1

Somalias Situational Environmental Health Assessment of Three Zones

Somaliland, Punt land and South Central-Mogadishu
Prepared for: WHO Office for Somalia
Project Period: From June 21
st
September 20
th
, 2010
Prepared by:
This report covers some areas only and does represent the whole profile of Somalia, though it reflects
strong similarities of the overall environmental health of the country. The areas covered include some of
the main urban cities, some rural areas and nomadic communities as well.
This report was prepared by the following members, with contributions from the local administration,
from the staff of WHO Somalia, local NGOs and, in many instances, by the common men and on the
streets.
Somaliland:
Dr. Ali Sheikh Omar Kabil Head of MOH/L Environmental Health (Public Health) Unit
Mr. Mahamoud Barre Deria Sanaag Regional Sanitation officer
Dr. Ali Ibrahim Bahar Project Team Leader and Coordinator
Puntland
Ahmed Abdihakim Ahmed Environmental and sanitation officer Mudug Region
Abdukadir Mohamed Burburshe Enviromental and sanitation officer Barri Region
South Central (Mogadishu):
Essa Haji Yusuf Head of Staff Sophpa
Ali Hussein Yusuf Communicable diseases officer
Ahmed Mohamed Mohamoud Treasure of Sophpa
Mohamed Abdilahi Mohamoud Sanitation officer
Comments and suggestions may be forwarded to
abahar57@gmail.com
2

Acknowledgements
The participants of this project acknowledge importance of this mission and thank the WHO-Somalia
Operation Office for financing this project, and providing all the needed technical support to facilitate
the sanitarians do their assignments. Undertaking this situation analysis and needs assessment for
environmental health in all zones in Somalia was a small window in assessing the situation up closely. I
am particularly grateful for all the support that WHO-Somaliland office in Hargeisa provided us during
our workshop. The inception workshop would not have been possible without the interest, technical,
logistical and resourceful support of the workshop coordinators in Hargeisa, Mr. Abdi Hassan Duale
(Abdi Gurey) and Asia Osman, WHO Hargeisa. Especial thanks to all WHO representatives in Puntland
and South Central (Mogadishu) for their guidance and technical support. Dr. Abdirahman Jama Hadi,
representative of WHO in Awdal region, provided all the necessary means for me to travel in around the
city of Borama to meet people and to visit sites of interest to the project. I thank him for his unwavering
attention.
I also wish to gratefully acknowledge the many individuals from many institutions and local government
offices, City Mayors, University staff, medical doctors and public health officials, business people and
local NGOs and others, who availed us their time to provide needed information and documents of
reference to accommodate our work. I also thank all the sanitarians who have done a tremendous and,
in some instances risky work to help this project.
Finally, a very special thank to Mr. Abdi Hassan Daule (Abdi Gurey) of WHO Hargeisa Office for his
relentless effort to see to it that I found whoever I needed to talk to and went where I needed to go
throughout the time I was working in this project. He even kept a constant contact with me as I traveled
alone to remote places for gathering information I needed for the completion of the project. Mr. Duale
made himself available to help me with all that at his disposal to make sure that I was comfortable and
taken care of well during my stay in Somaliland. I would like to express my sincere appreciation for his
help.








3

The number of International and Local UN/NGOs who were consulted: ANNEX -A
Authorities consulted: ANNEX-B
SOMALILAND (Excess): Annex-C
The Somaliland Consumer protection Agency (SCPA): Annex-D
Laboratory Support: Annex-E
Hargeisa Group Hospital: Annex-F
Table of Contents
Acronyms ....................................................................................................................4
Exective Summary ......................................................................................................5
Background ...............................................................................................................11
Zonal Situational Analysis:Somaliland...................................................................25
Need fo National Environment Health Laboratories .............................................81
Conclusions ...............................................................................................................85
Recommendations .....................................................................................................86
Puntland Situational Analysis ..................................................................................87
Conclusions............................................................................................................ 107
Recommendations ................................................................................................. 108
South Central Situational Analysis ...................................................................... 108
Recommendations ................................................................................................. 118
Annex-A ................................................................ 1Error! Bookmark not defined.
Annex-B ................................................................................................................. 119
Annex-C ................................................................................................................. 125
Annex-D ................................................................................................................. 126
Annex-E ................................................................................................................. 128
Annex-F ................................................................................................................. 129
References .............................................................................................................. 136
4

Acronyms

EPI Expanded Programme on Immunization
HBV Hepatitis B Virus
HCV Hepatitis C Virus
HCW Health-care waste
HCWM Health-care waste management
HIV Human immunodeficiency virus
ITCZ Tropical Convergence Zone
DDT tri-Chlorinated Hydrocarbon (pesticide)
PPP Private/Public/Partnership
NGO Non-profit-Organization
MCHs Mother/child/health services
EHA Environmental Health Assessment










5

EXECTIVE SUMMARY
1. SOMALIA: CURRENT STATE OF THE ENVIRONMENTAL
HEALTH
The traditional approach to environmental problems has been reactive. That is, the problem becomes
apparent: wildlife or people sicken and die, or drinking water or air tastes foul. Then researchers seek
the cause of the problem, and regulators seek to eliminate or reduce that cause
1
.
After more than 20 years of generalized conflict and violence in some areas, particularly the South
Central Zone, the destruction of all infrastructures in all zones, and the inabilities of the existing
governments to meet the basic needs of the public, Somalia is experiencing the worst environment
abuses ever, and consequently the environmental health has been in deep crisis. The tragedy in this part
of the world is that those above quoted traditional environmental approaches and precautionary
principles have been at the bare minimum at best, or have totally been nonexistent. Both the
environmental status and public health situations in all Somali populated regions have suffered a great
deal of disproportional tragic consequence as the result of total neglect, particularly the environment
and critical natural resources. The environment has been neglected and greatly damaged because of the
absence of strong government, lack of monitoring systems or effective regulations, lack of education on
part of the public and, above all, the presence of selfish and opportunistic groups of organizations or
individuals who are exploiting the fragile environment and taking advantage of the current situation in
the country.
1.1 Solid and Liquid Waste Management
While there are some important progresses have been made on the environmental initiatives of waste
nothing strategy by the developed countries, solid waste, just like many developing countries, is a
major problem in almost everywhere you look in Somalia, no matter what city or town you are in.
Empty, clear plastic bags, mixed domestic waste and trash bags filled with human feces and food
products are hanging from trees or scattered around all buildings. Urine-filled plastic bottles, chemical
waste from cars oil change as well as oil spill from gas stations and abandoned vehicles are desecrated
on the streets. Definitely, the amount of waste and piles of garbage in around the cities is as the result
of an uncontrolled and unmanaged hazardous waste, much of which has contributed to the frequent
6

cholera and diarrhea break- outs that have been on the rise. High-tech trash of electronics and hardware
imported from China and used computers from the U.S and elsewhere are also on the rise. New small
industries, such as soap producing plants, hides and skin processing plants, water filtration plants, food
processing plants and furniture industries have been on the rise. These small industries are contributing
to rising waste of both solid and chemical waste. The public is exposed to these hazardous materials on
daily bases through air, food, water, and consumer products. Hospital waste, including biological waste
and vaccination- syringes, unused medicines and injection vials, some even containing contents of
chemicals, are scattered around the hospital buildings with no proper planning and waste management
or protection of the public from these biohazard wastes. Blood, animal body parts and waste from the
slaughterhouses are floating on dry rivers or constantly being dumped on temporary ditches around the
cities, where both human and animal scavengers are searching for through, side by side. The eye cannot
escape the sight of pillars of fumes and dark smoke, from open incineration of solid waste, hovering
over all cities and villages, while the smell of organic waste in the air is excruciating to the newcomers
nose. Though it is a common knowledge that all anthropocentric activities, if not controlled, have the
potential to render harm to humans and the environment, unfortunately no one claims responsibilities
for the apparent hazardous materials in the environment. Little, if any, of an efficient and effective
hazardous waste management strategy has been put in place in urban cities, where most waste is
generated. Though no one seems to think that protecting the environment is not important, different
groups have different explanations for what is taking place, or may even have different ideas of what
environmental responsibility means. The public may want to have clean water, clean air or safe food,
but feel that the local government should be doing something about the problem. To the tree cutters
and charcoal producers, it is about survival and feeding his family. And for the business people, Qat
retailers, small industries and plastic bag producers, dumping waste in to the streets or even rivers may
make sense, for alternative ways of disposing of waste are likely to cost them more and diminish profit.
And finally to the local governments (if there is one), their claim is mainly about not having enough
funds to manage solid waste.
The existing environmental situation results, not only a public health concerns, but also destruction of
biodiversity, environmental contamination and loss of beeches and coral reefs. There is no significant
environmental research being conducted to assess the ecological consequences and human health in
this region for the past twenty years. The areas of risk assessment and risk management, which is critical
to understanding who is at risk or where is at risk, has not been incorporated into the educational
7

systems in the country. There are no effective environmental health institutions which are equipped
well to educate the public about the environmental threats and risks. There are no environmental
health labs that are equipped with the necessary tools to carryout critical environmental sampling and
analysis in order to set standards for food contaminants, air pollutants and water exposures. When an
activity raises threat [of harm] to human health or the environment, precautionary measures should be
taken even if some cause and effect relationships are not fully established scientifically
1
.
1.2 Misappropriation of Land Use: The Tragedy of the Commons.
The tragedy of the commons describes the consequences of using self-interest alone to guide the
exploitation of publically owned resources (air, water, land).
Contrary to John Muirs preservation ethics that believes wilderness mirrors divinity, nourishes
humanity, and vivifies the spirit, anthropocentrism or the human-centered ethics flourishes in todays
Somalia. Misappropriation of land and land grapping is a new phenomenon of real estate use in all
regions, where the land became a commodity of trade or the only major economic tool. One of the
obvious major problems associated with matching economic processes with the present environmental
resources is the way these natural resources are being abused. Market decisions fail to account for the
context of species or the interactions between resource quality and ecosystems function. No land is
preserved for national parks, recreation or even soccer fields for children in the cities to play. If you find
a piece of land, you own it; and that includes mountains, rivers and lakes, historical sites and
monuments. Of course, public properties and natural resources are being taken for personal use without
due process of law and without just compensation in todays Somalia. These illegal practices and
overexploitation of land and natural capital, on which humankind depends for food, security, medicines
and machines, including minerals and mountains as well as both renewable and nonrenewable
resources, could seriously deprive millions of Somalia to have the right to own a piece of land for
farming or for recreation in near future. Deforestation and desertification have been rampant in all
regions, particularly between the rivers in the South, which resulted disappearance of century -old trees.
The total loss of grass from grazing areas is followed by soil erosion in many parts of the country, not to
mention the total absence of animal zoo for wildlife and human interaction. There is no sign of
managing native species life for ecotourism in this biodiverse landscape. The lack of a strong
government in the whole country opened the doors for those who feel they have the right exploit the
natural resources for their own personal gains. A little value is put on the loss of ecosystems due to the
8

lack of education on the part of the decision makers, investors and dividend earners. New Practices of
clear-cutting agricultural methods, use of persistent pesticides and increased use uncontrolled fertilizers
by poorly managed farming communities could endanger wild-life habitat or cause migration and death,
which will greatly reduce biodiversity and genetic variation in these regions. Proper use and better
management of ecological process require understanding the difference in time frame of markets and
ecosystems. The time frame for market decisions is short, while many ecosystem processes take place
over tens of thousands and even millions of years. Focusing only on the economic value of resources
while ignoring environmental health may mask serious changes in environmental quality or functions.
There is a need for an effective public education on the importance of the ecological systems, human
interactions with environment, a need for a strong and viable government, and a need for strong and
sustainable global support of significant dialogue addressing the current environmental problems in the
country. Protecting the planets genetic wealth made sense morally and economically. It was
considered, rightly enough, what decent, civilized people should do.
3

Scientists have long argued that human actions have affected the environment; and Somalia is no
different. Human actions, anthropocentrism, have proven to be the chief cause of extinctions of large
animals. Many species and wild-life animals have either migrated, have become extinct or are in great
danger in todays Somalia. Though extinction is natural phenomena that involves a normally spread out
process of over time replacement, with the formation of new species, todays Somalia is experiencing a
great loss of habitat due to an accelerated human activities. A great loss of wild-life is due to rampant
human activities of deforestation in many parts of the country, alteration of the habitat for farming and
settlement, or cutting down trees in order to produce charcoal either for trade, economic benefits or
personal consumption. Such an impact exploitation of ecosystems led to a loss of Somalias wild-life and
extinction of many once kaleidoscopic birds and precious wild animals that once lived in a fertile
environment with rich biodiversity. Deforestation followed by desertification, erosion and soil
salinization are evident everywhere. These uncontrolled human actions have been the chief cause of
extinctions of many birds and large animals. Science has proven that when large the animals, such as
lions, elephants, cheetahs and horses, went extinct, the ecosystems in which they lived were affected.
Large herbivores were found responsible for distributing the seeds of many trees. When the herbivores
vanished, the fruit piled up under the trees and few seeds had the chance to sprout far enough from the
parent tree to thrive. In situations where the trees are being cut in a high rate like in Somalia, the large
trees are disappearing very fast. This is followed by the migration of many famous birds from many parts
9

of the country due to the loss of their habitat, resulting diminishing in numbers or total extinction.
Restoring the ecosystems will require the restoration of large animals that are either facing extinction or
endangerment as these large animals interact and co-evolve with other species and influencing entire
ecosystems. Such efforts of re-wilding in a small-scale have been tried elsewhere and hold the potential
to partially restore important ecological processes
3
of wildlife environment. Wilderness- where the
earth and its community of life are untrammeled by man, where man himself is a visitor who does not
remain.
3

1.3 Marine ecosystems
Marine ecosystems have been significantly influenced by people in virtually all parts of the world. In the
case of the Somali marine ecological status, a much more conscious and better-informed management
of the coastal ecosystems is critical. The Red Sea and Gulf of Aden extend over a distance of some 1700
nautical miles and are on average between 120 and 150 nautical miles wide
2
. This makes it a part of
major world shipping route which carries a good percent of global of global seaborne trade. A very high
percentage of the worlds crude and refined oil cargoes pass through the Red Sea and the Gulf of Aden,
which better explains the piracy business in some areas of the Somali coastal regions. Consequently this
region suffers a significant damage from a constant oil spill which goes uncontrolled and unreported.
Local people in the coastal cities reported oil residues and tar balls often found on the beaches. Several
of the coastal and marine ecosystems which support economically significant activities such as fisheries
are very vulnerable to oil pollution. Oil related damage to mangrove, seagrass beds or coral reefs could
have a serious and long lasting impact on fish stocks
4
. There are also illegal fishing activities taking place
in many parts of the coastal areas due to the absence of strong government or other authorities that
could monitor and protect these oceans. In addition, local reports indicate that illegal commercial
fishing and introduction of new diseases contribute to decline of biodiversity of marine life in the region.
The Somali coral reefs, great natural treasures that the Somalis do not even know, are at great risk of
being washed away completely. Industrial fishing today in Somalia is exclusively carried out by foreign
vessels. The coral reef ecological systems in the area, a habitat for other marine resources, mangroves
and seagrass beds often entangle with the nets used by these illegal vessels and thrown away on the
beach. It has been reported by the local fishermen that Egyptian boats chartered by Ex-President, Dahir
Rayale, of Somaliland had employed destructive fishing methods where they have removed a great
portion of coral reefs ecological systems on the coast of Lughaya, Somaliland, for relocation to Egyptian
coastal areas. Recent overfishing, especially for lobster, threatens the Somali coastal marine life. These
illegal actions combined with port generated pollution, result a great deal of coral reef destruction. In
the absence of efforts to enact truly protective and far-sighted environmental policies, little thought is
being given to future environmental impacts. Large areas in the coastal cities are being covered by
plastic bottles and plastic bags that people are carelessly left behind, blown from city streets by the
wind, or washed by and carried by the run-off water to the ocean front or deep into the ocean, where
the benthic regions of the ocean is used as land-fill. In addition, due to the absence of quality systems
10

for waste management, the public is constantly being exposed to hazardous waste materials, including
volatile organic compounds, some of which are emitted by uncontrolled small industries with an
increasing rate in these areas. The use persistent pesticides, including DDT
5
, on agricultures, on livestock
and for vector control has become very common practice. More serious than their physical presence on
the beach front is the fact that plastics have the capacity to leach out the chemical compounds
associated with their production and the public is not protected. Of course, the waste renders the water
less useful to wildlife or downstream humans and animals that are drinking the water. No one is
studying the health consequences of these daily exposures. Little, if any, epidemiologic studies have
been carried out to find out the toxicity, carcinogenic effects, or the chronic effects of these hazardous
materials on the public. Toxic chemical and solid waste pollution have been ignored or accepted for all
the ill-informed or selfish reasons. At the present, Somalia in general has no effective institutions or
strategy to address waste management in a coherent manner. There is a need for improved efforts to
create environmental policies and strict regulations to effectively get handle of the waste management
to safe our natural resources, including both terrestrial and aquatic ecosystems, which require
sustainability of their carrying capacity. For future generations to benefit from the resources available
for us today, we must follow the tenants of sustainable development.
1.4 Water Scarcity and Unsafe Drinking Water
For most human as well as some commercial and industrial uses in all over the world, the quality of the
water is as important as its quantity. Unfortunately, most Somalis are drinking unclean and
unchlorinated water from shallow boreholes, surface water, springs, rain water catchments of Barkeds
(cement catchments) and Ballis (earth catchments). Increased populations in the cities mean higher
water demands, more drained of aquifers, and consuming and polluting available surface water
resources. In addition, general sanitation of most of the population is very poor. Coupled with
overgrazing, removal of woods for fuels, and higher temperatures due to global warming the country is
facing water shortages. On the other hand, climate conditions such as draught sometimes continue,
particularly in certain areas in Punt land and Somaliland, for more than three consecutive years. Loss of
arable land, increase in farming, drought, degradation in the quality and availability of clean drinking water
and civil/tribal conflict are all partly responsible for spread of diseases. Recurrent drought, limited water
sources, lack of water infrastructure, and environmental degradation has led to a water and food security
crisis in some regions. Droughts have been a normal cycle of pastoral life generally in the country;
however with the rapid destruction of the environment caused by overgrazing and charcoal burning,
pastoralists have lost traditional coping mechanisms. The drought has at times become a humanitarian
crisis because distances between pasture and water have greatly increased as a result of desertification.
Poor and middle wealth-group pastoralists are unable to walk the distance from water points to good
pasture resulting in mass loss of livestock. Of course, there are few areas with adequate amount of
groundwater, with better managed quality system of delivery for the public, such as Boramas SHABA
11

water company, which operates under private/public partnership (PPP) arrangement. However, the
concern over the depletion of the groundwater aquifers and reserves is an issue, as aquifers are being
drained or in some places become saline due to influx of saltwater. A growing awareness of groundwater
as a critical natural resource leads to some basic questions. How much groundwater do we have left?
Estimates of the volume of groundwater are poorly known. Hence, the volume of groundwater in storage,
its quality, and the yield to wells vary greatly across. In addition, groundwater is used locally so the effects
of localized pumping on a given region are primary concern of some hydrogeologists in the country.
2. BACKGROUND
The World Health Organization (WHO) has undertaken this project with the view of carrying out a
situational environmental health assessment in three zones in Somalia: Somaliland, Puntland and South
central (Mogadishu). This project was financed by the World Health Organization with the objective of
collecting data for an environmental health assessment and to provide important and much needed
recommendations. This report gives an account of the main findings and of the situational health
assessment undertaken in Somalia during the period of 21 June through September 20
th
, 2010. It also
identifies generic issues, draws lessons for designing future interventions in Somalia and proposes an
action plan for remedial measures with a view of addressing the environmental issues in these three
zones. Furthermore, this environmental health review was conducted against the background of the
crisis that has plagued the South Central (Mogadishu) for the last 20 years.
2.1 Terms of Reference for Professor Ali Bahar: 4 months assignment
1) Undertake situation analysis and needs assessment for environmental health in all zones in
Somalia;
2) Draft a document, based on situation analysis and needs assessment, in which identified zonal
environmental health priorities can be used for drafting zonal environmental health action
plans;
3) Provide guidance on zonal consensus meetings for zonal environmental health action plans;
4) Formulate specific projects based on zonal environmental health action plans, that can be used
for fund raising ( e.g. CAP, flash appeals or submitted to bilateral donors);
5) Provide guidance on the establishment of zonal public health laboratories (health, water and
food); verify available laboratory equipment; identify missing equipment and supplies for the
proper functioning of PH lab services; and
6) Submit a final report.
2.2 The Physical Environment
4

Somalia, the country, with a total land area of 637,540 Km
2
, occupies the tip of the Horn of
Africa. With the longest coastline in Africa, Somalias coastline of 3,025 km ranges from the
Gulf of Aden in the north to the Indian Ocean in the east and south, respectively with a
12

coastline of 1,000 km and 2,000km. Somalia, the country, stretches close 1,550 km from north
to south between latitudes 12
0
00

N and 1
0
37

S, and 1,09km from west to east between

longitudes 41
0
00

and 51
0
21 E. Somalia is for the most part a flat country, rising in the southern
and central regions to a few hundred meters above sea level near the Ethiopian border. Shimer
Berris in Sanaag region is the countrys highest peak with the height of 2,407 km.
Climate changes are influenced by the Inter Tropical Convergence Zone (ITCZ). Though
elevation is high in some parts of the country, particularly the north, most of Somalia has semi -
arid to arid, and is hot and dry throughout the year, with low and erratic precipitation. With
droughts occurring every 2 to 3 years, followed by heavy and devastating floods, seasonal
changes are the primary determinants for the overall lives of the Somalis, timing and amount of
rainfall as well as adequacy of grazing of a particular season. There are, therefore, four
recognized seasons, two of which are rainy seasons (GU and Deyr) and the other two are dry
seasons (Jiilaal and Hagaa). The Gu rais begin in April and last until June (60% of the total rain).
Hagaa, July-September, is followed by Deyr, October- November, which is followed by Jiilaal
period that begins in December through March. The annual rainfall in the country ranges from
as little as 50 to 500 mm. The mean daily maximum temperatures range from 30
0
C to 40
0
C and
the mean daily minimum temperatures from vary from 20
0
C to more than 30
0
C.

