available. We desperately need a health centre,” Halima told Radio Ergo’s local reporter.

Her family’s ordeal deepened when her brother, a member of the local Macawiisley militia and the main provider for their family, was killed in clashes with Al-Shabaab on 27 July.

A day after his death, the family abandoned their 40 livestock because of mounting insecurity and fled.

Now Halima is responsible for 10 children including her late brother’s children and his wife. They survive on scraps of food shared by neighbours. She says she cannot even afford one dollar to buy the milk her mother relies on.

They reached Bukuri, 68 kilometres from Mahas, with help from relatives. After their vehicle broke down in Ali-Ganeey village, they were stranded for three days before another car gave them a lift. Now they face homelessness and hunger, surviving on food shared by neighbours.

“Our house had a big tree for shade, a stone room, and a toilet. Now Al-Shabaab are occupying it, and we cannot go back. We left behind everything we owned. We fled with nothing,” she said.

The family is currently living in a makeshift hut offered to them by relatives, who themselves have little.

Shuriye Mahamed Dhalin, an 80-year-old father of 15, also lost everything. He had relied on farming and 45 goats, but his family abandoned both when they fled on 21 July.

He noted that four of his children had been sick for two weeks but he cannot easily access or afford treatment. The nearest functioning health centre is in Beledweyne, 31 kilometres away.

“My children are ill with colds, rashes, and some even have measles. I am also unwell, suffering chest pains, cold, and injuries from a fall. Yet I haven’t received even a single pill. There is no healthcare here,” he said.

Shuriye, now in Ilanle village in Beledweyne, said his family had relied on free health services in Mahas for two years.

He worries that hunger will push his children into malnutrition. The family cooks once a day if relatives in Mogadishu send money. Otherwise, they go without food.

“We live on one-dollar handouts, sometimes getting help, sometimes not. We have no food, no shelter, no medicine. We spend the day under a shack built by others and sleep there at night. We don’t even have blankets to protect us from the cold.”

This elderly man said he had looked for casual work without success. His wives have also tried to get cleaning jobs, but none are available.

Five of his children have dropped out of school since the displacement. They had been attending free primary and middle school at home, but now the family cannot afford fees.

Mahas health coordinator, Mohamed Farah Sabriye, said pregnant women and new mothers were among the most affected, unable to access hospital care or transport.

“The health impact of this displacement is massive. People who once had free services now cannot even get a paracetamol tablet. Pregnant women have given birth on the move without receiving any care,” Mohamed stated.

He said they had informed the Somali government and Hirshabelle administration, but no action had been taken.

According to the Somali Disaster Management Agency (SODMA) and Hirshabelle authorities, 26,000 families have been displaced in Hiran in the past four months, facing severe humanitarian conditions.

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The nearest facility is in Afgoye, about 20 kilometres away from her place in Muuri village, and she doesn’t have anyone to take her there or to look after her other children, nor does she have money for transport. She’s seen many other poor, displaced women in her area faced with similar anxieties.

“Should I give birth in Mogadishu, or will I travel? What should I do? These thoughts haunt me constantly. Financial hardship prevents me from going anywhere. I can’t afford the transportation costs and I can’t abandon my children,” she said.

She is still grieving for her 18-month-old daughter who died in June 2024 from an undiagnosed illness. Mumino noticed rashes and a high fever but couldn’t access any medical help for the child.

Mumino has high blood pressure but has been unable to obtain her prescribed medication as it’s not available at the village’s single pharmacy. She has been taking garlic, hearing that it might help.

She hasn’t had any check-ups during her whole pregnancy and doesn’t know if she and her unborn baby are well.

“I have gone through so much hardship, I haven’t received any of the vaccinations pregnant women need. I heard from people that you eat garlic to feel better so I just eat that garlic, hoping it will help,” she said.

Her husband was killed in late December 2023 during fighting between government forces and Al-Shabaab militants. He died whilst he was working on their five-hectare farm in Bariire, about 20 kilometres west of Muuri.

