Nativity on a knife-edge: the struggle for survival in Somalia – in pictures

A young boy is measured to see if he is malnourished at a health centre near the Salama camp for displaced people, near Galkayo. Malnutrition is an underlying cause of a large percentage of deaths among children under the age of five in Somalia. Basic medical services are free to access here, but many cannot afford the transport to travel to them

For newborns in Somalia, many of whom are delivered in dusty, makeshift shelters without the assistance of a midwife or doctor, the risk of infection is high. With drought and conflict driving many women from their homes, one child in every 26 dies within 28 days of birth – many on the same day

All photographs: Kate Holt/Unicef

When Ubah Abdullahi went into labour she knew there was no chance of seeing a midwife or doctor. After a gruelling 12 hours her baby daughter arrived, delivered on to the floor of a makeshift shelter. Her family was among thousands driven from their homes by drought and conflict in central Somalia last year. Now living at the Najah camp for displaced people near Galkayo, Abdullahi did not have the money to travel to a health centre. ‘I couldn’t afford to take a taxi to the clinic but my mother-in-law was here to help,’ she said. Abdullahi is not alone. In Somalia seven out of 10 women give birth at home and babies born in basic shelters are at risk from infection and other complications

The sun sets over the Najah camp, where the majority of inhabitants are women and children. Babies born here are at grave risk due to infections and the lack of access to professional healthcare should complications occur. In Somalia the neonatal mortality rate – the death rate for babies under 28 days old – is the fourth highest in the world. One of every 26 babies dies within four weeks, many on the day they were born. Unicef’s health chief in Somalia, Samson Agbo, said many newborns could be saved if mothers could access proper medical care.

Women wait with their children outside a temporary community centre in the cooler evenings at the Najah camp. The effects of drought are still being felt throughout Somalia, which has forced thousands of people who were pastoralists to seek food and shelter around towns. A Unicef report found eight of the 10 most dangerous places to be born are in sub-Saharan Africa, where pregnant women are much less likely to receive assistance

Sahra Abdi holds a pan containing the rice she has to feed her five children. She arrived in the Najah camp at the start of February. Her four-year-old daughter died on the journey. Her husband has been suffering from mental health problems since all the family’s goats and sheep were wiped out by drought. He is being cared for by his mother in Galkayo town and Abdi is left at the camp to care for their children. Food shortages in such settlements mean many of the mothers are malnourished and commonly give birth to babies prematurely. In Somalia, where women have six or seven children on average, there is also a high adolescent fertility rate

Baby Farhia is cradled by an aunt in the maternity ward of Mudug teaching hospital in Galkayo. Her mother, Fadumo Abdullahi, had been forced to have a caesarean because she was suffering from pre-eclampsia. The condition was picked up on an antenatal visit, yet across Somalia many pregnant women do not have access to healthcare during their pregnancies, so complications are not identified early, leading to more serious health problems

Mariam Abdullahi comforts her newborn baby in the maternity ward of Mudug teaching hospital. Across Somalia, only 28% of babies were born in hospitals or clinics in 2017. Abdullahi said: ‘During a visit to the doctor before giving birth they told me the baby was large and I knew I would have care in a hospital’

A community elder prays next to the graves of two babies who died recently at the Najah camp. Local midwife Rahma Mohamed said that more support is needed for health services for expectant mothers. She works at the Salama mother and child health centre. ‘I think more women would come here if they realised it was free and if they had transport,’ she said. ‘We also need support to stay open 24 hours. And we have to do more to persuade women who still prefer to deliver under a tree or use traditional medicine’

By: Hannah Summers and Kate Holt

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