2.3 Land Use and Environmental Degradation
4

Somalias long-lasting civil strife has contributed to the current worsened environmental
conditions. Lack of insecurity and civil strife normally means that environmental issues have
been ignored and neglected, and such is the case here in Somalia. The total breakdown of
legislative controls governing the use and access to natural resources resulted deforestation in
populated areas, overfishing of selective and targeted offshore areas and near shore marine
species along the long coast from Ras Kabon to Zaila and in between. Natural resources and
precious minerals, such as diamond, gold, are being stolen without the knowledge of the public.
Such activities have been reported in the coastal areas and in the Golis ranges near Berbera,
Sheikh and Lughaya in Somaliland. The public has no access to these exclusive sites where
foreigners alone have the complete control of these sites. This further demonstrates how the
environment has been neglected and fell victim to few selfish, both local and international,
individuals. Many of these problems stem from or have laid the basis for the prolonged civil
strife which Somalia, especially the south central, continue to experience.


13

2.3.1 Charcoal: Energy Sources
Charcoal use as source of energy contributes to the continuing inherent environmental degradation in
Somaliland. Charcoal use and its demand for use at the household and community level have reached a
critical point and yet has not been tackled. Trees and forest all the regions are being burnt down
continuously through systematic and random riding by turning thick forest and large trees into charcoal
not only for the local consumption but also for export to Arab countries (gulf countries).
Charcoal dealers use the term of black gold for the charcoal trade. Charcoal is the most important single
fuel for 100% of the households in urban, pre-urban centers and main villages for cooking, heating and
for many other purposes at household by community levels including cooking and food catering
establishment etc worst of all the bulk of charcoal produced by burning forests is exported for sale in
foreign markets. While the scale of forests and trees destruction is leading to make entire forest lands
become barren without trees and vegetation (environmental degradation) causing desertification.
Virtually, there are either very limited or no remedies and interventions to avert the situation. The
impact of charcoal production on forest, socio-economic life health and environment is aggressively
mounting.
Shortage of charcoal supply used for household consumption lead to charcoal price hikes ($5 10$ per
bag). Increase in the price of charcoal encourage destruction of forests by charcoal dealers and poor
families suffered from the expensive charcoal and were not able to buy and resorting to get or collect
firewood outside their settlements in the towns. Occurrence of cyclical droughts in the regions, more
frequent. These droughts affected the livestock of the pastoralist communities and caused widespread
shortage of water, death of livestock and general malnutrition among children and vulnerable groups
and deteriorated health situation of the drought stricken population in the regions. Poor sanitation
resulting from the fumes where charcoal was burnt. Desertification of land leads to the lack of grass for
animals/livestock, as well as reduction of rainfall, soil erosion, reduction in local food production (Farm
Produce). Alternative sources of energy are either limited or costly e.g. electrically gas or gasoline. The
excessive production of charcoal and the continuous wiping out of forests is creating the nation to
inherit situations that are either impossible or costly to correct if immediate measures are not taken by
now.
14


The indicators of deforestation, main among them the charcoal, are imminent in every town,
landscape and in every city where charcoal is being used the main source of energy. Thousands
of such sacks come to the cities on the back of camels, cars and donkeys. A survey on the use of
charcoal was carried out by a local NGO in Somaliland (NAGAAD) revealed that 98 percent of
the household wives who responded to the survey use charcoal as their main source of energy,
where charcoal is the principle source of fuel for cooking and space heating, whereas firewood
is commonly used in rural areas. According to the survey, only five percent of this population
use efficient charcoal stoves. Nonetheless, if properly used, these stoves can conserve as high
as 40 percent of charcoal compared to the old traditional stoves.
Furthermore, millions of charcoal sacks are being exported from Somalia to the outside world,
especially to the Arab countries. Though these Arab countries have some other sources of
energy such as oil, they demand of charcoal is due to their habit of smoking shiisha, where
charcoal is a high demand. The problem for the Somalis is that the environmental resources
have become commodities where few are using for their personal profit. Alternative sources of
energy are either limited or costly e.g. electrically gas or gasoline. Furthermore, the excessive
production of charcoal and the continuous wiping out of forests is creating the nation to inherit
situations that are either impossible or costly to correct if immediate measures are not taken very soon.
This is due, on the most part, to the lack of government or the existence of very weak
governments that failed to protect the environment. Furthermore, todays environmental
degradation is an indicative of the lack of governing regulations.

These sacks contain charcoal
15





In 1984, before her collapse, the Democratic Republic of Somalia has approached the executive
director of UNEP
4
. The government requested assistance in assessing the coastal and marine
environmental problems of the country. The request included, among other things, drawing up
a national action plan for the protection, management and development of its marine and
coastal environment
4
. The UNEP responded positively to this request and, in collaboration with
Deforestation results
desertification and
loss of biodiversity
Conservation of
rich biodiversity
Gacan Libaax,
Somaliland

Garaaca, Somaliland
16

other members, (ESCHA, FAO, UNESCO, IMO, IAEA and IUCN), an eight-member mission
launched its work in Somalia from 11 to 25 June 1986. The terms of reference included:
1) Contingency planning for marine pollution, including incidents within ports and port
generated pollution;
2) Development of national capabilities for the monitoring and control of marine pollution
through training of staff and acquisition of employment; and
3) Development of national legislation for the protection and management of marine and
coastal environments.
The study concluded that there were no major pollution of the marine environment and
threat posed to the economy of Somalia. Deballasting and tank cleaning operations by
tankers were only significant forms of oil pollution reported at the time. The report also
mentioned that offshore oil exploration and production within the region was not taking
place at the time. Furthermore, land based sources of pollution was no a major concern or
threat to the marine life then. Industrial development was limited and the majority of
Somalias installed manufacturing plants were located within the urban centers in the
southern coastal zone. Industrial wastes discharges along the shore or directly into the sea
were estimated to be relatively small in terms of the total marine and coastal environment.
The major environmental pollutants at that time were the use pesticides, including DDT.
That was then. However, after the collapse of the governing systems the environmental
situation deteriorated tremendously.
Today the urban environment is in disarray and absence of adequate fisheries regulations
allows for almost unrestricted exploitation of living marine resources. Domestic sewage is
also a key contributor of pollution in coastal waters adjacent to major population centers.
The leaching of materials from dumps adjacent to the sea during periods of heavy rain
poses a serious potential hazard. In the absence of mechanisms or regulations to monitor
what are being washed into the ocean, large estimates of pathogenic organisms or toxic
wastes enter the coastal waters near the urban centers.



17

2.4 The Waste Composition.
Fig.1: Waste Composition.

Lasqorey: The waste of fish & bones thrown to the seashore {xaabo}.
18

uranium waste

Somali Tsunami washed toxic

Unwanted Fish and seafood thrown on the beach
19


Bossaso seashore


Bossaso Fish Market

20

Refuse Collection and disposal `
Mogadishu Beach: Somalia South Central Capital


21







Barbera Beach
22


Oil import from Yamen at Lughaya Beach

Waste at lughaya beach


Lughaya
23


Lughaya Beach


Zeila: The neglected Historical City

Zeila
24


The port of Zeila



25






Salt production in Zeila

Somali coastal areas has experienced significant and widespread environmental degradation as a result
of increasing pressures from human population growth and expansion and intensification of land use
4
.
Consequently, large quantities of plastic waste, human sewage, unwanted industrial and domestic
waste, as well as fertilizers and pesticides are being dumped on the beaches or gradually make their way
to the sea as runoff. This increased stress on the coastal habitats Coral reefs, mangrove, beaches
estituaries, and seagrassbeds is mainly due to degradation of the environmental health surounding the
beach areas. The beaches and marine life in general are impacted by sedimentation, dynamiting for
fishing, the removal of of Coral reefs souvenirs by tourists or by the locals for trade, as well as the
dredging of habours. Other damaging anthropocentric activities include, though not limited, the waste
from the coastal industries, hazadous waste and garbage, speedboats, oil spills and damaging fishing
methods such as trawling and oil pollution. This type of pollution is prevalented in the Somali coasts as
the presented above indicate.
2.5 ZONAL SITUATIONAL ANALYSIS
2.5.1 Somaliland Overview
1. Situation Analysis.
The development and implementation of effective environmental protection programs and the
provision of efficient environmental health control services provided to the people of Somaliland has
Table salt
26

been changing favorably-at least to some extent. In the post-conflict era in Somaliland since 1991, but, it
has been constantly facing formidable challenges that so far remained unresolved. The complexities of
environmental health activities promotion, in order improve environmental quality, cannot be
underestimated for scaling -up the profile of environmental health. Investments in public health
(environmental health) are known to bring about more pronounced and rapid effects to produce
improvements in public health status rather than increasing investments in health care proper.
Environmental health related hazards that pose threats to human health are numerous and in our
context include : grossly polluted environment/poor sanitation, contaminated drinking water supplies,
unsafe food breeding and proliferation of disease transmitting vermin and vector and lack of good
hygiene living conditions and habits of the people that are epidemiologically responsible for the highest
burden of disease among the population in general and children in particular have been at stake on
country-wide basis.
In Somaliland, environmental health activities, promotion, interventions and implementation of related
programs were launched and have been going on with the involvement of government institutions, aid
agencies. But, so far have not resulted increase in disease prevention and control, promotion of peoples
health status and public well-being and safety at the most desirable levels.
There is a wide spread recognition that current environmental pollution problems are posing imminent
public health hazards requiring immediate corrections through the application of environmental health
knowledge and principles using all pertinent measures and means in a well calculated approach:-
1 For the proper screening of all types of pollutants from the living environment (air, land and
sea (water) and the proper disposal of all kinds of wastes in a manner that is ecologically sound,
economically productive and socially helpful or sustaining healthy living habits and social norms.
In Somaliland, only 42% of the population has access to sanitary latrines and 41% have access to safe
water supplies (MICS) Multi-Indicator Cluster Survey 2006, UNICEF and MOH/L
Moreover, in Somaliland solid and liquid waste management and control, food protection programs
(food sanitation) water safety plans, housing, residential and institutional environmental sanitation
remain very rudimentary. Accumulated wastes and open dumping and defecating in open-land in and
around places of human settlement and work areas is very widely common due to technical, economic,
social and legal enforcement constraints. These constraints are compounded with the prevailing deep
influences of rapid urbanization, population growth, IDPs/refugees, emergence of light industries, new
and expanding technological advances (especially industrial wastes, plastic products) and not separately
disposing of hazardous wastes (infectious, chemical and toxic wastes) and very limited resources
available, as well as, lack of personnel with technical know-how and inadequately functioning
institutional framework for legal enforcement measures.
Finally, the lack of documenting, maintaining and using information from all available sources, a profile
of environmental quality indicators showing the changing status and effectiveness of environmental
health activities promotion and public health programs and their possible relationship to improved
quality of life, morbidity and mortality throughout the country is major setback to expedite efficiency in
sanitation and hygiene services.
In Somaliland, the per capita production of waste is relatively small for the country is very poor, as the
amount of wastes generated by a country reflects the level of affluence of that society. In the capital of
Hargeisa, per capita production of garbage is estimated at 0.45 kg per person/day and the city
population is about 700.000 persons. Hence, the daily production of garbage is 700.000 x 0.45kg = 315
tons 1000 kg
Currently, the daily removal of garbage from the city is estimated on average to be 38 loads of 6 tons
each (38x6=228) on daily basis. This means 87 tons are left lying in the town per day limited access to
sanitary latrines by the people and poor hygiene throughout the country and the exceedingly being
27

responsible for health problems of unmanaged wastes including hazardous wastes contributing to
diarrhoeal diseases outbreaks.
Acute watery diarrhoea/cholera outbreak and deaths (2007-2010) are exemplified as under:

Cases Deaths
2007 (all regions) 5325 (all ages) 715
2008 (Sanaag) 1200 (all ages) 280
2010 (Maroodi-Jeex) 500 (mainly children) 21

Moreover, environmental pollutants in the air, food and drinking water supplies that is associated with
chronic and degenerative diseases such as, Myco-toxins in food, inorganic and organic substances in
food and water and increasingly growing unhealthy lifestyles including smoking and tobacco use call for
sound standards and more effective pollution control and enforcement, as well as modified of lifestyles
The lack of public health laboratory to establish and monitor standards of environmental quality is a
major constraint. It has, therefore, become very crucial to gather information and analyze facts, make
plans, establish priorities and make decisions for action programs and effective interventions that will be
communicated to all concerned and interested parties. This can be achieved through environmental
health assessment by experts in the field of practice and accordingly the assessment has been carried
out in July-August 2010 with the support of World Health Organization (WHO).
The assessment is to revolve on the level of the currently prevailing environmental sanitation and
hygiene standards of the main towns, including streets, commercial centers, hospitals and other services
delivery institutions, communal food markets, water supply and their sources (quality and quantity) and
industries on one hand and the waste management and control systems on the other, is as follow:
1. Solid & liquid waste: waste reduction at the source, recycling, incinerators, landfills.
Lagoons, composting etc.
2. Water supply: Water sources, quality and quantities.
3. Food Safety; Communal Food Markets and slaughter houses.
4. Industry; Type of industry, principal raw materials, by products and
recovery systems, finished products, factory operations, source of water supply, waste water
treatment practices, etc
5. Chemical contamination Heavy metals, pesticides and aerosol hazards.
The assessment identified main challenges, gaps and priorities and will recommend the desired actions
and solutions.
2. Objectives of the assessment.

1 To assess and identify the factors critical to the causes of adverse environmental pollution and
their effects on human health and environmental degradation/undesirable consequences and to
accommodate recommended interventions for solutions.
2 To identify the strengths and weaknesses of main institutions involved in environmental health
activities promotion and the overall impact of their interventions on disease prevention and
control and improvement of public health status.
3 Generate baseline information and use the information so captured for future planning, priority
setting and development of environmental health programs in the Republic of Somaliland.
3 Methodology of the Assessment.
Dr. Ali Bahar, a professor of environmental science, was contacted by WHO EMRO for collaboration on
to lead the process of conducting environmental health assessment in Somaliland, Punt land and
Somalia. Then, the professor has arrived due time at Hargeisa and officially arranged the
28

implementation of the assessment with the collaboration of, WHO office in Hargeisa from the health
ministries and agencies of Somaliland and Somalia. Three days workshop was held at WHO compound
on 2325 June, 2010 with participation of (8) persons, where Professor, Bahar and Mr. Abdi Hassan
Dualeh of WHO facilitated the workshop. Among others, the workshop has focused on the main areas or
variables of the assessment related to environmental health issues and guidelines to be used for the
assessment , resources needed and timeline for the work undertakings. While, activity work plan
Agreement was prepared and WHO office in Hargeisa has entered an agreement with two national
counterparts in Somaliland to conduct the Environmental Health Assessment (EHA) in Somaliland and in
effect the work has began on I
st
July, 2010. Mr. Ali Sheikh Omer Kabil, head of environmental health unit
of the ministry of health and labor has been responsible for the overall assignment in Somaliland and
especially in the four regions of Maroodi-Jeeh, Sahil, Tog-dheer, and Awdal, as well as, working with
Professor Bahar and Mr. Abdi Hassan Dualeh. While Mr. Mohamoud Bare Deria, the regional sanitation
of Sanag region was duely assigned to collect assessment data from Sool and Sanag regions accordingly.
The assessment outcome of the six regions has then been compiled and a national Environmental Health
Assessment report is produced in a single document for the Republic of Somaliland. The environmental
health assessment aims to understand and analyze the important problems related to environmental
health issues, the causes of the underlying problems that challenged the need for conducting
Environmental Health Assessment in Somaliland and the way forward to improve environmental health
quality with reference to how the factors in the wider environment impact peoples health status. Thus,
working towards developing, creating, maintaining and improving the mechanisms under which people
and their environment should co-exist in peaceful harmony.
Finally, for the purpose of conducting the assessment, the survey design has been highlighted during the
workshop with a focus on the following.
4. Environmental Health Policy and Regulations.
For the situation analysis and needs assessments for Environmental Health in Somaliland a Terms of
Reference was made for the national health officers who were selected to conduct the assessment.
The terms of reference included but not limited to:
1 To collect existing Environmental Health data, collect and make analysis.
2 To list the main priorities.
3 To suggest appropriate interventions.
4 To conduct consensus workshop on priorities validations.
5 To submit a situation analysis report.
The population of Somaliland is estimated around 3.5 million persons (Government estimate), with an
average population growth of 3.5% (WHO/MOH/L/, (2006 annual report). Fifty five percent of the
population is either nomadic or semi-nomadic, while the remaining Forty-five percent live in urban
centers or rural towns. The mobile lifestyle of pastoralist communities is major challenge of accessing a
health services in rural areas. The average life expectancy for males is 50 years and 55 years for the
females (UN demographic yearbook 1999). While Somaliland national health policy has estimated the
Somaliland population lifespan without differentiation by sex at 47 years (national health policy, version,
1999). Generally, poverty and seasonal communicable diseases outbreaks caused by poor sanitation and
hygiene practices, such cholera, acute watery and bloody diarrhoeal diseases and malaria contribute to
high morbidity and mortality rates mostly among children under five years of age. Child mortality rate
(109) 1000 live births, and maternal mortality rate 1013/100,000 live births (MICS-2006) Therefore,
health indicators in Somaliland are among the worst in the world. As a result of years of war, famines
and underinvestment, the health sector remains very weak and the MOHL is unable to provide and
guarantee adequate services for the entire population. Somaliland is experiencing an increase in the
number of refugees from Somalia (40,000 refuges /IDPs, UN OCHA, 2007. report) live in very poor
29