Mumino has been struggling alone to provide for herself and her eight children selling vegetables that she spreads out on a sack on the ground in the local market.

“I am the only one working for the family now, there is no one else. I sell whatever vegetables I can find in the market. Sometimes we get something, sometimes we go without. During the day we might have one meal. If we find food at night we eat. If not, we sleep hungry,” she told Radio Ergo.

“This should be my time to rest, but I have no choice other than to keep working to feed my children, doing jobs I’ve never done before.”

The family fled to Muuri in early 2024 after being displaced by conflict and drought from their home in Dhanane, Lower Shabelle region.

The poor road to Muuri becomes impassable at dusk, cutting off any chance of emergency medical help after dark. Women and children are particularly vulnerable.

Muuri resident, Mahmud Hassan Ali has been tending to his two-year-old son in the shade of a tree outside their hut. The boy has been sick since April 2024 with high fevers, rashes and extreme weakness.

“The fever lasts for days and nights without stopping,” Mahmud described. “My son has become so weak he can’t even cough properly. Rashes cover his body.”

Mahmud tried selling his two goats at the market to raise money for medical treatment, but couldn’t find buyers because the animals were too emaciated.

His farming income has dwindled to just $1-2 per day due to poor seasonal rains, so there isn’t enough food.

“My son’s condition worsens daily,” Mahmud said. “The biggest problem is we have no health facility here at all.”

A surgeon at Banadir Mother and Child Hospital in Mogadishu, Dr Abdiasis Ismail, hearing the symptoms described by Muuri residents, suspected the children might have measles or chickenpox.

Muuri village chairman, Aynashe Abdullahi, said that at least 20 women had died in childbirth since January 2024, as well as 10 children from undiagnosed illnesses.

The village’s single well cannot meet demand, forcing residents to pay 5,000 Somali shillings per jerrycan or walk to collect unsafe water from the Shabelle River six kilometres away.

Some 900 families arrived in Muuri in mid-June 2024, after fleeing nearby conflicts. This has overwhelmed the villages already scarce resources.

Education has collapsed since Al-Shabaab burned the local school. Children now try to study outdoors without books, pens or shelter from sun and rain.

“We have begged the South West State administration and humanitarian organisations for a health centre. Our people are suffering terribly. They need help immediately,” the village chairmn appealed.

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The centres in Jana-Abdalle, Bahdadhe, and Raskamboni in Lower Juba and Dollow in Gedo region are providing free outpatient services, vaccinations, maternal care, and general treatment to communities in these districts, as well as in other parts of the regions through mobile clinics.

A mobile clinic run to Badhadhe enabled Aisha Farah Muse, 60, to get back to herding her livestock after being off work due to a leg injury.

“It turns out it wasn’t a broken bone but a detached muscle. My knee moved out of place, shifting towards the ankle. The doctors fixed my leg, put the knee back in place, and applied a cast and bandage,” she said.

Aisha couldn’t afford to go to Kismayo for medical attention. She has 10 children to feed and since drought killed their 300 cows and 200 goats three years ago, she has struggled desperately to recover her livelihood.

“We have no money, we don’t have any income to tell you about now. We people are pastoralists, and livestock has no market. If we don’t find anything, we just sleep hungry at night,” she stated.

Maryan Abdi Budul, 45, took her children to the health centre opened in April in Jana Abdalle for free medical services including treatment and vaccinations for her five children.

Maryan was treated for malaria and a bladder infection. Her children got their first measles, polio and diphtheria vaccinations.

After a month of medication, she said she felt much better.

“I was told I had malaria and an infection. I was given a series of 10 injections and I took all the medicine prescribed,” she said. “I couldn’t control my urine and it was terrible losing that control.”

Being able to access free treatment and vaccines was important for Maryan. Travelling the 60 kilometres to Kismayo would have cost at least $100.

“We faced great difficulties getting treatment. You have to be hosted in a hotel or finding people who know you, relatives or your own children, to help you. Only after that can you go to a doctor. We are very relieved to have this centre,” she told Radio Ergo.