conditions in Somaliland) and economic immigrants from neighboring Ethiopia further exacerbates the
pressure on health sector. Furthermore, scare resources impede the collection and analysis of health
information data, in order to plan for effective responses.
As a result, during drafting the environmental Health Assessment report major challenges were
encountered due to lack of reliable information and data.
Organization of Services
Health care services and policies are managed by the ministry of Health. While services are rendered at
the level of three public health tiers or three interdependent health facilities namely the public
hospitals, MCHs (health centers) and health posts. There are 6 regional hospitals and 5 district hospitals,
84 MCHs and 152 health posts. Horgeisa Group hospital plays a major role as national referral hospital,
as well as, M-jeeh regional hospitals. There are also one national Malaria center and eight TB centers,
and B three mental health hospitals,
In Hargeisa Group Hospital, Borama, Barbara and Burao hospitals there VCT centers within these
hospitals that deal with HIV/ADIS patients. The MCHs and health posts have been summed for each
region to indicate the total of MCHs and health posts that are located in each region. Preparation and
organization of the Environmental health assessment in Somaliland Environmental health applies the
knowledge of the principles of physical, biological and social sciences to the improvement, control and
management of mans environment for two main reasons.
1 The protection of human populations from effects of adverse environmental health-related
risk factors; and
2 The protection of the environments from the potentially deleterious effects of human
activities and the overall improvement of environmental quality for human health, well-being
and development,
To implement the Environmental health assessment the Somaliland assessment team was well prepared
and organized, whereas an action plan was developed and regularly followed to complete the
assessment on time and collaboration with Somaliland WHO Office in Hargeisa. The assessment
envisaged identifying, understanding and analysis on the existing major environmental health- related
risks factors/ problems, the causes of those problems and how such unresolved problems in the wider
environment impact environmental quality and peoples health status and what could be done as lasting
solutions. In line with our plan of action we have employed a multi-faceted study approach for gathering
rigorous up to date, relevant and scientific information, then analyzed facts, established priorities, made
decisions and plans for appropriate and cost-effective action programme and the use of monitoring
indicators.
1 Top desk review (Secondary data collection) through reading and extracting needed information
from the previous document on the main issues of concern relating to environmental health/
public health for the last five years.
2 These included MOHL annual reports, key documents from stakeholders records/ reports and
research/studies (multi- indictors surveys, healthy city initiative (Hargiesa city health profile
assessment, 2008 etc.
The available literature on the subject of study has been meticulously reviewed and summary notes
have been made including gaps that will be bridged by the primary data.
1 Key personalities from government institutions, private sector, UN/LNGOs agencies, civil
society and field specialist were contacted in their duty stations. Through consultative
meetings the desired information on the key variables of interest related to environmental
health has been gathered incorporated in to the final synthesis of the assessment report
(outcome).
2 Mission visits have been carried out to reach destinations- workplaces, sanitary facilities,
30

factories, communal food markets etc direct observations, check-ups/ investigations, writing
anecdotes and having participatory meetings and discussions with relevant authorities,
officers, individuals etc on the current achievements, constraints challenges (opportunities).
This variety of interwoven model approaches that have been employed by the Somaliland
Environmental Health assessment team culminated the collection of much needed Bench mark Data
on the current situation of environmental health standards and institutions framework throughout
Somaliland, intern, environmental health programme management, financing, and use of technology.
Priority setting capacity building of the institution involved in Environmental health, provision of sanitary
facilities and waste handling practices, as well as monitoring outputs with use of indicators were much
focused for assessment.
Finally, recommendations were made, while recommended action plan and the recommended process
for implementing the plan of action have developed and the whole report was submitted to professor
Bahar.
The Sanitary Situation of Main Urban Centers
The sources of garbage in urban centers are the households, commercial centers/market areas,
industries, institutions street waste and those resulting from demolition and construction works etc.
Summarily, residential and commercially waste constitute the largest source of both solid and liquid
waste, problems related to poorly managed garbage is unsightliness, vector and rodents which
transition during the per capital production of waste in Somaliland is estimated at 0.45kg per
person/day. Collection, storage, transport and disposal of solid are highly rudimentary due to set of
factors including lack of qualified personnel and inadequate unskilled crews to lead sanitation disposal
procedures, transport, temporary garbage at collection points and inadequate or poorly used terminal
dumpsites and in most instance open dumping, is practiced due to low level of public education and
information and law-enforcement. No land fill operations or incineration system is used in almost all
urban centers., the situation is favorably better than it was before ten years ago, given that the country
is peaceful and stable and authorities and citizens at least mind to take responsibility to the tasks that
are ascribed to them. The most pressing priorities include the following but not limited to:

1 Land use plans for the disposal of solid waste in temporary waste collection point and terminal
dumpsites (sanitary infrastructure facilities)
2 Capital budget
3 Heavy machinery (garbage collection transport vehicles, bulldozers, graders and compactors)
4 Sufficient number of crew/employees for collection and loading
5 Trained are qualified public health inspectors and sanitation and officers supervisors
6 Vacuum tankers construction of lagoons for liquid waste disposal coordination
7 Effective stakeholder coordination
8 Scaling up the profile of sanitation to meet MDG 7
9 Extensive public education and legal enforcements of relevant laws
10 Performances & efficiency measurement systems supervision & monitoring
11 Solid waste & liquid waste disposal
12 Comprehensive waste management separation of regulatory responsibilities & national, regional
and district levels including supervision, control and service operation levels.



31

Hargeisa: Solid Waste
Hargeisa city population is 700,000 persons per capita production of garbage in city (all inclusive street,
household, commercial and industrial wastes).0.45kg per person/ day (Hargeisa city health profile
assessments survey document healthy city initiative 2008). People with access to sanitary facilities is
42% (M, CS, 2007), and people with access cafe, water supply 41% (M.C.S).
Poor sanitation related and water borne: Diseases (MOHL Annual/ reports 2005 & 2006).
Diarrhea Diseases rank the second in the top ten diseases morbidity and mortality. Waste handling
practice (collection, storage transportation and disposal) are highly rudimentary and there is no inter
Medical Dump Site. Waste disposal terminal sites (open dumping) and poorly managed large dug pits
found on observation located on landscape depression are subject to lead contamination of surface and
ground water. Integrated quality control for food and water consumption is lacking.


Gobanimo Market: Hargeisa
32




33

Hargeisa municipality contracted out garbage collection in the city by two private companies:
1 DHIS private company is responsible for garbage collection from the northern part of the city.
2 Sabawanaag private is responsible for garbage removal from the southern part of the city.
DHIS removes 22 loads, of Solid waste each day municipality wants to relieve the burden of work form
DHIS by taking assignment on garbage removal ensure part of the northern location of the city form
temporary dump sites. Sabawanaag removes 18 loads of Solid waste per day from the householders,
streets & temporary dump sites.
The transportation of waste is done by tipper trucks to two terminal dump sites located in the north of
the city and south of the city, the private companies were instructed to buy 10 plots by each of them for
temporary garbage collection points-dump sites. So for, this has not been materialized. As part of our
efforts to improve efficiency of the garbage collection from the city we have ordered 12 trailers from
China in order to enhance the efficiency of the mechanized machinery. The mayor indicated that neither
reducing the garbage at the source nor recycling system is in use the cutting edge of recycling the solid
waste is the level of cost- recovery which provides a very minimal salvageable value in relation to
investment (cost) in recycling. Hence, in the management of garbage the system of sustainability is a
major issue of concern.
The Honorable Mayor indicated that the most drastic product of the Solid waste is the plastic bags/
containers that are thrown away. WFP participates in the collection of plastic bag through food for work
program but on ad-hoc basis. Both technical and financial constraints impede the removal of garbage
from the city effectively he concluded. In the slaughter house, the major has indicated that the good
sanitary operating practices are well maintained by the private company who runs the slaughterhouse.
Finally the mayor has assigned one of his sanitation officers to take us to the dump site located north to
the city (15km away).
34










Mr. Abdi Hassan Duale Of WHO is
taking pictures of a waste truck.


H
a
r
g
e
i
s
a

35

Hargeisa under Smoke: Open incineration


36

Solid Waste From Hargeisa
37

38

This is one of the main dumpsites around the city of Hargeisa
39

This is a dump site in Barbera, not too far from the beach. Mr. Abdi Hassan Duale (Gurey) of WHO was
taking a picture of one of our cars.
Burcoa: Solid Waste
Visit to Burao town Garbage terminal dumpsite
During the environmental health assessment mission we have visited Burao town waste disposal site.
The garbage terminal dumpsite located at 7km and southwards of Burao town, the terminal dumpsite
was a large excavated dug dumpsite used for the disposal of solid wastes, in a semi-controlled tipping.
We have seen that tipper trucks carrying solid wastes directly dumping inside the dug pit the tipper
trucks are owned by Burao municipality. The site was guarded by site supervisors who were responsible
to oversee and monitor that tipper trucks have dumped the loads of garbage into the pit. The solid
waste was properly dumped into the excavated semi-land fill operated dumpsite. The disposal
S
o
l
i
d

w
a
s
t
e

f
r
o
m

B
a
r
b
e
r
a

t
o
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n

40

procedure of the garbage in Burao town was better managed than the one in Hargeisa. There were no
birds or wild animals roaming in the disposal site. The disposal site itself and the garbage has constituted
a minimal public health threat to the town resident population or to those who live in far located areas
at least for the time being. The system of garbage disposal in Burao town can be easily turned into
sanitary landfill method provided some investment and machinery is made available. This will in turn
become a model to be followed by other municipalities of Somaliland.


This truck picks up several loads of the solid waste a day from the City of Buroa, Somaliland.
The serious nature of the solid waste threat in every big city of the whole country and the
environmental needs have been presented in our salient discussions. The lack of efficiency, sufficient
funds, or commitment and effective strategy to deal with the municipal and industrial waste was
evident. Every local and international NGOs we had interviewed made similar comment when it comes
to the waste issue. There were general consensuses that the local governments in these different
regions were not adequately handling their end of the bargain in managing the waste problem. Likewise,
the local government was pointing the finger to a different and passing the blame. Though some of
these shortcomings were due to shortage of funds, it was lack of an effective strategy and commitment
on the part of the local government to enforce the regulations and follow up with a study on how well
their strategy was working.
Burcoa solid waste dumpsite
41

This failure, on the major part, is the lack of environmental policies and effective vision on how to
control waste while following well defined regulations to meet the challenge. Another explanation could
be that, although some environmental policies are preventive, most have focused on cleaning up
messes after the fact-what the environmentalists call end of pipe solutions
3
. Preventive and proactive
measures should be taken to protect the environmental damages. It is not enough to address problems
only after they have become so obvious that they cannot be ignored often, literally waiting for the
dead bodies to appear or for coastlines to disappear into the ocean.
Borama: Borama town sanitation
The town is generally poor in sanitation for the production of garbage and its removal
are not proportionally matching accumulated garbage is seen in and around the
quarters of the town, although, the municipal administration of the town who is the
caretaker of the sanitation do strive to promote town sanitation.The dumpsite for the
terminal disposal of the solid wastes locates about 3 3.5km north of Borama town at
the junction of the beginning of river valley (Dry River). It is indiscriminately dumped
inside the large natural depression and around its surroundings outside the
depression/garbage dumpsite. The danger of pollution of water sources is absolutely
unavoidable, even though the solid waste was removed from the town and dumped in
far away waste pit. Now the pit is nearly being filled up with garbage and new site is
needed.

Waste from the city of Borama
42


This man (truck driver) was explaining to us, during our visit to the site, that it was very difficult to pick
up the waste from all places in the City of Borama because of financial difficulties that the local
government was facing. There were no enough trucks to pick up the waste; not enough gasoline was
provided by the local government to make more than three trips a day; and there were no enough
incentives for the men who were loading and loading the waste with their bare hands. For example, this
man on the top of the truck makes something like less than $0.4 a day (less than 40 cents). No one could
live on or feed his family with this kind of income.

Erigavo town Solid Waste
A similar situation to that of Borama town prevails in Erigavo town. However, Erigavo town is one of the
cleanest towns in Somaliland for the municipality takes its responsibility to keep the town clean, and
closely works with and takes advice from the regional sanitation officer, Mr. Mohamoud Barre Dualeh.
The only major problem is that the dumpsite is a natural depression and is partly protected by fence,
which is up now being filled. Therefore, a new terminal dumpsite is urgently needed.

Lasanod town Solid Waste
Lasanod is perhaps the worst in solid and liquid waste management there is no official care taker of the
solid waste, although, the municipality is entitled to do so and is minimally involved at least to organize
clean up campaign with the participation of the resident population of the town. The garbage collection
and disposal was previously implemented by a local NGO called SAVO headed by the late engineer Said
Abdi. Since his death in 2005, things have fallen apart. The dumpsite is open land in between two small
hills located north east of Lasanod. The poor sanitation condition can be easily accessed by large
43

quantities of flies that are always remains a menace to sanitation and hygiene standards. Only Lasanod
town cannot be associated with abundance of field, but also, Berbera, Borama and even Burao and
Hargeisa do host such disease carrying vector in large quantities according to seasonal climate changes.
All in all we need to improve our sanitation to the highest standards with our own efforts and resources
appeal the international community, for urgent assistance both technically and financially. In summary,
waste reduction at the source is not practically used at all levels, so also, neither sorting nor recycling is
in use. Garbage burning in dumpsites is not in practice. While sorting of hazardous wastes and disposing
it separately is not employed in all situations including hospitals and industrials waste. Finally, the
general consensus of the public and government is that concerted efforts and collaborative actions must
applied collectively to keep our cities towns rural settlements and environment clean, safe, pollution,
free, aesthetic, healthful and pleasing. Hence, our expectations should match realities through action of
the citizens of the nation as whole.
While sorting of hazardous wastes and disposing it separately is not employed in all situation including
hospitals and industrials waste. Finally, the general consensus of the public and government is that
concerted efforts and collaborative actions must applied collectively to keep our cities towns rural
settlements and environment clean, safe, pollution, free, aesthetic, healthful and pleasing. Hence, our
expectations should match realities through action of the citizens of the nation as whole.

Inventory
Sanitation equipments/facilities & machinery in the town

Region: City/town machinery dumpsites
Maroodi jeex Hargeisa 12 Tip per trucks 2
Bulldozer
Gabiley 1 tipper truck 1
Togwajaale 1 tipper truck 1
Awdal Borama 2 tipper trucks 1
Sahil Berbera 2 tipper trucks 1
Togdheer Burao 4 tipper trucks 1
Sanag Erigavo 2 tipper trucks 1

Non-mechanized inventories such as, donkey carts, wheel-barrows, shovels and rakes are available for
use, but are limited.

Liquid wastes in major urban centers

Liquid wastes here are referred waste water from domestic waste water, closet, septic tank, latrine,
laundries, hotels,flushing etc, for practical purposes and from public health point of view, these waste
water should be considered sewage (waste water) and containing pathogens from latrines septic tanks,
bathroom showers, wash basins, from clothes washing, dish washing etc or otherwise should be treated.
In Somaliland, such waste water is neither treated nor disposed of sanitarily in oxidation ponds. Vacuum
tanker trucks carrying waste water from latrines, septic tanks and soak away pits spill over in open land
fields especially valleys. The contaminated waste water (leachate) reaches to contaminate underground
water through subsurface absorption system or is washed away by rainfall run off(rain storms) water
into shallow wells, dams, in this practice is common in all urban settings we need introducing a system
of waste water treatment and reuse.
44


2.6 Slaughterhouses
Hargeisa Slaughterhouse
We met the slaughterhouse management body, who gave us comprehensive information on the
slaughterhouse ownership, facilities equipments operations and compliance with sanitary and hygiene
procedures and standards (regulations). Good Sanitary operating Practices were observed.
Inspections/observation
Location of the slaughterhouse: located in the eastern edge of the city with no zoning restrictions in
place. Buildings and dwellings are as close as less than 100 meters to the site. Premises and
infrastructure: Premises is protected by fence, buildings, work blocks and cemented concrete platforms
for slaughtering animals in good repair, smooth, clean and had lighting, ventilation and adequate
drainage for sewage and liquid waste disposal system. Septic tanks and refuse, offal manure, non-edible
parts, condemned meats disposed of separately.
Health of livestock heads for slaughtering (Animals Health)
Disease free from anti-mortem veterinary inspection and meat supplied to the market is certified for
quality assurance by veterinary post-mortem permits.
Water supply: the borehole was under repair and maintenance at the time of the visit.
Water tankernig trucks supply water to the slaughterhouse with cost $250 per day.
Struck tankers x 50 barrels x 200 liters = 50,000 liters/day.
Transportation: 6 transport vehicles used only for edible meat, some of them equipped with cooling
system, found clean and hygienic, meat wrapped and protected.
Overall slaughterhouse sanitation and hygiene
In animal slaughtering areas, a high degree of cleanliness of the slaughterhouse is maintained and
personnel observe hygienic safe practices. At the time of the visit, the slaughterhouse was clean and
adequate water and cleaning agents and chemicals have been used, effluent biological liquid water
sewage drained into water tight septic tanks. No overflow of septic tanks to the dry-riverbed nor
2.6.1 Hargeisa: Generated Blood and Biohazard Waste:

Hargeisa Slaughterhouse
45


46


Inside the slaughterhouse was clean and well managed. It is operated by a private company with
partnership with the local government. The blood and the animal parts and waste are removed by
trucks and located to the earth catchments shown in the above pictures. Offensive odors observed on
inspection in the site. Two vacuum tanker trucks remove sewage from the septic tanks and the
hazardous biological waste are poured into open cesspools/ditches with overflow liquid drains into low
lands, gullies and rivers that lead to contaminate extensive areas. The sewage disposal ditches are
located near the Nasahablood hills. The lagoons are poorly designed unprotected and allowed to drain
liquid into the entire basin of watershed areas lying below towards the lagoons. Wild brid/ animals and
other carnivores swim in the pools and feed on the refuse and other organic (biological) wastes that are
indiscriminately dumped near the cesspools. There is high possibility of epizone diseases outbreak
affecting the population living in adjacent or far places in the downstream. Need to construct proper
oxidation ponds which should be treated and protected.
Management and ownership
The slaughterhouse is owned and managed by a private company called Mandeeq. The premises are
owned by Hargeisa municipality and the company has invested to expand the slaughterhouse. Hargeisa
municipality ensures legal enforcement for the use of slaughterhouse in slaughtering animals by the
public. Slaughtering animals outside the slaughterhouse is illegal and carries penalty personnel of the
slaughterhouse: 96 persons. Butchers have code numbers to slaughter animals in the slaughterhouse
that are strictly observed and followed. The whole premises were free from insects and rodents.
Number of animals slaughterhouse per/day

1. Sheep/goats: 1000 heads
2. Cattle: 60 cows/heads
3. Camels: 30 camels/heads


inside the slaughterhouse.
47

Open Landfills: Biological waste from the main slaughterhouse in Hargeisa
Solid and liquid wastes disposal

Solid wastes
Remnants or the unwanted parts of the slaughtered animals, offal manure and other solids were
cleaned from the slaughterhouse premises and have been thrown crudely in open dumpsites (separate
place or where garbage is of dumped) attracting fleets of car rivers birds and animals with resultant high
level environmental pollution. No recycling system has been ever used.

Liquid waste

Liquid waste is emptied from septic tanks in the slaughterhouse and poured into open pools up to the
level of overflow, where flooded biological liquid wastes drain into down streams/open lands (Hargeisa).
The overflow design of liquid wastes from the slaughterhouse into downstream valleys and open fields
is the norm of practice to dispose of liquid wastes from slaughterhouses. Burao, Borama and Berbera
slaughterhouses do the same. No standard sanitary disposal system for solid and liquid wastes in both
private (commercial) slaughtering (Hargeisa slaughterhouse) and municipal slaughtering houses has
been established to meet minimum sanitary and hygiene standards for compliance in the design,
construction and operation of slaughtering houses as meat plants under regulatory-framework
formulated to protect public health safety, and welfare. The lagoon system combined with initiative
solid screening, biological effluent, treatment systems sludge (composting) for testing recycling to
produce fertilizers as important measures.


Animal Bones
48


Hargeisa: Blood from the slaughterhouse stored in an earth catchment near Nasa Hablood
49




Animal Blood from Hargeisa slaughterhouse
50


Nasa hablood immersed in blood.
51


The above pictures and the proceeding ones from different waste sites demonstrate a great
damage and colossal negligence to the environment and the high risk it poses to the public,
who depends on it for survival. Clearly, these open landfills of both solid and liquid wastes,
including human and animal daily wastes, impact the environment and the ecological systems
surrounding all big towns and cities in the entire country. Even though the country is not
heavily industrialized, the uncontrolled municipal, agricultural and industrial wastes are being
scattered everywhere and every space available. Often these wastes are directly washed or are
flooded into the rivers and deep into the local drinking water. Most people and their livestock
drink from hand-dig, shallow water wells or directly from the rivers, Brakeds and other water
catchments, especially during the rainy seasons. There are no effective environmental
assessments carried out regarding whether the potential toxic exposure from these open waste
sites find their ways into the public food chain and into the breathing air. There are no
environmental health and exposure assessment agencies that are equipped to established
methods of exposure assessments and sampling techniques that could examine what the public
Animal Offal Waste
Human Waste
52

is being exposed to through air, soil, water, food or through occupation. Furthermore,
population continue to increase, more people are being forced into the big cities by poverty
looking for jobs. Domestic waste and industrial waste will continue to increase exponentially.
Countries to Somalia, In addition, there reports of extensive illegal export of hazardous toxic
wastes, including radioactive waste, from industrial to Somalia. There are also growing local
industries inside the country that are remained unregulated even though they have the
potential to pollute the environment. Such industries include two leather tanning and
producing factories in Dacarbudhuq, between Hargeisa and Barbera and many more such as
soap producing industries that are scattered in the country without being monitored. These
new factories, whether they produce leather, water, cloth, plastic bags or furniture, do not
spend a dime on shouldering the burden of safe disposal in order to protecting the
environment and the public. These safeguard includes building modern landfills, maybe one in
every region where the waste could be managed. Such directive should require the
manufactures, restaurants and other businesses, under the leadership of the local governments
or independent agencies, to set up an infrastructure to collect the waste. It goes without
saying, therefore, that, in the absence of regulations, and without proper landfills or waste
treatment plants, this waste here and in the whole country will be out of control and the public
remains at the mercy of such exposure.
2.6.2 Burao town slaughterhouse
Burao town slaughterhouse has been constructed in an open sky slaughterhouse design without roofing
or rooms the slaughtering plots for sheep/goats, camels or cows have been having concrete floors, are
drained and clean at the time of our inspection visit the cleaning operation of the slaughterhouse was in
progress or going on while the slaughterhouse was observed relatively clean inside. However, the
sanitary condition of the slaughterhouse for the disposal of liquid wastes was extremely a real threat to
the whole environment around the slaughterhouse and entire basin of the dry river and along its further
tip in the downstream. The septic tanks that are constructed many years for the collection and
decomposition of liquid wastes have been destroyed and were no longer in use as soak away pits.
Therefore, the liquid waste from the slaughterhouse is drained into the dry river bed (Togdheer river
bed) and to the furthest point in the downstream. This has constituted an alarming public health hazard
to the whole population of the town and to the communities who are living far located areas along the
banks of the river or those who get water from the shallow wells located along the river banks or inside
the river bed. The slaughterhouse in Burao town needs immediate relocation and redevelopment into
modern slaughterhouse through proper design and construction of new one.
Ownership & Management: Burao Municipality
Number of personnel
Number of animals slaughtered:
Sheep and goats: 750 heads
Camels: 25 heads
Cows: 00 heads

53

Blood and animal waste poured directly into the dry river


Waste from the slaughterhouse
54



Borama Current slaughterhouse
Borama slaughterhouse is the open sky traditional type construction of slaughterhouse. It locates south
east of the town near the valley and the dry river called Qorgab, where a large number of shallow well
locate to provide water supplies to a large portion of the town population, as well as, to rural and
pastoralist communities. The slaughterhouse resembles that of Barbera or Burao town in the aspect of
sanitation and hygiene standards and capacity to handle the number of slaughtered animals in the
slaughterhouse per day. The slaughterhouse is constrained by lack of water supply for cleanliness and
the hard crust of the earth where it locates has made difficult to dug and construct septic tanks for
River
Down into the riverbed
55

sewage, hence, the sewage overflows on open land and drains into the Qorgab valley and river bed
leading to constantly contaminate the shallow wells water. But now, a new slaughterhouse is being
built and the problem will be solved in the near future at least partially.

Number of heads slaughtered

1. Sheep and goats: 130 heads
2. Cattle 20 heads
3. Camels 5 heads


56







2.6.4 A New Slaughterhouse in Borama

57


The waste from the slaughterhouse is separated at different steps. The solid waste is collected
at the first collection point and will be transported to an open earth catchment where is treated
with bacteria to break down the waste. The waste will be eventually used as a fertilizer. Any
remaining fatty material will be removed at the second chamber before the septic tank and is
added to the solid waste. The liquid waste passes through septic tank and will be released into
an open field where it will be absorbed into the soil. The unanswered question, however, is
whether this liquid is safe to be released into the soil. It was not clear from the conversation I
had with Dr. Wamalwa Kinyanjjui, hygiene consultant for FAO Somalia, whether all necessary
measures were taken to insure strict environment safety and the protection of the community
residing near and around plant after it became operational. He sounded as if the final decision
on how to address these concerns were not made yet, though her assured an overall safety of
the environment.
F
a
t

S
e
p
t
i
c

S
o
l
i
d

Solids separate in
here
Additional fat is removed
Septic tank
Liquid, mostly water, is
released into the soil.
New construction for slaughterhouse in Borama city.
58

Erigavo slaughterhouse
In Erigavo and Lasanod towns the capital towns of Sanag and Sool regions respectively have no
slaughterhouse or there are no premises and infrastructure for slaughtering animals in either of the
towns. Therefore, the animals to be slaughtered are subject to open-land, exposure. Blood is drained
into the soil and the remnants and unwanted body parts of the slaughtered livestock are thrown and left
in the open field. Later in the night or whenever people leave from the sites, birds and wild canine
animals, vector and rodents come together to the slaughter places and feed on the remnants blood and
other biological wastes. While in the rainy these dirty biological wastes are washed into the down
streams to contaminate shallow wells water and surface water supplies of the public especially, rural
and nomadic communities. This can cause serious diseases outbreaks or various epizone diseases, at the
same time this practice is a continuous source of poor sanitation and unhygienic living conditions
surrounding the whole environments of the towns that urgently requires to be altered through
appropriate interventions.
The number of animals slaughtered by type in each town per day is as follows:
Erigavo town (Sool)

1. Sheep & Goats: 160 heads per day (average)
2. Camels: 18 heads per day
3. Cattle: 12 heads per day

Lasanod town (Sool)

1. Sheep and Goats: 175 heads per day
2. Camels: 20 heads per day
3. Cattle: 8 heads per day

Hygiene slaughtering of livestock and observing standard sanitary operating practices in meat handling
and delivering to the market was found reasonably maintained in Hargeisa slaughterhouses.
Manual cleaning and disinfection to improve and maintain slaughterhouse sanitation and hygienic
standards with use of brushes, chlorine and detergents was also reasonably effective in Hargeisa
slaughterhouse. All surfaces of concrete cement (construction) floors or the marble lined floor of
Hargeisa slaughterhouse, Burao town-cemented slaughterhouse and to some extent Borama
slaughterhouse were smooth without cracks and sloped to drains waste water, repair and maintenance
were in place. Berbera slaughterhouse cement floor was found cracked without repair and Erigavo and
Lasanod sanitation is critically alarming as there are no slaughterhouse places at present.

Water supply for cleaning (removal of dirt and organic substances)
No piped water from main source was available for all slaughterhouses; water is made available to the
slaughterhouses by water tankering trucks.



59



2.7.1 Chemical (toxic) wastes: Daar-budhuq leather tanning factories (Between
Hargeisa and Barbera).

There are two leather tanning factories located in Daar-budhuq town; one is owned by Chinese
company and the other by Somalilanders. The two tanning factories locate at the eastern bank and the
western bank of Daar-budhuq river valley, which has got a perennial stream and contains multiple
shallow wells, where the town populations get their drinking water supplies from. It is well known that
leather tanning factories use heavy chemical element of chromium (inorganic toxic chemical) and both
factories had no prevention measures of the resultant waste water from the factory operations to
contaminate shallow wells water through direct sewage spills or sub-surface absorption systems
(leachate). Sewage water spills already drained into the river from the Chinese factory in 2009, the
Somalilanders factory had waste water pools without concrete cement floor. Furthermore, the Chinese
waste water ponds located outside the site of the factory. There is potential/actual contamination of the
water supplies obtained for the river wells for drinking. Thus, sooner or later health problems of the
communities living along the entire river radius up to the sea will emerge. We need to carry-out a)
baseline survey/study of the safety and concentration levels of chromium in the drinking water supplies
b) to study peoples health status at present.
60

The Chinese- Owned Leather Factory in
Daar Budhuq.
61





Chemicals used in the leather factory.

62

Chemical Waste Produced by the Factory.

Second Leather Factory Operated By Somalis
The liquid waste is dumped in here on daily basis. The
environmental impact of these chemicals is a great
concern.
63


Chemical and Liquid Waste Produced by the Factory (released into an earth catchment).
Somali-owned leather factory in
Daar Budhuq
64




Liquid waste from the plant is separated in these
compartments. The color is an indication of the
type of chemicals used. Some of chemicals used
in the plant include chromium salts (blue color).
65

2.8.4 Sources of Medical Waste
Hargeisa General Hospital premises.
Hazardous wastes

Infectious wastes

We met the Director of Hargeisa Group Hospital and discussed with him on the methods used for the
end-destruction of biological wastes and contaminated articles in the hospital. In Hargeisa Group
Hospital the volume of biological wastes produced within the hospital is large enough in volume.
There is no exposure of the waste in general within the wards, laboratory and operating theatre for such
waste is strictly handled in sanitary way. However, to dispose it, no infection control mechanisms are in
place, subordinate staff is instructed to dispose it and the hazardous biological waste is dumped where
hospital ordinary garbage is collected and the end-product is disposed of in the terminal/dumpsite
where city garbage is dumped. Storage of biological waste in the hospital, health centers, private clinics
and pharmacies must done in special way to protect public health. No incineration system is adequately
done in admit all health facilities except a fan. The situation of the medical laboratory in the
management of hazardous wastes collection was also reasonably good. But, still the end destruction
was not proper. It was indicated that it is done with incinerator. But the incinerator is not in use either
for quite on long time. The infections in both public health and private sector facilities constitute a major
public health hazards at all levels there is an urgent need to introduce convenient and safe infectious
waste end-destruction sanitarily, while, a large incinerator is needed to be constructed and used.

66


Inside Hargeisa Hospital
67


Mothers placentas are scattered in
this site, inside Hargeisa hospital.
Human blood and parts of human
waste can be seen in this site.
68


Though the medical staff and administrator in this hospital praised themselves on how much
improvement in the public health sector has been attained with the meager resources to have, it is
nonetheless hard to imagine that someone will use this toilet, let alone that this is actually inside a
hospital, where mothers seek help for post and pre-natal care; where mothers deliver babies or a place
where someone comes to have an operation and treatment. But is true! This is inside Hargeisa Hospital.
This, in fact, reflects Hargeisas public health administration where neither the environment nor the
public is protected from this hazardous waste. This an example of the work of a poor public health
These toilets are inside the hospital, next to the patients
wards.
69

administrator, who either lacks the tools, the knowledge, or both, to use his all arsenals available to him
in order to protect the public from the exposure to such environmentally hazardous waste. The
Hargeisa group hospital administrator, Mr. Mohamoud Sh. Farah, estimates that the hospital needs
about $94,0000 to improve its environment (Annex-F). The arsenal, in general terms, of regulatory and
managerial tools available for the protection of environmental health is formidable. It includes stringent
regulatory controls with highly specific and demanding standards, many of which are backed by
penalties for noncompliance. It also includes more analytical and participatory measures intended to
help public officials and the general citizenry make prudent policy decisions, neither of which seem to
have been considered. However, given the general state of the country where governance is either in
total collapse (south central) or lacks the funds and the technical staff to improve this dire situation
(Somaliland and Punt land), one would imagine that all medical facilities in the country are in shambles.
To our surprise, however, we found some clean hospitals and medical facilities in Borama city,
Somaliland, that have been managed better where the environment and the patients were both
protected.







This incinerator is out
of commission.
Inside Hargeisa General Hospital
70


Borama General Hospital
inside Boramas General hospital

The
waste is collected from the hospital premises on daily bases by the same trucks that collect the waste
from the city. The difference is that the medical staff and administrator in this hospital see it that the
truck driver gets paid for his services. Hence, this is an example of an administrator who cares about the
facility, the environment inside the hospital and ultimately the patients health and safety. This is a
system tailored to the community needs in order to reduce environmental risk in the hospital to an
T
h
i
s

i
n
c
i
n
e
r
a
t
o
r

i
s

w
o
r
k
i
n
g

a
n
d

i
s

c
l
e
a
n

Waste is removed from the
hospital on daily bases. Inside Boram General Hospital
71

acceptable and tolerable safe level while using economically manageable method. The emphasis here
was focused on keeping the hospital clean and the public safe, even under current financial constraints
they are under. In that regard, it is critical that the health departments in this country found ways to
reduce environmental risk and regain their earlier preeminence in environmental health. To do so, the
health professionals should seek partnership with the varied public agencies, both local and
international, that are currently playing some limited role in the country. However, more importantly,
the role of government is very critical in order to establish enforceable regulations that could be
sustained.
Health facilities in Somaliland
Health care services and policies are managed by the ministry of Health. While services are rendered at
the level of three public health tiers or three interdependent health facilities namely the public
hospitals, MCHs (health centers) and health posts. There are 6 regional hospitals and 5 district hospitals,
84 MCHs and 152 health posts. Horgeisa Group hospital plays a major role as national referral hospital,
as well as, M-jeeh regional hospitals. There are also one national Malaria center and eight TB centers,
and B three mental health hospitals,
Table1:Distribution of Health Facilities
Regional
/District
Regional
hosp.
Mental
hosp.
District
Hosp.
TB
hosp
Malaria
Hosp.
Mchs HP Total
M-jeeh
(Hargeisa)
1 1 - 1 1 26 21 51
District
Gabiley
- - 1 1 - 1 - 3
Awdal
(Borama)
1 - - 1 17 30 52
Zela 1 1
Sahil
(Barbara)
1 1 - 1 - 7 11 24
Sheikh - - 1 1 - - - 2
Tog-dheer
Burao
1 1 - 1 - 17 30 50
Sanag
Argavo
1 - - 1 - 8 30 40
Bsdhan - - 1 - - - - 1
Sool
(Lasanod)
1 - - 1 - 8 30 40
Total 6 3 5 8 1 84 152 264
In Hargeisa Group Hospital, Borama, Barbara and Burao hospitals there VCT centers within these
hospitals that deal with HIV/ADIS patients. The MCHs and health posts have been summed for each
region to indicate the total of MCHs and health posts that are located in each region.


72




Table: 2.; Relate to disease control centers
Level
National Regional District Village
or



-

-





-

-

-

-

- - -
Disease
control
centers

TB centres
7


1


8

8
Gov.



Malaria
control
centres



1




-




-




-









//

HIV/AIDs
VCT
4
4
//
Mental health
hospital



3


3


//


Immunization
services
NIDs&
CHDs EPI
Camgaii
ns
EPI
Campaigns
MCHs

Fixed &
mobile
outreach
& MCHs




7 Sanitation
centers
MOHL/U
N/ INGOs
LNGOs
partners
Private
compani
es in
Hargeisa
Municipaliti
es
Commun
ities
//
8 Food safety Food catering establishments inspection by municipal hygiene
inspectors
Food storage warehouses inspection
Food processing and water & soft drinks
Slaughterhouse bothing factories no action pesticides in local
food produce an



73


2.8.4 Water Delivery Systems in Somaliland
Water in its fluid form is the material that makes life possible on Earth. For most humans as well as
industrial use, the quality of the water is as important as its quantity. Water must be sustainably free of
dissolved salts, plant and animal waste, and bacterial contamination to be suitable for human
consumption. However, today in many parts of the world, including Somalia, despite advances in
drilling, irrigation and purification clean fresh water is a concern. Unfortunately, the outlook for the
worlds freshwater supply is not very promising. Major problems include location, quality, quantity,
ownership and control of potable water. Though some areas of the world have abundant freshwater
resources, there are others, as the case in Somalia that are facing water shortage. These shortages of
potable water in Somalia sometimes contribute to human abuse in the form of pollution. Water
pollution has negatively affected water supplies because people do not have access to safe drinking
water. In addition, demand is increasing for fresh water for industrial, agricultural, and personal needs.
With an increasing population size that might be approaching its population doubling in the next 20
years, and with the high rate of urbanization the whole country is experiencing due to the destitute
situation population migrating to urban areas, as well as severe destruction of the environment through
charcoal-burning and harmful pastoral management practices, the demand for safe drinking water will
increase even more.
One of the areas we have paid attention to in this project was the quality of drinking water in all three
regions. Sadly, however, our report reflects very serious and poor quality water systems, or the lack
thereof. Our work revealed, as indicated in our reports in the following paragraphs, most of the
populations draw water from the unprotected water catchments or wells, and that the quality of water
for human consumption was poor. It reveals that the general sanitation of the population and
residential areas is inadequate. There are several sources of drinking for the average Somalis, which
includes, rain water (surface water), showllow wells, Berkads, and ground water. Very small fraction of
the population receives piped water, and almost none of them receive chlorinated water.

74






Borehole water
75

Meeting With Hargeisa water authority
Hargeisa water agency general manager
(7/5/2010)
Environmental quality improvement through better management repair and maintenance of
infrastructure and maintenance and provision of liquid wastes disposal facilities ratified. Acceptance of
continuous water chlorination for public health protection well documented. Support to the installation
of the gravity dosers agreed together to be funded by the agency. Training of staff with support of WHO.
Need for training agency personnel improve their knowledge and skills in chlorination were seen as a
priority. Quantity of water supplied to Hargeisa per day is 9000 public meters. Around 70% of the city
population receives pipe water each person receiving 18 liters/day.
The remaining 30% of the city population receive water from water tanking trucks obtained from
shallow wells.

Decisions/action points
Hargeisa water agency should make waste water drainage pools/lagoons. Used engine oil ditch will be
dug by the agency instantly. Repairs of the water supplies booster station will be made by the agency
WHO will support the staff training MOHL & MWMR will train staff Gravity dozer will be installed by
MOHL & MWMR. Training cost prepared and submitted for approval.



Manual chlorination. The chlorine
feeder was missing
76



Environmental Contamination



Hargeisa water supply visit to Biyo-khadar booster station for Hargeisa water supply 5/07/2010.
Observations:
Water chlorination:
Two main reservoirs in Biyo-khadar that store pumped water from Geed-deeble are chlorinated through
dosing chlorine solution by using home- made feeders made-up to 200 liters volume plastic container
(barrel). Residual chlorine is monitored at distal points in the distribution network in Hargeisa city. The
gravity doser installed earlier in Biyo-Khadar provided by WHO and through MOHL given to Hargeisa
water authority was dismantled due to mal-functioning. Excess overflow water spills and used engine oil
drain into the same open land through soak away pit over running on soil and contaminating the
environment and water supplies located far away from the source. A ditch over filled by used engine oil
was dug in the compound of the water works for disposal of burnt engine oil. The water pumping
booster station needed renovation as cracks and debris appeared in the infrastructure. The room for the
gravity dozer was assessed for renovation
Advice was given to the water supply booster station manager to dispose of waste water drains in pool
rather than leaving to run in a stream. Used engine oil should be disposed of in large ditch separate from
the water drains.