Maryan struggles with food insecurity, as her five-hectare farm has remained uncultivated since 2023 following severe flooding. She owes $400 to shops where a relative guarantees her credit as traders distrust her due to her lack of income.

The Jubbaland health ministry conducted needs assessments early last year, identifying areas like Jana Abdalle as suffering from poor roads and shortage or absence of medical facilities and resources.

The new five-room centre in Jana Abdalle employs nine staff including doctors and nurses.

The programme has been implemented by Jubbaland Ministry of Health, Vision Corps Initiative (VCI) and Core Group Partners Project, with funding from the Bill and Melinda Gates Foundation.

VCI officer Mohamed Ahmed Nur said the health centres operated 24 hours a day with trained nurses. They provided maternal health services, outpatient services, and administered all vaccinations on the ministry’s schedule.

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The price of a barrel of fresh water soared to $5 from $1.50 in April, when the town’s only borehole system broke down – solar panels, pumps, and pipes failed and haven’t been repaired.

Nadifo Osman Yusuf ’s family of 15 are forced to drink salty water. She and her two daughters manage to collect 40 litres a day from a hand-dug well a long walk away near the coast.

“The whole town is thirsty – we can’t find drinking water. We are suffering a lot. Walking to the well takes us an hour and the water we fetch causes problems because it is not clean. Our shoulders and backs hurt and it takes us three hours waiting at the well to get this water,” Nadifo complained.

Water tankers supplying fresh water to the town do not offer credit. She has no cash to buy it for her young children and elderly mother.

Earlier in June, two of her children were hospitalised with stomach pain, diarrhoea, and vomiting. Doctors said the illnesses were caused by the poor quality of the water.

“The children are coughing and have diarrhoea from the contaminated water we got from the well. I carried one of the children in serious condition on my back to the hospital as we had no transport. He was treated with pills, ORS, and injections. I stayed with him for seven days in the hospital and now he is better,” she explained.

Nadifo earns a paltry income from odd laundry jobs in town. For the past two months, she has not been able to give her children even one daily meal consistently.

Banderbeyla’s economy is at a low ebb, with the impact of prolonged drought and the current stormy ocean conditions that limit fishing activities and shrink livelihoods.

Nadifo had been relying on cleaning jobs earning $3 to $5 a day, but now she is lucky to make even two dollars. The shop where she used to buy on credit cut off her account when her debt reached $350. Her family now survives on small aid sent occasionally by relatives in Bossaso.

“This year is the worst. The children are crying from hunger; there is no work. Poverty came because of the sea – there is no daily income from fishing now. And I am a mother who stays at home – I have no assets. I cook what I beg from kind people,” Nadifo said.

Five of her children have stopped school because she cannot cover the $50 monthly fees for regular and Koranic classes. Her family has lived off fishing for many years. Her husband, a fisherman, is unable to earn a living after sustaining a back injury last year.

A local grandmother, Sahra Hanaf Kulan, is raising five children alone. She knows the water she fetches is unsafe for drinking, but she had nothing else to offer the children. She can’t even access firewood or charcoal to boil it.

“The water is far from where I live, and we have to carry it on our backs. I buy a 20-litre jerrycan but sometimes I can’t carry the water because I am sick. I think it might be tuberculosis; I got it from carrying heavy loads of water on my back. My lower ribs hurt from carrying jerrycans, and the children are hungry and crying. There is no government helping us. No one is helping us,” Sahra said.

For the past week, she hasn’t once lit a fire to cook a meal. She can’t take on manual work and has no one else to assist her. Her only son died suddenly last December, leaving her to care for his five children. The children’s unmet needs cause her to cry often.

The last aid she received was a month ago when charitable individuals gave her a few kilograms of millet that lasted a week.