Burao town water supply
We visited and met Burao town water agency officers who simmarily pointed out that Burao town
receives its water supply from two main sources boreholes and shallow wells and water from these
sources is used for all purposes. The boreholes where the town gets its water from are water is owned
by different stakeholders who are involved in the public water supply system. These owners of the main
borehole water supply sources are
A waste from the water plant (mostly oil)is
released to the environment.
77

1. Burao water agency which owns: 5 borehole wells
2. Togdheer regional ministry of water & Mineral resources: 4 borehole wells
3. Private owners owning: 22 borehole wells

While there are 30 shallow wells owned by individuals that provide water supply to the community
residing along Togdheer dry river banks and also by some business units close to the shallow wells.
Almost around 20% of Burao town population use this water supply from shallow wells throughout the
year, the shallow wells water was highly contaminated during the cholera outbreak in 2007, where the
coli form concentration were 1000 coli forms per 1ml of water (MOH & OXFAM GB).
Owners do also refuse well water chlorination, the borehole well owned by the government (water
agency and Ministry of water) provide water to the public through direct connection from the borehole
or pipe directly coming from the borehole into the dwelling houses or business units and of course
through kiosks installed at strategic points and convenient locations for the public use. In private owned
boreholes, water is transported by tinkering trucks get water for the wells and distributed to the public.
Major constraints observed in Burao water supply
There is no synchronized management system in the production and distribution of water supplies in
Burao for there is no central (main) storage reservoirs for the pumped water supply from the boreholes
owned by different stakeholders. Hence, in the event of water borne diseases outbreak or in the
ordinary business of maintaining water quality chlorination of water is not possible. So also, people run-
out of water if there is a breakdown of one borehole providing water to certain areas of the town. There
is therefore priority need to construct central water storage tank for Burao water supply system at the
very earliest possible.
Water supply in Erigavo, Lasanod, Berbera and Gabiley
Erigavo and Berbera water supply systems are modest in quantity and quality to suffice public demands
but need expansion to meet the public demand, while water supply in Gabiley is so scarce and Lasanod
water is from shallow wells which are grossly polluted and bitter in taste. Gabiley borehole wells yield
little water and do contain exceptional high contents of chlorine that is injurious to health and gives
water to bitter taste. In Lasanod, the drinking water supplies are hard water and alternative water
supply is rainwater harvesting. Water shortage- crises is, however, common in Somaliland with cyclic
droughts being regularly experienced in every 2 3 years. Rain water harvesting is a priority
intervention to increase public water supply. Water treatment processes should be promoted for the
protection of public health in surface and ground water.
Borama water supply
Borama water supply is perhaps the most efficient water supply system to the public. It operates under
ppp and about 90% of the town population gets. Water from the Sheba company water supply is
chlorinated regularly and is of high quality for drinking. To address the need for safe drinking water, and
to improve the health and well being of the population in Borama city, the participation of the private
sector in the urban services for safe drinking water was viewed as critically important proposition. This
realization has established the bases for the formation of a public-private-partnership (PPP) company
that delivers safe drinking water for the population of Borama city. A study was carried out by the
international consultants Hydroconseil on commercialization of urban water distribution and
collection and disposal of solid and liquid waste in Somalia/Somaliland in April 2002. That study was
funded by the European Union and UNCEF Somalia where the a Lease Agreement Contract has been
developed between the Borama Municipality, Ministry of Water and Mineral Resources, and Borama
Utility Corporation, a private company to operate and manage the Borama Water Supply
System(SHABA).
78

Fig. 2: Growth Indicator of SHABA Water Company (Borama)












Fig. 3. Household Connections Per 1000 Inhabitants


Fig.4: Water Distribution in 2008



79

Today the establishment of PPPs for water remains a sustainable methodology which is intended to
reduce the longer term reliance on foreign support for its operation. While only less than 70% of the
population of Hargeisa uses piped water, roughly more than 90% of Boramas population uses piped
water at their homes, businesses and work places. However, as Mr. Abdirahman Abdisalam, director of
planning and water quality, emphases, initiating a PPP is bound to failure without having properly
studied and improved water supply infrastructures in place. In other words, a successful PPP cannot be
established without a strong functioning Public Partnership and supportive national water policy and
water regulations in place. In addition, a strong aspiration for change should exist, a strong commitment
must be thought and received from the local and regional authorities, a strong community leadership
should be available. And finally, transparent procedures should be followed for company shareholders
and company formation. Because of SHABA took these steps and all these procedures and transparency,
it remains a sustainable and strong company that is making a profit while providing respectable services
with quality water to the community in Borama city, Awdal, Somaliland, as seen below.

Testing Chlorine level in
tap water inside SHABAs
office
80




Achievements
Public private partnership in urban water supply system in Borama over 90% of the town population
receives safe drinking water from boreholes. Gabiley water supply is very scarce and it is difficult to
provide adequate water to the public we are trying to improve and manage through ppp. Berbera water
supply is to be tested for ppp. Burao water supply: There is no central water storage reservoir in Burao
water supply system is directly piped from the boreholes into the dwelling houses business premises
and work places. Sanag and Sool: hard water from shallow wells the water is not good for drinking, salts
in water are recorded as high as 9000mg/liter in some places.

Rain water harvesting is common by using dams, Barkets etc, there is lack of coordination between line
ministries, a wider spectrum and holistic approach is needed for effective WASH coordination to level
out water born diseases. The same policy of ppp can be applied in the management of water and the
health system. Emerging problems is the leather tanning factories in Daar-budhuq the compound of the
factory was a geological camp owned by MWMR, baseline study of water supplies in Daar-budhuq
needed in order to establish contamination levels of ground water from the beginning. Need for setting
holistic approach for environmental quality monitoring by experts/environmentalists from WHO, MOHL
& MWMR. should establish water and environmental quality control center, training people in health,
water and sanitation collectively will be one strategy plan to control water-borne diseases was the view-
point of the MWMR high ranking authorities problems high in the agenda. Water tankering trucks from
dams and shallow wells without chlorine are causing disease outbreaks by users.
Boreholes we are engaged in water redevelopment plans to improve access to safe water and increase
perceptive water consumption. Sewage water and water supply systems, where vacuum tankers carry
sewage one time and drinking water supply in another time.
Tog-wajale Barkets and dams are the source of public water supply and water is green water showing
it has changed in color due to pollution.
Communal food markets

All main towns and some peri-urban centers have at least one communal food market with
infrastructure and construction design specification for food sales-especially meat, groceries (vegetables
Inside the finance office
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& fruits) and milk etc. Generally, the meat market is part of the communal food market. It is the main
meat bizarre for the urban and peri-urban areas. The basic levels of sanitation and hygiene standards in
those communal food markets range from poor to relatively satisfactory. In some meat markets, the
tables of the meat vendors are made up of cement stands and in others, wooden or metallic tables are
used for meat display and sales. In most cases, cleaning practices are sub-standard for there are no
adequate water supplies or even lack of water for washing the whole premises after and before use.
Meat is generally open, exposed to dust and flies and rodents can get easily to contaminate. However,
meat markets are relatively more secure than open-street vending of meat. If adequate water supply is
made available and cement floors are regularly maintained smooth without cracks the sanitary situation
of meat markets will substantially be improved. Vegetable and milk markets are either located within
the main communal food market or at a fringe part of the building separated from the meat market or
adjacent building next to the meat market. The grocery and milk market areas are generally cleaner than
the meat market and could be categorized as moderately hygienic. But, a large portion of garbage is
usually generated from spoiled vegetables thrown away. Groceries are perishable food items and large
quantities of vegetable and fruits get spoiled for there is no cooling and preservation system installed in
Somaliland food markets and adds weight to street garbage. The plastics used to transport vegetables
and milk as containers and for distribution are harmful and hazardous and not ideal to use for edible
items and are not environmentally friendly. The container are plastic tins which are not easily washable
and do attract flies, hence, they pose constant health problems to public alternative supply of utensil
are highly recommended to be used for they are biodegradable. Open field food vendors are also
common with unhygienic habits.
Food Catering Processing Establishment and Warehouses

The food catering establishment (food-drink establishment) range from city star hotels, restaurants,
teashops, snack bars and soft drinks premises which are reasonably hygienic, clean and attractive.
However, ravaged small buildings in slum areas used as food catering places that are unclean, dirty and
offensive are also common in all urban setting. Local government hygiene inspectors do carry out
regular inspection visits to food premises and corrective measures for improving sanitation and hygiene
are recommended by the inspection teams and implemented by food vendors. Generally, minimum
standards of cleanliness are maintained, while slum market areas are demolished by the municipal
authorities from time to time. The food processing establishments include bakery factories, soft drinks
bottling companies and dry powder soft drinks, processing and packaging factories. In other ward,
expired and spoiled food are condemned and destroyed from time to time.
Although it is not approved by laboratory for quality assurance, these food processing bottling and
packaging factories fairly meet the standards of commercial sterility of the food items moving for sales.
The manufacturing process follows fair hygiene manufacturing practices. However, it is well noted a
laboratory approval for quality assurance is highly obligatory.

2.8.5: Need for National Laboratories for Environmental Exposure Assessment
As part of the attempts to understand better human exposures to hazardous substances released into
the environment, there should be a way to test these contaminants in the water, food and air, and in
the work place. Today, there are no existing environmental testing activities or function environmental
labs, private or governmental, in the whole country. There is a great need of environmental laboratories
with their skilled employees who could monitor hazardous substances in the environment. There is
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definitely a dire need for the creation of an environmental agency that could provide the expertise and
the know-how on risk assessment. Such an agency should provide a starting point from which exposure
assessors can consider the priorities among environmental media or contaminants as it develops
guidelines for conducting exposure assessments for use in risk assessment. There is need for the
creation of such agency that could develop exposure-assessment strategies. Such strategies will require
the knowledge and involvement of scientists who should be responsible for running programs on human
study research, environmental testing, and developing exposure assessment protocols and guidelines.
Such guidelines will include public education and awareness, risk assessment and risk management,
including enforcement and monitoring. The awareness provides an opportunity to link exposure
assessment with the practical application of risk reduction and exposure mitigation strategies that
could protect the public from the adverse health effects or the biological effects of the contaminants in
the food, water and in the air. Customarily when carrying out epidemiologic studies, as relationships
between particular agents and health effects will become better understood, risk-assessment
methodology will be evolved to estimate the likelihood that exposure to a given pollutant will produce a
given health effect. Generally, the measurement methodology involves three steps:
1. Sampling
2. Separation, and
3. Detection.

At the present time there are no laboratories equipped to carry out the above methodology with
accuracy and effectively. Quality assurance is a critical part of exposure studies and must be established
as part of the initial study design, at which point it should be decided what precision and accuracy are
needed to test the contaminant of interest. The choice of sampling strategy and measurement methods
hinges on the physical, chemical, and biological characteristics of the pollutants of interest. Separation
techniques involve chromatography processes such as liquid chromatography, gas chromatography,
mass spectrometry, atomic absorption, ion chromatography, thin-layer chromatography, just to
mention a few. While detection methods involve detection devices such as flame-ionization detectors,
photoionization detectors, selective ionization detectors, thermal conduction devices and so on. There is
a need for an environmental laboratory equipped with some the advanced instrumental techniques with
high caliber skilled staff operating them.
Unfortunately, none of these instrumentations are available in here and it is very difficult for any
scientist to engage a field study or carry out research and development work without having these
instruments. The only available labs are found inside the public hospitals with very limited and
instruments. The ministry of health of the republic of Somaliland is currently undertaking the
operationlization of essential drugs/mechanics quality control monitoring and assurance by using the
available mini-lab for the testing of samples of the various essential drugs used in both the public and
private health sectors. Trained and qualified quality control officers do make the required drugs quality
control tests including the potency, dose and weight of the medicines in Hargeisa Group Hospital,
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affiliated premises. The min-lab is made available by the WHO to the Ministry of Health (Annex-E), in
order to promote the functioning institutional framework and systems of the ministry to bring about
improvements in national health services especially towards the procurement and dispensing effective
quality medicines in health care settings country-wide. However, the mini-lab is only an entry point to
drugs quality control for its capacity is very limited. A broader public health laboratory with international
standards for comprehensive and integrated quality control systems of food and drug safety and
monitoring environmental quality in all aspect is an absolute necessity to be supported and established,
indoor to protect public health and environments.









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Hargeisa Group Hospital
Borama General Hospital Specimen
collection station
85

There are also few other initiatives to establish environmental and safety protection agency in
Somaliland. The Somaliland Consumer protection Agency (SCPA) is an autonomous consumer protection
agency established under presidential decree on October 31, 2009. The aim of the organization is to
protect the rights of the consumers by ensuring that products and services consumed within the country
meet quality and safety standards. As the sole agency mandated to undertake consumer related
matters, SCPA intends to establish a comprehensive and very effective consumer protection system with
all applicable specifications, measurement system, calibration program, and quality control system.
Furthermore, SCPA will establish modern laboratories in all regions and will therefore require proper lab
equipment to ensure that the quality of consumer goods meet international standards. However, one
major herald the agency facing is the lack of financial support to begin its operation (Annex-C).



2.9 CONCLUSION
This situational environmental health assessment has revealed the reality on ground in relaying the
environmental health in the three regions selected for this project, Somaliland, Puntland and South-
Central Somalia. There exist near saturation of public health problems due to poor sanitation and lack of
hygiene living condition, throughout the regions. It, therefore, calls for immediate and effective
interventions to scale back some of the problems and to introduce new initiatives and guidance for
better waste management systems. It is critical that all regions make the needed changes to save the
environment and improve peoples health status. The assessment has also identified that people want
to change for the better, and have also the know-how expertise in the country, as well, if the right
people, especially capable Somalis, are put in positions to manage the situation inside the country,
instead of putting things completely under the authority of someone who wants to handle the problems
from the distance, while living as far as Nairobi and in farther other places. There is a multitude of
international and local NGOs who, though providing some modest work and guidance, failed to provide
sustainable environmental and public health protection strategies. Their track records on the
environmental health are decidedly mixed at best, if not a reflection of their total disregard to the
environmental health conditions in the whole country. Despite their bold statements in their preamble
and lofty environmental goals, however, their work demonstrated many shortcomings. Many of their
goals of environmental health have neither be met nor, in many cases, approached with sustainable
strategies. The sheer volume of abandoned and over flooding waste in all regions we have visited, and
the perceived potential threat to human health, is a testimony to their failed strategies that, though
elegant in theory, were not intended to address the environmental health issues in the country in a
sustainable and lasting way. This current alarming situation alone necessitates immediate and effective
regulatory responses that can address the environmental health and that of the public. These regulatory
strategies should be designed to reduce the amount of waste and promote its reuse or recycling, which
is a prevention-oriented environmental policy. Building modern landfills and incinerators are definitely a
tall order for the government and the all the NGOs operating in these regions. In addition, public health
officials should be invited to have a more forceful participatory role when assessing the health risks of
proposed development projects. Most importantly, there is a need for transparency and corruption-free
systems to guarantee that the allocated funds are spent where they were intended to be spent. As it is
now, there are many projects that would not see the days light and will not materialize without having
money changing hands, a corruption at its worst form that transcends across international donor
representatives, local NGOs and as well as ground engineers and government officials.
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Environmental laws and regulations are not a recent phenomenon in the world. According to the
International Organization for Standardizations ISO 14001, environmental management systems have a
policy objectives that include improving environmental performance, complying with regulations,
preventing pollution, auditing performance and disclosing information to the public, and Somalia
shouldnt be different. It is time that the international communities and the international donors have
refocused their energy and redirected their resources towards addressing the critical environmental
issues discussed on this report. It is time that the International donors focused on less geopolitics,
regarding the Somali issue, and more on addressing the human and environmental needs and concerns
delineated in this report.
2.9.1 RECOMMENDATIONS
The current environmental health situation calls for two major and critical measures to be taken: 1) to
address immediately the current volume of biohazard waste, both solid and liquid, which poses
immediate public and environmental health adverse consequences, in order to avoid further exposure;
and 2) to establish an effective and operating system to reduce any further degradation of both
terrestrial and aquatic ecological systems that are now under great stress. More specific
recommendations include:
immediately address the solid waste problem and design better landfills, incinerators and
better waste management systems
it is recommended that the local government and the local NGOs formulate and implement
effective environmental policy to address the solid waste issues
immediately address and protect the oceans from abuses and destruction of Coral reefs
define and design an environmental protection program, agency or department that promotes
an active involvement in the environmental and public health protection programs, and make it
sustainable
allocate an adequate resources for the protection of all ecological systems that could guarantee
the protection of biodiversity
increase capacity building at all levels and start training for the conservation of habitats and
biodiversity at local and regional level
establish the legal and policy framework for conservation of habitats and biodiversity, both in
terrestrial and aquatic ecosystems
reduce deforestation and degradation of the environment to improve and sustain
environmental health
start a dialogue on how to sustain the small initiatives working towards better environment
health
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should involve, invite and employ Somali scientists to start working on research to identify
environmental contaminants that are saturating the food cycle in the country
build and sustain better equipped environmental health laboratories run by skilled staff and
scientists to develop and epidemiological studies on public health and environmental health
build and sustain better equipped public health laboratories run by skilled staff and scientists to
develop and epidemiological studies on public health and environmental health

increase and sustain the regional co-operation and encourage their efforts to come together,
share knowledge, and work together for better environment, as we did in this project.
try to bring this group back together and commend them for work they have done, despite all
odds and difficulties they have faced to produce this report.
Introduction and strengthening of public health inspection services and regulatory framework
for law enforcement measures.

launch comprehensive public education information and communication and awareness
programs

enforce occupational health and safety programs at the work place

Introduce appropriate low-cost sanitation technology options in the integrated management
and control of solid and liquid wastes.


PUNTLAND: SANATARIAN ZONAL REPORTS
SITUATIONAL ANALYSIS
Puntland State of Somalia, Ministry of Health
Environmental/public health assessment in Puntland.
By ministry of health assisted by WHO Somalia
The public and environmental health policy:

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REGIONS
Bari
Karkaar
Nugal
Mudug
Sool
Sanaag
FOREWORD
The overall goal of the Public and environmental health Sectors of the Government of the Puntland
State of Somalia is to attain the highest possible health status and social well being of the individual, the
family., the community and the society as whole.. In order to attain the stated health status, the
Government of Puntland is seeking to provide equitable, affordable and sustainable, promotive,
preventive, curative and rehabilitative health care services, with the ultimate objective of reducing
morbidity mortality, improving life expectancy, fostering comprehensive social development as well as
poverty reduction.
To achieve the fore stated goal, the Government of the Puntland State of Somalia, through the Ministry
of Health, has articulated the public and environmental health Policy, which I am hereby forwarding.
This policy will guide the process of Health Sector Reform (HSR), Planning and Management as well as
health care service delivery. The challenge of the Health Sector Reform, Planning and service delivery is
for it to attain the highest possible health status for people of Puntland State within the background of
scarcity of facilities, manpower, limited resources, lack of human resource, lack of joint Cooperation line
ministers/local authority/ regions/districts and insufficient international agencies support . To achieve
this, the Government of Puntland through the Ministry of Health has taken a step to develop the public
and environmental Policy which aim to:-
(a) Transform the current donor-driven healthcare system into a self-sustaining, community-based co-
financed and co-managed healthcare system, and this will require that the government to promote
capacity building of the human and institutional structures, the communities in planning, management,
monitoring the provision of quality health services.
(b) The cornerstone of Health Sector Reform is devolution of the functions of planning, budgeting, and
management of health services, resource mobilization and service delivery to the regions/districts;
(c) The central Ministry of Health will be restructured to make it lean, cost-effective and responsive to
the challenges of the HSR decentralization vision. The core functions of the Ministry of Health will
include, policy formulation, strategic planning, resource mobilization, financing and budgeting, donor
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co-ordination, legislation, monitoring and evaluation of the performance of the health sector, human
resource development policy, and inter-sect oral collaboration with other line ministries.
(d) The balance between curative and preventive health in the allocation of resources to hospitals and
the district health systems will while favoring the delivery of National.
Essential Health Care Package shall not be allowed to shift too much towards the curative side, given the
fact that the system will still have to promote preventive health services
(e) The policy of the Government of Puntland on rehabilitation and construction of health infrastructure
will be that of consolidation of existing health facilities first and construction of new facilities only if
absolutely necessary.
(f) The Policy of the government will be to strengthen the currently available environmental health
services which are currently under severed by developing appropriate action plans and necessary
legislation to promote healthy eating habits in order to gain appropriate health status.
Finally, the E.H health policy is a living document. It will be periodically revisited and revised to
accommodate the dynamics of the health sector. To operationally the conceptual ideals of the National
Health Policy, a medium-term National Health Strategic Plan will be developed. This plan will be coated
in order to compare the vision with the available resources. The Ministry of Health Annual Work Plans
will roll out from the National Strategic Plan.In order to realize the vision and the mission of this policy,
the government will require commitment of all sectors of the people of Puntland.
2. Government
The Puntland State is divided into central, regional and local authorities, which are districts in the rural
and municipalities in the urban settlements. The administrative system created for governance provides
for clear separation of powers and responsibilities between the executive, the judiciary and the
Parliament. Punlands State Charter allows the operation of Shari, Secular and customary laws. In line
with the Somali tradition, the elders still act as the authority in all aspects of life. At present in Puntland,
the traditional elders continue to be the highest moral authority of the land. They are called upon to
arbitrate the cases of disagreements in the regional and interregional authorities, or between political
organizations and arrangements. The regional authorities, parliament, the executive and the inter-
regional governments are all vested with the responsibility to manage the affairs of the regions in all
walks of life. The moral authority is however, vested in the traditional elders as afore stated.
3. Health status
The statistics currently available, although scarce indicate that upper respiratory tract infections and
diarrhea are the two main causes of morbidity/mortality among the adult and children population in
Puntland State. As in the rest of the region, the health status can be categorized as poor. The rates of
preventable diseases, especially infections ones that include diarrhea (both blood and watery), acute
respiratory infections, malaria, tuberculosis, and STIs are still high. Also included in the high category are
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complications of pregnancy and childbirth. Malnutrion due unavailability of food as well as misplaced
nutritional practiced is also still prevalent. The problem mainly relates to availably of health care
delivery facilities, health seeking behavior, the health policy, and access to preventive health
interventions. In addition, the country is witnessing an increase in cases of trauma, metabolic and
degenerative conditions such as diabetes, rheumatic diseases, and hypertension. The mortality rate in
Puntland is still high. 100,000. Infant mortality rate (IMR) is 175 per 1,000 live births, and child mortality
rate (CMR) is 211 per 1,000 live births according to Multiple Indicator Cluster Survey.(last survey) ,
However the recent unpublished data indicate that this situation could have changed, and that the
current IMR is about 73 per 1000 live births and CMR is 115 per 1000 live births.
A significant contribution to mortality is from the maternal mortality ratio, which is estimated to be
1,600 per 100,000 live births, (and the unpublished recent survey indicates that this figure has changed
to 1013 per 100,000 live births). Because of low rates of contraception (11.1%), most women become
pregnant within less than 2 years and hence this means that a high number of women, i.e. more than
25%, die within 40 months following the first pregnancy. The most common causes of maternal death
include anemia, pre-partum and post-partum hemorrhage, malaria during pregnancy, sepsis or infection
after birth, and UTI. A major contributing factor to the bleeding include bleeding during and after
delivery, obstructed labour, infections during pregnancy, and as a result of female genital mutilation
(FGM). Other factors include too short birth intervals, poor nutrition, and poor modes of delivery given
that most deliveries still occur at home. Infectious diseases are the most common causes of ill health
and death. It is estimated that in Puntland State, there are approximately 2,000 new cases of
tuberculosis annually. The high rate of tuberculosis is attributable to overcrowded homes, refugees and
refugee camps, disintegrated systems of treatment and follow up, and uncontrolled use of anti-
tuberculosis drugs leading to a possibility of having drug resistant tuberculosis. In addition, there are
other pre-disposing factors such as malnutrition, measles and the human immunodeficiency virus(HIV)
infections. The rate of tuberculosis among the HIV-infected currently stands at 4.5% disability in
Puntland. Malaria is seasonal and hence results in high mortality sometimes as much as 20% of
childhood mortality. It is estimated that malaria still accounts for 10% of all hospital admissions in major
hospitals in Puntland. Other emerging health problems that pose major threats to the people of
Puntland include STIs (about 20% in MCH) and HIV/AIDS (1% in Puntland). There are also other diseases
that affect the people and indirectly affect their productivity. These include diseases of the eyes and the
skin that are largely preventable. Others are renal diseases are also becoming common.
4. Determinants of health
The major determinants of health in Puntland State are education status, access to safe water,
sanitation and nutrition. These are yet to be fully developed. Although the rate of malnutrition is still not
as high as in some neighboring countries, acute wasting and precipitous severe malnutrition occurs from
time to time due to frequent occurrence of severe drought, outbreaks of diarrhea, malaria and measles
and infection with HIV virus. The Multiple Indicator Cluster Survey (MIDS) conducted with the assistance
of UNICEF in revealed that only 24% of the population have access to safe water. Among the nomadic
community, only 2% of the community obtain water from protected sources. It was also found out that
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in urban centers, more families use pit latrines or such facilities for sanitation, and shallow wells were
the main water sources. However, in urban areas, some of these wells are dug close to pit latrines and
septic tanks; hence there is high likelihood of cross-contamination. Basic education is an important
determinant of health. Education empowers the recipients with information, perspective, and income-
generating capacity that facilitate the lifestyle that prevents most of the diseases related to lack of
sanitation. However, it is estimated that currently only 27.7% of the children aged 9-14 years are
attending school and this varies between 34% in urban area, 13.3% in rural areas and 1.3% in nomadic
`communities. Low levels of education severely limit the capacity of the people to appreciate health
behavior associated with health risks. Health is also influenced by the general infrastructure such as
communication systems and access to preventive health services.
The combined effects of factors such as infrastructure, attitude of workers in public health facilities, lack
of health promotion and education, cultural beliefs, and availability of alternative services are other
major determinants of health. Currently, the quality of health services offered by public health facilities
in Puntland is wanting and utilization is low. The results of Multiple Indicator Cluster Survey in the late
1990s (1997/98) indicate that among the different populations of Puntland, only 21% use public health
facilities. The rate is lower among the nomads (8%) while in urban areas the rate still remains lower than
50%.The recent survey which is still unpublished only 6.9% of the deliveries are done in the
hospital/MCH with approximately 60.5% of the deliveries being assisted by TBAs or relatives/friends. On
immunization 8% of the children have immunization cards, and only 25% have had BCG vaccination
while 30% have had measles vaccination and 20% have had DPT vaccination. ITN availability is about
22% and antibiotic treatment for chest infections stand at 26.1%.The solid fuel use still stand at 99.4%,
indicating high level of population within the households. Private health facilities in Puntland do not
offer preventive services hence the rate of using preventive health services is still low. There was also a
low rate of awareness of positive health seeking behaviour because of lack of health promotion services.
5. Water and sanitation
People and their livestock depend on traditional hand-dug wells, springs, rainwater catchments such as
Berkeds (cement catchments) ,Ballis (earth catchments), and boreholes. the most of the populations
draw water from the unprotected water catchments or wells, and that the quality of water for human
consumption was poor. This study also revealed that the general sanitation of the population's
residential areas was poor.
6. Policy Development
Given the above, the Government of the Puntland State of Somalia is determined to review its health
and environment policies and put in place a healthcare delivery system that will be and sustainable. This
policy therefore should provide clear and constructive guidelines for legal and institutional framework,
which strengthens effective and efficient management by provision of appropriate infrastructure and
skilled manpower for delivery of appropriate health system in Puntland:
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- establishes a health system that is effectively re-oriented towards health service delivery through
primary health care
- improve professionalism and quality of care in all health facilities including mobile outreach activities;
- improves collaboration and partnership between the health sector, communities, private, other
sectors, donor community, NGOs, and faith based organizations.
- achieves a significant reduction is the rates of infant, child and maternal mortality, through the
provision of competent and skilled health care personnel, appropriate health delivery facilities and
better services etc
- improves on the delivery of the National Essential Health Care Package including the delivery of Safe
Motherhood and the Young Child Survival Strategies.
- increases overall pooled resources for the health sector through mobilization of adequate
- Resources, equitable distribution and development of effective cost-recovery system
- promotes responsibility for safe self-care to individuals, families and communities.
- Promotes good sanitation practices in order to produce a healthy and working society.
Health facilities in punland.
The resources available to the Ministry of Health currently are limited. Its role is primarily to coordinate
the activities of the international agencies and international and local NGOs who provide support to the
health sector. The goal of the Ministry of Health is to improve the health of the population of Puntland
through increased access to health services. In order to improve health services in urban areas that have
higher population densities, the international and local NGOs have constructed MCHs and health posts.
CHWs and TBAs have also been trained on basic health services. The main causes of morbidity and
mortality in Puntland are acute infectious diseases, chronic communicable diseases, adverse behaviors
and unhealthy traditional practices. The most common infectious diseases that contribute to the
morbidity and mortality, probably accounting for more than half the deaths for children under five years
in puntland include: - Malaria, ARI (pneumonia) and diarrhoea. Tetanus (especially neonatal) and TB are
also among the contributors of mortality in children and mothers of child bearing age. HIV/AIDS
prevalence, which is estimated at 1%, is not a major cause of morbidity and mortality at the moment.
However going by the trend in neighboring countries, this situation might change in future in the
absence of preventive measures. Outbreaks of measles, cholera, dysentery and meningitis pose a major
threat to the public health both in morbidity and mortality.
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List of the functional MCHs and OPDs including the supporting agencies/institutions
S/N Regional location: Nugal
Name of the MCH Locality- village/town Institution/agency
1 Gambool MCH Garowe MOH
2 Waaberi MCH Garowe MOH
3 Badey MCH Eyl PUPA
4 Dawad MCH Eyl SRCS
5 Burtinle MCH Burtinle _1 MOH
6 Dangorayo MCH Dangorayo SRCS
7 Hasbahalle MCH Hasbahalle SRCS
8 Godob jiiraan MCH Godob jiiraan SRCS
9 Jalam MCH Jalam SRCS
10 Kalabayr MCH Kalabayr SRCS
11 Sinujiif MCH Sinujiif SRCS
12 Qarhis MCH Qarhis SRCS
13 Burtinle MCH_2 Burtinle MERLIN

S/N Regional location: Mudug
Name of the MCH Locality- village/town Institution/agency
1 Galkacyo MCH-1 Galkacyo- southern SRCS
2 Galkacyo MCH-2 Galkacyo- southern SDRO
3 Garsoor IDP MCH Galkacyo- northern PMWDO
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4 Israac IDP MCH Galkacyo- northern PMWDO
5 Hurumar IDP MCH Galkacyo- northern PMWDO
6 Galkacyo northern MCH Galkacyo- northern MOH
7 Galdogob MCH-1 Galdogob SRCS
8 Galdogob MCH-2 Galdogob MERLIN
9 Harfo MCH Harfo SRCS
10 Bursalah MCH Bursalah MOH
11 Jariban MCH Jariban SRCS
12 Balli-busle MCH Balli-busle SRCS
13 Baad weyn MCH Baad weyn SRCS

S/N Regional location: Karkaar
Name of the MCH Locality- village/town Institution/agency
1 Qardho MCH Qardho AAH
2 Dhudo MCH Dhudo AAH
3 Beyla MCH Bender beyla SC UK
4 Rako MCH Rako SRCS
5 Sheerbi MCH Sheerbi AAH
6 Waaciye MCH Waaciye SRCS
7 Haafuun MCH Haafuun SC UK

S/N Regional location: Bari
Name of the MCH Locality- village/town Institution/agency
1 Ugaas yaasin MCH Bosaso AAH
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2 B/abdulaahi MCH Bosaso MOH
3 Boqolka bush MCH Bosaso MOH
4 Buulo elay/aduur MCH Bosaso MOH
5 Shabeele IDP MCH Bosaso MOH
6 Tuurjaalle MCH Bosaso MOH
7 Armo MCH Armo MOH
8 Baargaal MCH Baargaal HODMAN
9 Iskushuban MCH Iskushuban SRCS
10 Ufeyn MCH Ufeyn SRCS
11 Haabo MCH Haabo BIOFIT

S/N Regional location: East Sanaag
Name of the MCH Locality- village/town Institution/agency
1 Badhan MCH Badhan MOH
2 Dhahar MCH Dhahar MOH
3 Lasqoray MCH Lasqoray LASQORAY CONCERN

S/N Regional location: Sool & Cayn regions
Name of the MCH Locality- village/town Institution/agency
1 Taleeh MCH Taleeh MOH
2 Hudun MCH Hudun MOH
3 Buuhoodle MCH Buuhoodle MOH
4 Boocame MCH Boocame MOH

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Table 1: Distribution of Mothers by Place of Delivery: 2008 (Percentage)
Place of delivery Urban
Hospital 16.1
Private Midwife Clinics 12.0
Home 72.0
Total 100.1
Source: Ministry of Health
Table 2: Availability of Health Personnel: 2007
Description Bari Nugaal Sool Sanaag Mudug Cayn Karkaar Total
Doctor 28 8 7 3 10 5 3 36
Pharmacist 3 5 4 9 4 0 2 24
Post bas nurse* 1 4 1 3 2 2 8 20
Midwives 18 5 2 18 6 13 1 45
Nurses 25 45 35 48 76 8 6 218
Lab. Tech. 6 3 3 4 4 2 3 19
Asst. lab. Tech. 28 3 10 4 4 2 0 23
Sanitation 14 13 10 8 2 4 4 41
CHWs 72 125 19 17 70 5 2 238
TBAs 72 12 19 14 1 5 1 52
Total 267 215 110 128 179 46 30 708
Source: Ministry of Health
*Post bas nurse is a qualified graduate nurse from college with additional training


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Table 3: Health Indicators: 2008
Health Profile Indicator
Crude death rate per 1,000 population 16
Infant mortality rate per 1,000 live birth 128
Maternal mortality rate per 100,000 live birth 1,550
Mortality rate under 5 per 1,000 live birth 205
Life expectancy at birth 47
Antenatal care attendance 50
Children with less than 2.5kg 10
women delivered at health facility 12
women delivered at home 88
women assisted TBA 80
women assisted by qualified health provider 10
Percentage of Children < 5 years had diarrhoea two weeks pr or the survey 21
Percentage of women aware of any family planning and methods 37
Percentage of women aware of modern family planning and methods 10
Percentage of women aware of HIV/AIDS as STDs 58
Percentage of women aware of syphilis as STDs 5
Population with access to safe drinking water 23
Source: Ministry of Health
Some ongoing projects.
UNICEF Somalia
North East zone
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Wash
Annual work plan 2010
Executive Summary
The program aims at enhancing capacity of institutions and communities to manage WASH systems
effectively and efficiently, sustaining existing WASH services and expanding services to the unserved,
sustaining and expanding hygiene education to communities through schools and MCHs and satisfying
UNICEF's Core Commitment for Children in responding to WASH needs in emergency situations.
1. Outcome: Increased access to safe water, improved hygiene and sanitation services for 310,000
unserved population.
2010 Target: 310,000 unserved population have increased access to safe water and improved
hygiene and sanitation services.
2. Output 1: 2 Regional offices of Ministry of Public Work and Transportation (MoPW&T)/ PSAWEN
rehabilitated/ equipped, 36 government officials received technical training on WASH and water
policy promoted involving water authorities and communities in 10 locations within 2 regions, 5
districts..
2010 Target: Infrastructural and institutional capacity of WASH authorities enhanced in 2 regional
offices and water policy promoted in 10 locations within 2 regions, 5 districts.
3. Output 2: 4 urban/semi urban water schemes, 5 water yards, 5 solar powered shallow wells, 10
hand pumps, 15 protected shallow wells and 20 berkads rehabilitated/ constructed benefiting
310,000 unserved population.
2010 Target: Water infrastructure servicing 310,000 people within 6 regions, 12 districts
rehabilitated with community and/or private sector involvement/ participation.
4. Output 3: 204 communal latrines, 40 school latrines and 10 MCHs latrines constructed and
functional benefiting 25,620 people and 140,000 people within 6 regions, 18 districts are exposed to
continuous education on good hygiene and are involved in environmental sanitation activities
2010 Target: 5 communities, 40 Schools and 10 MCHs within 6 regions, 10 districts have functional
sanitation facilities, exposed to continuous education on good hygiene and are involved in
environmental sanitation activities.
5. Output 4: Supplies (5 generator sets, 5 pumps, 3,750 pieces of pipes & fittings) delivered to
partners, 40 personnel from local WASH authority trained on emergency response benefiting 60,000
affected people.
2010 Target: Enhanced 5 water infrastructure and technical capacity of WASH authorities in 6
regions to respond to emergencies.
6. Total Funds Planned: US$ 2,861,250
7. Total Funds Received:
8. Total Funds Required:

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Environmental health Assessment in mudug region.
This assessment was started 27/06/2010 in mudug region to assess the public &environmental health of
the province which target to know the public and environmental health facilities, which are working and
which are not working, and existing needs and gaps. The team engaged for this assessment focused on
the following areas:
Garbage (waste) disposal monitoring.
From the collapse of central government of Somalia there was not active management system of waste
disposal in mudug region. The local authority has been trying to monitoring the waste disposal from the
foundation of puntland governmen , but due to insufficient facilities ,local government has not
succeeded to manage enough .
Mudug local government has only one car for transportation of Garbage /solid waste in Galkaio city
which has population of more then three hundred thousand people. The city produce different solid
waste such as commercial garbage , food market garbage ,home garbage ,mechanical scarabs, and
hospital/clinics/pharmacies waste, which are very hazardous to human health ,and there is no separate
collection system, also there is no garbage collection points in galkaio. There is one disposal pit which is
far away from the town about 7k/m to use as final disposal but the most Garbage of the town are not
brought to that pit disposal, because the people adapted to throw garbage to an organized between the
villages and streets, due to insufficient of facilities and power full authority in addition to lack of
awareness of the community. The workers involve collection garbage do not have enough material,
necessary equipments and personal protection cloths, so that garbage hazards are dangerous for the
workers involved the collection of waste especially and the population in general. The other mudug
districts like Galdogob, and Jariban and other villages of the region, community are trying to solve their
problems related to that issue. So that they need to be supported how they can manage the waste
disposal in their districts.
Food market hygiene
There was no food market hygiene guideline in the region since the collapse of central government of
Somalia, so that the food market hygiene are very poor, because there is no guideline or regulation to
control food market, like restaurants, cafeteria, milk, meat and fisheries markets. Also there is no
control food transportation and storages, and system to manage food poisoning.
This has caused many disease related to lack of food hygiene ( food born- disease).which is more in
Puntland population. There is slaughter slab, meat and milk market, which are under construction in
Galkaio city implementing by VSF-Suisse /VSF-Germany organization. There is also ongoing fish market
construction implementing by Care international. In Galkaio.


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Sewage system
There is no sewage system at all in Puntland cities, the rain water and other liquid wastes collected in
the streets and between the villages, which causes poor sanitation in the towns and mosquito spread
and there is no proper mosquito control in mudug region.
Public latrines and laundry
There is no controlling unit of public latrine and laundry in the region because there is no guideline and
regulation to manage that issue.
Water sources.
There are several kinds of sources of water in mugud region, like dip ground water, rain water, shallow
wells and Berkeds. but the main drinking water sources in mudug region are ground water.The main
water providing company in mudug region is Galkaio water company (Galwa) which supplying water to
the Galkaio city. Since 2003 till now and the company reached the pipe water 6497 homes in galkaio.
This programme co-operated by local traders and puntland government supported by UNICEF.
Company has three boreholes and one tank which is not enough to hold the required water, the
company does not make any kinds of water treatment, so that the salt contents and minerals are high in
the water. Some other districts and villages have poor water supply. Only Galdogob district, Bursalax
and Bacadweyn have pipe water although many homes are not getting pipe water yet. Only 1549 homes
have pipe water in Galdogob town, while Ba'adweyn homes have 291 pipe water, and Bursalax homes
have 251pipe water. Total families have pipe water in Mudug region = 8388 families
Agencies involve public/environmental health working in mudug region.
There agencies involved to the public and environmental health in the Mudug region are: UN
agencies(WHO, UNicef UNFPA, UNHCR) and international NGOs (Marline, SRCS, save the children, DRC,
care international, NRC, Islamic relief and relief international)
Environmental health assessment in Nugal
This assessment has started in Nugal region 13 July 2010 and this focused on the following areas:
Garbage (waste) disposal monitoring (solid waste management).
Since the Puntland government establishment up to 2007 the local authority was responsible for the
garbage management, but this management was not enough due to insufficient facilities, human
resources and necessary materials. From 2007 the Local NGO (Nabad Relief and Development
Organization) have become responsible for the waste management in Nugal region and this NGO
supported by the Local government, the local authority contracted with Nabad NGO to manage the
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waste disposal in Garawe city, and other Nugal region area for 6 years. The Nabad NGO created a new
system in garowe for collection of the waste/ garbage, now garowe has 3 points garbage collection and
they are processing 5 other points collection garbage.
The NGO has 2 cars for transportation of the waste/ garbage to the final disposal pit which far from the
city around 8 K/ms and one Biesh, that hung up the garbage. And they also have one car for
transportation liquid waste. There is no separate garbage collection system to separate garbage which
produced commercial, homes and hospital/ clinics and pharmacies waste. The waste collection workers
have not enough materials and necessary equipments. Other Nugal region districts, like Dangorayo ,
Burtule and Eyl have not garbage disposal monitoring
Food market hygiene guidelines
A number of recent disease are commonly transmitted through food and live animals in markets. The
disease represent both food safety and occupational health issues that must be addressed by improving
the conditions in food markets. Prevention and control of food borne diseases and zoonoses in markets
have become major public health concerns requiring immediate attention. In Nugal region the food
market hygiene are very poor, and there is no guideline and regulation to control food markets, like
restaurants , cafeteria, milk markets and delivery system .also there is no control food transportation
and storage. There is one slaughter house in Garowe but that is not active now.
Sewage system.
The main populated towns in nugal region are lacking sewage, however, in Garowe alone, Nabaad
organization has one car for transportation a liquid waste that produce Garowe restaurants to pit
disposal.
Public latrines and laundry.
Despite the number of public latrines and laundries in the urban areas have increased tremendously in
the last 10 years, there are neither a system of government guidelines and regulations Nor
implementation of any activities regarding controlling their public related hygiene.
Water sources.
There are several kinds of sources of water in Nugal region, like dip ground water, rain water, wells,
Barkedes and ponds.but the main drink water sources in Nugal region are water ponds and barkets. The
main water providing company in nugal region is Nugal water company(PPP) which supplying water to
the Garowe city. Since 2006 till now and the company reached the pipe water 2493homes in Garwe.
The public private partnership (PPP) programme co-operated by local traders and puntland government
supported by UNICEF. The company has one boreholes and one tank which is no enough to hold the
required water. The company does not make any kinds of water treatment , so that the salt contents
and minerals are high in the water. The Eyl district have poor water supply providing by Dawad and Adra
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water companies, only 83 families have pipe water in Eyl district. And most of homes have not pipe
water. The main drink water in the other districts and villages in the Nugal region are Barkates and
ponds.
Agencies involve public/environmental health working in Nugal region.
The agencies involved to the public and environmental health in the Nugal region are: UN agencies
(WHO, UNicef, UNFPA,UNHCR) and international NGOs (Marline, SRCS, and save the children,AAh).
Environment health assessment in Sool region.
Garbage (waste) disposal monitoring (solid waste management). There is no solid waste management in
sool region, the community in sool region was tried many times to manage Garbages in their region but
the are not secceded ,because they was not get any support from local government , and now there is
no any waste disposal monitoring in that region.
Food market hygiene
There is no food market hygiene guideline in Sool region sins the collapse of central government of
Somalia, so that the food market hygiene are very poor, because there is no guideline or regulation to
control food market, like restaurants, cafeteria, milk, meat and fisheries markets. Al so there is no
control food transportation and storages, and system to manage food poisoning.
Sewage system
There is no sewage system at all in puntland cities, the rain water and other liquid wastes collected in
the streets and between the villages, which causes poor sanitation in the towns and mosquito spread
and there is no proper mosquito control in Sool region.
Public latrines and laundry
There is no controlling to public latrine and laundry in the region because there is no guideline and
regulation to manage that issue.
Water sources.
There several kinds of sources of water in Sool region are rain water, wells, Berkeds and ponds. And
there is no water supple (safe drink water in sool region).
IDPs inpuntland.
The humanitarian crisis in Somalia, persist with 42% of the population (estimated at 3.2million) in need
of emergency humanitarian assistance and livelihood support. Puntland hosts the largest number of
IDPs from conflict affected arrears of Somalia particular the south-central regions . Bosaso and Galkaio
has the largest number of IDPs estimated. The IDPs face many challenges including Acute water, food
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shortage, Acute malnutrition for children below five years ,poor hygiene and sanitation and lack of
shelter.
Energy consumption and environmental health.
The main source of household energy is the charcoal. However, charcoal production is seen as one of
economic activities that have had a divesting effect on the environment. The effects caused by charcoal
production include environmental degradation and soil erosion and destroy of pasture. The recent
charcoal studies show that despite the consumption has increased double in the last 7 years, so is its
negative effects on the environment. However, there have been private sector initiative which were
developed to be an alternative solution to the consumption of the charcoal. Somgas is a private
company that has introduced Natural gas to replace the charcoal, however, the limited number of urban
households are adopted its consumption. The main reasons are 1). The gas is more expensive than the
charcoal. 2). the families are scared on the level of safety requirements needed to use the natural gas
An Assessment Report on Fishing
During my assessment we conducted a serious of interview with the coast community Ministry of fishing
and other merchants who are involved in fishing. I conducted a field visit in three locations Bari and
Sanag regions (Lasqoray,Bargal and Habbo). The tool that I was using during my assessment was
interviewing the cost community and perfect observation in the area. Somalia economy is based mainly
in two : livestock and fish .
Livestock heads has been decimated duo to consecutive seasons of below average rain fall and destitute
pastoralists are gathering in the main villages in search of assistance. Failure of not giving a care to sea
resources have a huge negative impact on the Somali economy, as a fish export is a major economic
activity in Somalia, indeed fishing is central to the life of Somali people and is the dominant lively hood
for the majority of urban population. Although Somali economy was able to adapt and grow in spite of
not benefiting the resources, putting more effort fishing will no doubt to prove to have appositive effect
on the local market and export market. The fishing sector provides food and income to over 60% of the
country population. The fish export market provides excellent income opportunities for fisher men and
allow them to get more return on their lively hood investment when compared to the local fish market.

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Going for fishing {Bargaal}

Customers gathering surround the area & start selecting, bargain then buying the fish.{ Bargaal }
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the fisher slaughter prepare the fish quality in pieces { Bosaso }
Since there is no government reporting , Somali sea which is rich in different kinds of fish and sea living
creatures has been pillaged because of over fishing , uranium radioactive wests is put and burried in the
sea , sometimes there is something like a big bloom full of toxics floating the surface of the water. Some
of the sea living creatures has disappeared like hamper head fish, aseba . Some others are likely to
disappear if the condition doest change like lobster, turtle, and taraaqad . Careless wests, such as sharks
killed for their dorsal fins for use as soaps and aphrodisiacs in the Asian countries, only depletes the
value of resources of the sea.
Those who are stealing the sea resources do over fishing carelessly and do a kind of eradication.
They collect different kinds of fish eggs and pregnant lobster to plant in their own sea.
They destroy the sea plateau in which the fish bread, grow and hide.
When fishing they differentiate and throw the unwanted and small fishes in the sea as wests
while dead.
There are uranium radioactive wests seen laying the coast.
Somali Tsunami washed the hidden toxic.

As all these happen at the start of 2007 there was influx of fish seen laying the sea shoe dead because of
the toxic. And in the late of 2007 there was a break of new disease (kadudiye) a febrile disease having
signs of join pain, high fever vomiting of not responding to ant inflammatory ,ant biotic, and ant pain
medicines, which killed many people. If not intervened or kept eye on it many other disasters will be
seen.

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Uranium radioactive wests

Somali Tsunami washed toxic

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The thrown of un wanted & small fishes as wests
In late 2000 a group of merchants opened a fish processing and canning facilities in two districts
(Lasqoray& Xabbo) these medium sized factories is the first of their kind to be opened in Somalia since
the civil war. The plants canes and processes locally caught Tuna and Sardines. In fact they provided
alternative lively hood opportunities for the local community especially for destitute pastoralists. There
is a now defect fish processing facility which was built by soviet union in the 1970, unfortunately the old
processing plant was pillaged in 1995 during the civil war and was partially destroyed by heavy shelling.
The factories produce 800 tons of canned fish per year for the domestic markets and export markets
(UAE& Kenya). The wests of the factories is not managed well, the west fish and bones thrown to the
margin of the sea side.
lasqorey fish factory

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the west fish & bones thrown to the margin of the sea side.{xaabbo}.

Dry cooking of fish ( Xaniid )
Conclusions:
The puntland government has so many gabs in the side of public and environmental health as this
assessment proved but the ministry of health is planning to improve the health and sanitation in all
Puntland Zone. These gabs include: absence of the legislation of the environmental health and
sanitation such as food control legislation, water quality control legislation, system to manage solid and
liquid waste and monitoring of hazardous waste exposure, also there is no available epidemiological
studies and education in place . According to the puntland state population the proportion of the
population who get pipe water is very little, so the most of the puntland population used unsanitary
water from shallow wells, berkedes and ponds. No existing method for of liquid waste management in
Puntland state. Also the most of puntland districts use burning landfills (open), because there is no
existing method for garbage collection monitoring system. The most of the IDPs refugee comps in
Puntland suffering from lack of safe drinking water, lack of sanitation and insufficient shelter.

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Recommendations:
1. To establish a coordinated and intersect oral cooperation system of line ministries of health,
education, veterinary agriculture , mineral water ,planning, interior, and ministry of work ,
local authorities UN agencies, international and local NGOs involved public and environmental
health.
2. The ministry of health should develop comprehensive health policy based on targets priories
and direction.
3. Regulation/ legislation for food hygiene, water hygiene and waste management needed and
to be re-enforce.
4. To improve and strengthen health delivery system in all regions.
5. To improve health qualified recruitment in public facilities.
6. To give priority on access the punt land community to safe drinking water.
7. To increase IDPs aid programs about the drinking water and sanitation.
8. Rehabilitation and protect WASH services to benefit IDPs and effected population
9. To establish Biological control programs to reduce mosquito population in each region of punt
land.

By: Ahmed abdihakim ahmed : Environmental health assessment in punt land.
Region:
SOUTH-CENTRAL (MOGADISHU): SANATARIAN ZONAL REPORTS
South Central Environmental Health Status Data Collection Preliminary Report
DRINKING WATER TREATMENT SYSTEM (CHLORINE)
In the former military government there was only one source of water supply which was managed by
Mogadishu Water supply Agency (AWD) using gas form chlorination system for water treatment, there
was no AWD and cholera outbreak cases, but after the collapse of the previous government the
Mogadishu water supply agency collapsed too. The water source of Mogadishu and its outskirts
surrounding IDP settlements became a lot of different wells established by different persons in the
community for commercial purpose, no chlorination system is functioning properly, there was annually
AWD and Cholera outbreaks relapsing in Mogadishu community, number of CTC centers for cholera
treatment established by some local and international NGOs. After that Somali Public Health
Professional Association (SOPHPA) organization supported by UNICEF started to chlorination at most of
water source wells in Mogadishu and its outskirts IDPs settlement from Dec-2008, this caused to prevent
and reduce annually AWD and Cholera outbreaks in Mogadishu and outskirts for two years now and still
underway, this activity made great impact in the community, Sophpa currently chlorinating 217 main
wells in Mogadishu and its outskirt IDP settlements and 58 water points (Kiosks) in Af-goye corridor.


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SOLID WASTAGE MANAGEMENT SYSTEMS
Refuse or garbage collection and disposal systems
During the previous regime there was municipal solid waste management department employing:
a. Number of sweepers or cleaners staff.
b. Number of protective clothes for the staff
c. Nutrition for the staff
d. Number of dust pins for refuse or garbage collection in the public premises
e. Bulk containers for refuse or garbage collection in temporary areas
f. Number of temporary sites for refuse or garbage collection
g. Number of refuse or garbage collection vehicles
h. Number of tractors cleaning road blockage sands during rainy seasons
i. Refuse or garbage disposal area called Karan Tips
There were public health experts from MOH and WHO consulting about the water chlorination system
and refuse or garbage collection and disposal systems. But now there is no refuse or garbage collection
and disposal systems functioning properly. Today the community mostly use for managing the refuse or
garbage from their houses to collect and burn near the houses or digging small holes on the earth and
dumping the refuse or garbage. Owners of public premises and some of the community use for refuse or
garbage disposal in some areas in the town till it becomes like heaps. Sometimes local and international
NGOs like IIDA and SAACID collect and dispose of the refuse or garbage collected from the heaped area
in the town and using to dispose like land reclamation systems dumping the refuse or the garbage in
outside big digged lands by those who are collecting the stones for building every day till the land
became big holes and cracked area. For six months from Sep-2007 to Feb-2008 SAACID and DRC
conducted refuse collection and disposal system, there was sweepers collecting the refuse/garbage
voluntarily in the sixteen districts of Banadir region and they were giving to each of the sweeper $60.00
per month per person as support, 16 vehicles were collecting daily the refuse/garbage each one was
carrying 6 times per day a full load nearly 500 metric tons of refuse/garbage was collecting from the
town to disposal areas. IIDA organization getting support from WFP conducted garbage collection and
disposal system in Mogadishu from Apr-2008 to Mar-2009 using 7,100 different staff from whole 16
districts of the capital and 6 vehicles for disposal of refuse to the disposal areas. Each vehicle was
loading four full tanks of refuse per day, and each staff was paid monthly food for work, disposal areas
were three sites Kaysaney, Halane and near school policia areas for land reclamation. There was public
health officers from SOPHPA organization consulting and supervising with IIDA about collection and
disposal of garbage systems, this activity made a great impact and reduced scatred garbage and heap
ones at everywhere in the town and motivating jobless lower class families got some sort of life support
and devaluation of food prices in the markets, but now no refuse/garbage collection and disposal
systems functioning properly.
FOOD AND DRUG CONTROL SYSTEMS
In the previous government there was public health laboratory for the control of food and drugs using
two methods bacteriological and chemically analysis. The food was analyzed if it is fit for human
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consumption or not and also its nutrition value, also the drugs was used for quality control, checking the
composition if its the standard one or not and validity.
SEAPORTS
There was public health office in the seaport working by a public health officer or public health inspector
to keep the international health regulations and his activities was as follows:
1. food and drug control
2. Deratization exemption certificate for ships control
3. Vaccine books control, etc
AIRPORTS AND BORDERS
Also like there were public health inspectors or public health officers keeping the international health
regulations:
1. International health vaccine books control
2. To keep from the country international quarantineable diseases
3. food and drug control
The expired foods/drinks and drugs which is unfit for human consumption was disposed in the disposal
place and burned there by public health inspectors following the public health law for the country. All
these processes now are not functioning properly, there is less nutrition and expired food in the
markets, and there is also less composition and expired drugs in the drugs market.
PHARMACIES
There are no qualified health professionals selling the drugs or medicine, no proper keeping of the drugs
like cold storage for the drugs. The sun heat and light are occurring direct to drugs; heat and lights are
affecting the drugs and as you know this will cause chemical reaction or chemical change to the drug or
medicine. There is mostly no quality & expired drugs are often in the drug markets, drugs are sold and
kept in improper places.
VEGETABLE MARKETS
No suitable designed place to sold it,
No proper keeping of the vegetables especially those used to be eaten raw.
No health cards for food handlers,
No dust pins for keeping refuse or garbage.
FISH MARKETS
No dust pins for keeping refuse or garbage.
No water tap for cleansing usage
Floor is not smooth and clean
Walls are not painted
No health cards for the staff
No cold storage for keeping the fish
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No first-aid kits in the market
No drainage system for waste water
No doors exist dogs and cats enters
MEAT MARKETS
Butchers abandoned former meat markets and sold it now in unsuitable designed open places with
other food and vegetable markets, they use cracked wooden tables which cannot be cleaned well; the
dust and flies can easily contaminate the meat.
SLAUGHTERING HOUSE HYGIENE
There are a lot number of slaughter houses in the town. One is the old one located in Karan district and
it needs to repair, the floor is cracked, walls are also cracked and needs repair and painting, there is no
ceiling, no proper water pipes for cleansing, no dust pins for proper keeping of refuse and garbage
collection, no protective clothes for staff, no health cards for the staff, no drainage system, no first-aid
kits and now it is not functioning properly.












113

Waberi Community Disposal sites inside Mogadishu













114














115


Vegetable market in Hamar weyne
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There are two private modern slaughterhouses. One is in process and the other one is functioning
properly called SOFMEAT (Somali Fresh Meat). It has the animal pin section to check the health of
animals while there are alive, the dirty unit section for slaughtering the animals, the cleansing unit for
the meat, the cold storage section for keeping the meat properly. The staff has health cards to check
their health status in order to prevent communicable diseases from them. It has first-aid kits; it has
water pipes functioning properly for cleansing; it has dust pins to keep the refuse and garbage properly,
they had office for public health inspectors for meat inspection for clarification its fit for human
consumption or not and also office for vintner groups checking animals health. There are other five sites
using mostly the community for slaughtering which is unhygienic system. They slaughtering the animals
in naked place or open air which can be contaminated, leaving the waste from the animals and bones
like heaps in that place and making offensive odor to the near living community in that area and one of
this sites is like the one in Waberi district near former military airport base known as the Afasione, other
four slaughter sites are located in gubta behind cigarettes industry ,dharkenkly, karan and near halane
area these will cause public health hazards to the communitys live.
PUBLIC PREMISES
In the previous government, there was public health office in Mogadishu local government for the
control of all public health related issues especially public premises involving food like restaurants,
cafeterias, pave-rages of drinking, shops, pharmacies, barbers, hotels, stores, markets, and drainage
and sewage disposal. There was public health inspectors from ministry of health (MOH) attached to the
local government public health office responsible to control all the above mentioned public premises.
Restaurants, cafeterias, pave-rages
a- Suitable design for public premises (Kitchen, Dining room, storage, Floor, walls, sealing,
ventilation and sewage tank)
b- Licenses
c- Three compartments for washing utensils (Hot water, Soda water, running water)
d- Health cards for food handlers
e- Personal hygiene and uniforms
f- Dust bins for refuse collection
g- Toilets
h- Proper food keeping
i- Sink for washing hands
Since the collapse of the former government, not system controls public premises, some of the
merchants paid more effort of full filling hygiene and sanitation of their premises but most of them have
unsuitable design site, some of them sell food in an open air area near the streets which can easily be
contaminated by the flies and dust. In generally there are no food and drug market hygiene guidelines.
Challenges:
a. main challenge is insecurity problem
b. less kits for water chlorine residual testing
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c. less supporting funds
d. No municipal department for refuse/garbage collection and disposal system functioning
properly.
e. No international and local NGO sustained collection and disposal of refuse/garbage system
f. No proper functioning of law and order which can control requirements of the public health
premises.
g. No chemical and bacteriological laboratory and lab technician functioning for food and drug
control.
h. No powerful public health inspectors functioning at markets, borders, sea and airports.
Recommendation
a. Provide enough kits for chlorine residual testing
b. upgrading of capacity of public health inspectors involving this program
c. sustainability of chlorination system in Mogadishu, its outskirts IDPs settlements and the rest of
Somalia in order to prevent from the water borne related diseases such as AWD, Cholera, etc
d. To find municipal department functioning properly for refuse/garbage collection and disposal
system
e. To find sustainable program for refuse/garbage collection system supported by national or
international agencies.
f. Restore and rehabilitate former slaughter houses fish, meat and vegetable markets as soon as
law and order is restored
g. Provide chemical and bacteriological laboratory and train or update lab technicians for food and
drug control
h. Update public health inspectors functioning with municipal public health control department
like public premises, industries, borders, sea and airports with their mechanisms.
i. Restore public health and communicable diseases control department of MOH

Environmental Sea pollution for S C S Report
Somali have long coast which is about 3,335 km, borders the Gulf of Aden in the North, Indian Ocean in
the East to South and Kenya in the South. It is the longest and fullest of natural resource coastline in
Africa. The previous Military regimes were controlling the whole coast of Somali from the vessels
dumping industrial wastes and all other pollution and also they were not allowing their community to
dispose the garbage or refuse in to the sea and dispose refuse to disposal area, but there were sewage
drainage system like Hamaeweyne and two slaughter houses like one near Marina and other one near
the main jail of Mogadishu. After the collapse the Military Government no one is controlling the Coasts
of Somali foreign vessels have dumped chemical wastes to the Somali sea shore, for instance, in Eil-dher,
a small town in Gal-gadud region, and also in Meddle Shabale Region such as Adale, where in the year
2000, the seashore water put out a blue-black color effluence which was oily-liquid with unprecedented
proportion. In addition, a large number of sealed, strange containers were seen floating out. The
residents haphazardly and curiously tried to investigate it. Consequently, many were killed as they were
opening or destroying such containers. Another event was when the same containers appeared on the
kismayo, Barawe, Marka Mogadishu seashores in 2005, and the community in Mogadishu dumped the
rubbish to the sea shore. However, after piracy started in Somali, the chemical waste from the ships had
119

stopped. The only functioning drainage system in Mogadishu today is the Hamarweyne sewage
drainage.
Challenge
1) no powerful Government
2) no Refuse disposal system functioning
3) no public Health system functioning
Recommendation
Strengthen the Government
Develop public Health system
Achieve Refuse Collection and disposal
Prepared by: `
1. Esse Haji Hassan
2. Ahmed Mohamed Mohamud
3. Ali Hussien Yusuf
4. Mohamed Abdulahi Mohamud












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Annex-A
Scheduled of visits for Professor Bahar, WHO Consultant of situational analysis and needs assessment on
environmental health:
Agency/Ministry
CMS WHO, Candlelight, Ministry of Health& labor, UN Habitat, IDPs-Hargeisa, WFP, SWISS GROUP,
UNICEF, Municipality (Hargeisa), Disposal sites (Hargeisa, Barbera, Buroa, Borama), Ministry of Water,
Water Agency, Ministry of Planning, Water Reservoir (Hargeisa, Borama), Industries, Hargeisa Hospital,
Markets, slaughterhouses (Hargeisa, Burcoa, Borama), Medical association (Hargeisa), Faculty of
Medicine (Hargeisa), water facility (Hargeisa), CESVO, NAGAD Umbrella, MCHs, Borama Hospitals
(general hospital, Al-Hayatt hospital, medical school hospital), Amoud University, Elo University, Ports
(Barbera, Lughaya, Zeila), SHABA water facility (Borama), Minicipality (Borama), New slaughterhouse
(Borama).
Annex-B
SOMALILAND (In Excess)
Republic of Somalialnd.
Ministry of Health & Labor.
_____________________________________

Environmental Health (Public Health) Unit of the Department of Communicable Disease Control (CDC)
& Public Health.
Report on Environmental Health Assessment in Somaliland.
Implemented by: MOH/L Environmental Health Unit.
Supported by: World Health Organization.
Prepared & Written by: Dr. Ali Sheikh Omar Kabil
Head of MOH/L Environmental Health (Public Health) Unit
Mr.Mohamoud Barre Deria
Sanag Regional Sanitation Officer

Tel: 4318223/4424513

Email: Calixaad7@hotmail.com

Hargeisa Somaliland

MEETINGS &VISITS-Annex?