“What can I cook if I don’t have anything to use? Should I cook sand?” she exclaimed. “Neighbours sometimes share cooked food with us. Adults don’t eat; the children go to sleep hungry and cry a lot. We haven’t received anything in a while. I am asking for something for my children to eat.”

The children are not in school and they have no relatives in the area to turn to for help.

“Their father used to go out to fish when the sea was good, earning a daily income. He bought flour, rice, sugar, oil, dates, and pasta. Their father used to work but now he is dead and no one is working for the children now,” she said.

A local doctor warned radio listeners that drinking salty water could cause watery diarrhoea, typhoid and other health risks. Boiling may kill bacteria, viruses and worms, but did not remove salt and other harmful dissolved solids.

Local officials in Banderbeyla say complaints have been sent to the Puntland administration and the company that built the borehole system, but so far they haven’t had any response.

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Maryan heads the Malable Mother and Child Health Centre in Wanleweyn, Lower Shabelle region, that is managed by New Ways Organisation (NWO) and provides free services to approximately 800 women and children every month from various parts of Lower Shabelle region.

In May, NWO recognised Maryan Best Midwife among hundreds of others they evaluated, awarding her this accolade for her success in raising community awareness and for connecting hundreds of women to health centres.

Maryan focuses on helping women understand the importance of receiving medical care throughout their pregnancy until delivery. She regularly visits neighbourhoods and rural areas to spread awareness. She has handled cases where women suffered severe complications attended by untrained traditional midwives.

She recalled one of the most memorable emergencies she with:

“The most painful incident I encountered a few years ago was a woman brought from a place 15 kilometres from Walanweyn town, who had been in labour for seven days. Unfortunately, her baby died in the womb. We put her in a car, and when they reached the hospital in Mogadishu, they were sent back because they couldn’t afford the service.

I then made a difficult decision. I didn’t have any midwifery equipment but I took a razor blade confident in my experience and God. I delivered the dead baby from the womb, and then for 15 days I continuously treated the mother until she fully recovered.”

Maryan has trained 60 women in professional midwifery over the past five years. They visit in groups all districts of Lower Shabelle region and rural areas, educating people on the importance of maternal and child health and the risks of women not receiving adequate medical assistance.

This effort has encouraged many mothers to seek maternal health care at medical centres, as well as reducing the incidence of female genital mutilation (FGM).

“The numbers of FGM cases have changed, it is way down from the previous hundred per cent. A lot has changed and people have understood the problems with FGM, like difficulties with menstruation, marriage and labour. Our messages have been accepted,” she stated.

Data collection by NWO in Wanlaweyn and surrounding areas has indicated a decline in FGM in the town. This is attributed to the tireless advocacy of Maryan and her teams.

Maryan joined the Civil Nursing School in Mogadishu in 1987 and started working after graduating in health centres in 1990, just as the civil war was beginning.

Her work includes advising women on breastfeeding, child nutrition and appropriate diets. These efforts are strongly supported by the women she has trained.

“If a child is breastfed for two years, they develop strong immunity against diseases. Also, their brain development is good, improving their future education” she tells the community.

Maryan and the women she has trained are well known throughout the region. They are sought after in health centres, as they have the full trust of the community.

One of her trainees, Deqa Mohamed Ali, 27, has been working for one year at Dayura Clinic in Wanlaweyn as a midwife.

“Among the tasks I currently perform is providing important weekly awareness sessions to pregnant mothers. I encourage them to take essential vaccinations for their health and their children’s. Also, we remind them to vaccinate the baby immediately after birth,” said Deqa.

She has helped many mothers deliver safely, voluntarily supervising at difficult labours and emergencies including in homes.

Deqa leads a team of 15 women trained by Maryan, who regularly visit villages to conduct awareness campaigns.

“We sit under a tree while local women gather. There, we conduct awareness about the importance of child vaccination and the dangers of FGM.”

Deqa’s $200 monthly salary has helped her supplements her husband’s income as a driver so they both support their family of seven children.

Deqa says she wants to further develop her skills and aspires to reach the level of her role model – Maryan.

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