Meetings & visits 03/07/2010 meeting the honorable mayor of Hargeisa
Professor Bahar commented that there are many good things that have been done and many problems
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were still faced in the management and control of the wastes in Hargeisa.
The Hon. Major Mr. Hussein Mohamoud Jiir highlighted that solid waste management in the form of
public private partnership
Visit to the dump site

1 The dump site was observed in being in terrible situation, whereas the
indiscriminately dumped Solid waste over vast area was drastically threatening whole
environment, including human and livestock health and vegetation. The dump site was
unsightly, highly polluted and attracting all carnivores birds and wild animals. It is
located low land neighboring farms, grazing land and depression for surface water
collection. Immediate intervention was m needed. The municipality officer was
informed to convey the outcome to the Mayor.

Recommendation
Short term
1 Redressing and constructing the site as proper land fill site.
2 Starting land fill operation with the provision of needed machinery and expert
personnel. In the long-term: site relocation

Water supply Quality & Quantity
MINISTRY OF WATER AND MINERAL RESOURCES
H.E. Minister, honorable D.G. and water quality officer
MWMRs Ultimate goal: provide safe drinking water supplies. For water quality monitoring laboratory
has been established with the support of WHO equipments for analysis are available. There is lack of
reagents (chemicals), therefore the laboratory is non-functioning. No water testing is disaster to the
work of the ministry being done.
Financial Constraints: the government revenue is very low and ministry of water receives annual budget
of $130,000 (USD) and not exceeding the low basic salaries. We are having a water scarcity in the
country
Water bottling factories
Safi water bottling factory inspection in Hargiesa
At the time of the inspection the factory was not working, but we have accessed to inspect it
thoroughly.
Water source (Borehole water from Hargeisa waater supply)
Water is obtained from stand pipes of Hargeisa water supply by water-tankering trucks and thus water is
poured into underground water reservoir. The water is then pumped to elevated water tanks. Water
from the elevated tanks then by gravity flows down to pass a series of water filters for purification;
while a minimum water quality monitoring equipments are installed especially for PH & TDs and
conductivity. The filtered water is then filled or bottled in plastic bottles under hermetically sealed
conditions at least to some extent. The label on the bottles giving specifications on trace element
concentration levels is highly questionable for validation and needs verification by
International/Standard Laboratory.
b. Togdheer mineral water (Maaxda) bottling factory
We visited and inspected Maaxda water factory, the manager of the factory has briefed us that the
factory is not working to-day (the date of our visit and inspection) for it is the week end day which is
specifically spare for the meticulous cleaning operation of the factory once in a week as a procedure to
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fallow, While in the other six days of the week the factory makes the production of healthy water at rate
2000 cartoons of water per day.
Water sources of the factory (Borehole water owned the factory)
The factory has got a borehole well of its own and water is pumped from the deep well to a number of
water tanks that rest on elevated concrete cement stand poles/stand with flat platform to rest on.
Then the raw water passes through multiple filtration processes in a series of filter machines with water
quality monitoring and assurance devices. The manager has stated that they give priority to water
quality parameters in the production and manufacturing of bottled healthy drinking water supplies to
the consumers. The next step is to produce the required quantity of water to meat public demand with
supply side.
Water quality assurance:
Water disinfection procedures with chlorine compounds were observed. Moreover, ozone and
ultraviolet (Florescent light) treatment of water before bottling was seen to be in place.
The staff of the factory was found well prepared and observing pursuing and adhering to the standards
of international code of hygiene practices in the processing of food and related products for human
consumption to occur under hermetically sealed conditions and meet the required commercial sterility
of canned/bottled and packaged food items including drinking water supplies during processing and
manufacturing.
Mini-laboratory for quality control
A small laboratory has been set up within factory to monitor water quality. The mini-lab was staffed by
both a national laboratory officer and an expatriate, the laboratory handles such as basic tests as PH
TDS, conductivity etc. Moreover, in trace elements concentration levels in water that appear on the
label of the bottled water containers was said it is certified by a laboratory in India under what has been
termed as certified industry inspection in semester or yearly interval periods. However, the contents
of the trace elements specified and written on the label marked on the bottles containing healthy
mineral water of Togdheer Maaxda needs further examination by competent and qualified standard
public health laboratory.
Waste recycling (Plastic bottles reuse)
The manager of the factory stated that recycling of the empty plastic bottles has very little salvageable
value in relation to the costs of investment for recycling which should be highly escalating. Therefore
from the point of cost considerations alone importing the plastic bottles is much cheaper for the factory.
The Somaliland ministry of water and mineral resources has got basic mini-lab equipments for water
testing and quality monitoring supplied to the ministry by WHO. However, there is a complete lack of
reagents/chemicals needed for use to conduct water quality tests at present. There is, therefore an
urgent need to bring chemicals to operationalise the water mini-laboratory at the very earliest possible
time.
Meeting with the officers from ministry of Agriculture and Livestock
Ministry of Agriculture
The Director of plant entomology department of the Ministry of Agriculture was met. We discussed
together the pesticides in use, their import, registration, use disposal and the concerns linked to the
pesticides and hazardous chemicals to human health and public safety. The Director summary gave us
the following debriefing:
Spraying operations are carried-out by the trained personnel of the ministry or they do supervise the
farmers on using pesticides. Pesticide containers when empted are crushed-burnt or buried pesticides
are toxic substances and buried burned for it causes problems to the soil, such odor. When people are
exposed to pesticides, we fall sick or it causes ill-health, mainly skin diseases and respiratory problems.
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In over dose situations, it can cause mental illness. Neither import is licensed nor there is available data
on the types and number of pesticides stock piled in the country. FAO is working with the ministry to
bring treated seedlings (vegetable seeds, seeds of cereals). Pesticides have been analyzed to cause
germination problems when it enters the soil. Farmers use pesticides on their own for spray operation
of farm produces, but do not understand the health hazards of pesticide when used improperly
Uniform/protective clothing are needed to be worm by farmers. Ministry of agriculture is planning to
launch pesticide risk communication through the media in 2010, so that the public should become
aware of it. The pesticide spills from the ex-locust control compound into the Hargeisa river has been
the worst incident of toxic substance exposure to Somaliland people requiring further investigation of
those who are the victims collaboration between MOHL and Agriculture Ministry is highly mandatory.
Ministry of Livestock
The ministerial expert, Director of Animal Health & Husbandry stated that the chemicals used for the
control of ticks and other ectopartities in livestock that once were a great threat to cause environmental
pollution have now been abandoned altogether and thus no longer constitute a public health hazard.
Dye drugs that are used to stain animal/skin are used for all purposes of animal health and husbandry in
the control of ticks and ectoparasites. We therefore, should not worry about toxic chemical pollution
resulting substance used for animal health. We should rather focus on zoonotic diseases for
collaboration as line ministries.

MOHL public health office concern in the use of chemicals for vegetables, fruits-
crops and livestock
The two officers were reminded that food safety is a priority issue for the protection of public health
Treated animals with chemical substances including drugs and sprayed farm produce with pesticides
carry threat to health of the human beings. If animals products or farm produce are eaten before the
chemical are shedded of or excreted from the body of animals or otherwise within the recommended
timelines that should be observed as public health protection measure, the pesticide residue in treated
food items or khat could pose emergency health threat requiring prevention and control. Food quality
assurance remains highly skeptical in the inadequately functioning institutional framework of the line
ministries for ensuring public health and safety. The establishment of food quality control assurance and
monitoring committee is highly mandatory
WHO support is absolutely necessary at the very earliest possible time.
The pesticide spills into Hargeisa dry river bed in 1988 (desert locust control compound)
Water samples from the shallow wells as far as, HALLO village have been collected and tested for safety
and pesticide concentration levels in the past by both FAO & WHO. Blood samples from the people using
this water should be tested for ingestion of the pesticides, once, again.
WHO/FAO support is needed
It is citizens rights to get protected from the deleterious effects of chemicals to human health and those
who have been responsible for the exposure of the toxic substances to human subjects must bear
liabilities including those government institutions who have the regulatory responsibilities for the
protection of public health provision immediate climate of the threat and compensation to those
already affected under the international worms and law.
Rural sanitation
SRCS meeting
Sanitation and water projects are supported by German Red Cross and implemented by Somaliland red
Crescent society (SRCS) in rural areas.
Aim of the projects
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Support rural population in WASH, (water sanitation and hygiene) through the provision of basic
physical and social amenities, build their capacity for action and ensure sustainability of projects with
community involvements.
Major programmes
Supporting household latrines construction & promoting their proper use, construction or rehabilitation
of water facilities, establishment and training of water, sanitation and hygiene communities.
Achievements (investment to date 2005 2009) infrastructure or sanitation facilities
Rain water harvesting
1. Barkeds: New or rehabilitated = 268 Barked
2. Shallow wells 101 wells
3. Sand dams 15 dams
4. Mini water system
5. Borehole
6. School water tanks 24
7. Model latrines (Demonstration) 20
8. Family latrines 3235
9. School latrines 55
Human excreta disposal
122 Cariks support
123 Hygiene education and community mobilization
Community involvement (role)
124 Digging pit latrines
125 Construction of superstructure
Community latrines (household)
Year Region Number of latrines
2007 Maroodijeex 60 dry pit latrines
Togdheer 186 dry pit latrines
2008 Maroodijeex 137 dry pit latrines
Togdheer 215
2009 Maroodijeex 280
Togdheer 365
Total 1223

Meetings & interviews
Swiss Group (Caritas)
We met the sanitation officers of the organization and we have collected information through the
achievements reports of the agency that were delivered to us both in written (documents) and interview
responses.
The agency is involved in rural sanitation in two regions namely Maroodijeex and Togdheer
The focus areas of intervention are:
1. Human excreta disposal systems by conservancy methods at rural villages and schools
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2. Distribution of sanitary have tools for clean-up campaigns in solid waste management in non-
mechanized manner.
3. Rain water harvesting (WASH infrastructure)
Objectives of the support to Somaliland communities
Investing actions to support rural population in improving their water supply, sanitation and hygiene and
health leading to improving peoples livelihoods and community development.
Distribution of sanitary hand tools
(Maroodijeex and Togdheer together)
2007: 1.
Wheel-barrows Shovels Rakes Pick axes Wedwed
154 313 130 61

2.
Buckets Plastic sheets Land macriphon
466 158 12


3.
Donkey carts 22


B. WASH infrastructure (Maroodijeex & Togdheer)
Wells, dams and Berkets and Garbage pits
1. Shallow wells
2. Surface dams
3. Berkets
4. Garbage pits
5. Ohters
Conclusion
The assessment has been masterminded for implementation by WHO experts and among other has
brought to the surface the reality on ground relating on ground relating to the due investments that
were made in environmental health activities promotion over the years and the near saturation of
public health problems existing, but related to poor sanitation and lack of hygiene living condition,
throughout Somaliland on one hand and what the recommended interventions for scaling up the profile
of sanitation in Somaliland would mean for the nation to make the desired change and difference
towards the improvement of peoples health status.
The assessment has identified what people want to change, how it would be changed, as well as, what
should be done and who is best placed to do so.
Recommendations
1 Adequate investment and scaling up the profile of public/Environmental sanitation.(Sanitation)
2 Establishment of national environment health working group committee with clear terms of
reference under responsible regulatory authority with one lead government ministry, the
Ministry of Health of the republic of Somaliland for coordination and development of guidelines.
3 Development of environmental health policy, laws and guidelines.
4 Training new cadres of public health inspectors/sanitation officers not exceeding 15 persons at
the beginning
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5 Establishment and support and capacity building of national and regional network
environmental health offices in MOH, central MOH department directorate RHO and in
municipality offices at district levels.
6 Establishment and operationlize of public health laboratory for integrated quality control system
Introduce appropriate low-cost sanitation technology options in the integrated management
and control of solid and liquid wastes.
7 Provision of sanitation amenities to met MDG 7
8 Introduction and strengthening public health inspection services regulatory framework and law
enforcement measures.
9 Comprehensive public education information and communication and awareness raising.
10 Occupational health and safety programs.
11 Investigation of public/private funding and market development for waste recycling and
sanitation and hygiene services including solid and liquid wastes management
12 Research and studies
13 Structured and proper disposal of human excreta by conservancy methods
14 Rain water harvesting and water redevelopment plans (borehole and shallow wells rain water
harvesting)
15 Launching environmental protection measures and investigating the development of alternative
fuel generating and use options.
16 Proper and structured solid and liquid management systems to the standards of modern waste
management methods.
17 Provision of solid transfer stations on the cities and procurement of adequate number of heavy
machinery and employee of crews/cleaners.


Annex-C
Mayor of Hargeisa
Minister of Minerals and Water (Hargeisa)
Directors and Presidents of NGOs
Mayor of Lughaya
Dean of Medical School (Hargeisa)
Hospital administrators (Hargeisa)
Dean of University of Amoud
President of University of Elo
Medical Doctors (Borama)

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Annex-D:

Jamhuuriyadda Soomaaliland Republic of Somaliland
Hayadda Dhowrista Tayada Somaliland Consumer
Agabka. Protection Agency.
(HDTA) Hargeisa (SCPA) - Hargeisa
Ref: _______________ Date: June 19, 2010

To: - U.N. Agencies and International NGOS
The Somaliland Consumer protection Agency (SCPA) is an autonomous consumer protection
agency established under presidential decree on October 31, 2009. The aim of the
organization is to protect the rights of the consumers by ensuring that products and
services consumed within the country meet quality and safety standards.
SCPA is a catalyst organization that will greatly contribute to the overall development of the
country particularly more so in terms of upholding the rights of the consumers hence part of
the good governance system.
As the sole agency mandated to undertake consumer related matters, SCPA intends to
establish a comprehensive and very effective consumer protection system with all applicable
specifications, measurement system, calibration program, and quality control system.
Furthermore, SCPA will establish modern laboratories in all regions and will therefore
require proper lab equipment to ensure that the quality of consumer goods meet
international standards.
Since the Government of Somaliland will not be in a position to finance all consumer-related
activities, SCPA is urgently seeking from FOA financial and technical support in order for the
organization to begin its operations concerning consumer protection.
Regards,
Ibrahim Deria Afhakama,
___________________________
Managing Director
SCPA

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129

Annex: E
Laboratory support
Hepatitis B test statistics for Somalia | TB laboratories in Somalia

Training of Laboratory Technicians

As part of continuing activities to support populations in the worst drought affected areas,
WHO organized a course for laboratory technicians on disease epidemic preparedness and
response in June. The workshop was designed for laboratory technicians throughout Somalia.
The same laboratory training for epidemic preparedness and response to disease outbreaks in cross-border
areas was organized from December 5 2005 - 12 January 2006 in Hargeisa. During the past biennium 2004-
2005 WHO upgraded the Hargeisa, Bossaso and Mogadishu laboratories into public health reference
laboratories. Technical support was also provided to health facilities run by local and international NGOs.

Blood safety

In the current biennium 2006-2007, WHO will support the incorporation of laboratory training programmes
into the health and science institutes in Hargeisa, Bossaso and Mogadishu. There are also plans to establish
3 reference blood transfusion centers; introduce CD4/CD8 count methods in 4 reference laboratories to
monitor progress of patients on antiretroviral treatment and the introduction of ELISA and PCR techniques in
4 reference laboratories. Both public and private health facilities in Somalia are supported by WHO.
Hospitals receive equipment, supplies and reagents including blood safety reagents.
Out of the 125 laboratories in Somalia, 27 provide blood transfusion services. Blood collected is screened for
HIV, Hepatitis B and C and Syphilis. To further enhance the skills of laboratory technicians WHO and
partners provided guidelines on the preparation of Standard Operation Procedures for blood safety. Ice-lined
refrigerators were placed in 20 regional hospitals to provide blood transfusion services in Somalia as part of
the upgrading of their laboratories. As part of activities to improve laboratory services, a hepatitis B and C
sero prevalence study is currently being conducted to ascertain the prevalence of these diseases.


TB Laboratory Network
TB laboratory network in the country has been greatly expanded. About 50 sputum microscopy centers have
been established in the country, compared to 27 in 2002.


Peripheral Laboratories
Seventy six peripheral laboratories have been established in the MCH clinics supported by various NGOs
including SRCS, COSV, GHC, WVI, AAH, MSF-Belgium, MSF-Holland, MOH, InterSOS, Muslim Aid, IMC, DMO,
SCF-U.K, COOPI and MERLIN.

Reference Laboratories
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Reference laboratories in Hargeisa, Bossaso and Merka have been strengthened with specialist equipment,
including ELISA, Chemistry Analyzer, Haematology analyzer and CD4 machines to support blood safety and
Anti-Retroviral Treatment (ART) program introduced in Hargeisa, Merka, Bossaso, Garowe, Wajid, Eldere
and Hardere. Hargeisa reference laboratory has been participating in External Quality Assessment (EQA)
programme organized by EMRO and its performance compares favorably with many laboratories in EMRO
countries.


Research Studies
The laboratory provided effective support to the recent HIV/STIs surveillance, Malariametric survey and
HBV/HCV prevalence studies.

Constraints
The fluctuating insecurity situation in some parts of Southern and Central zone of Somalia quite often makes
the region inaccessible to international staffs

Annex-F
SOMALILAND PEOPLE DEVELOPMENT ORGANIZATION
(SPDO)

Project Proposal



Hargeisa General Hospital
.




131

FUNDING BY: UNICEF

IMPLEMENTING BY SPDO
HEAD Office Hargeisa
Bahsane Building (Cimaratul Salam)
West of Ex-national Cinema
Radio hargeisa road

Email: iloxidhspdo@hotmail.com


Somaliland Peoples Development organization
Iloxidhspdo@hotmail.com
+2522-4429047, +2522-4406881
+252-2-521743 (Office) 2522-521187-fax
Hargeisa, Somaliland

Ref: ______________ Date: 10/03/2010


To: Hargeisa General Hospital Hargeisa.
To: UNICEF Office Hargeisa
132



Sub: Project proposal

Please find here with the project proposal for the construction/rehabilitation of latrines, hand
wash facilities in Hargeisa general Hospital submitted by the SPDO which is a LNGO specialized
in water and sanitation.
Therefore, SPDO is kindly requesting from your Organization to support that very important
program.


Best regards,
Mohamoud Sh. Farah
Chairperson of SPDO
PROJECT SUMMERY
Project Title: Improvement to the Hygiene and Sanitation
facilities of Hargeisa General Hospital.
Implementing partner: SPDO LNGO.
Funding Agency: UNICEF
Project location: Hargeisa District, Marodi-jeh Region
Contact Person: Mohamoud Sh. Farah
133

Tel: 4429047, Telesom
Project Beneficiaries: Patients of Hargeisa G. Hospital
Project budget: $ 98142


Background

Hargeisa town is growing very fast and the populations are increasing exponentially. According
to report from UN habitat on urbanization Hargeisa is one of the fast growing urbanization town
in Hargeisa. Increase in the urban population must have increase service delivery facilities in
proportion such as health, education, water supply and sanitation etc.
Hargeisa hospital was first build during the British colony while the population of the town was
very small compared today. During the establishment of Somaliland the government with the
assistance of UN/International organizations identified as a priority to rehabilitate Hargeisa
Hospital. In addition to that patted in assisting Hargeisa group hospital.
The situation of Hargeisa hospital is now much better than before. It also accommodates more
in and out patients. These beneficiaries need improvement to the sanitation facilities in order to
cover the demand this area have not received yet the required assistance.
Hospital wastes are very dangerous since sick people are visiting the hospital. These wastes
and garbages required special handling and disposal so that they will not spread diseases.
Human faeces also require enough latrines with adequate water supply and suitable septic
tanks appropriate for hospital hygiene and sanitation standards.
Hargeisa hospital has different wards each of these should have accessible and suitable hygiene
and sanitation facilities which is very close to the patients the septic tanks must also enough to
the demand of each ward. Delivery rooms, operation theaterries should have easily cleaning
walls and proper waste and garbage collection facilities.
There must be also hand washing facilities in every wards so that patients doctors assistants
and visitors should get enough water supply and soap every moment.
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There must be also garbage collection net work and safe intermediate dumping sites. There
should be also enough incinerators to destroy very dangerous garbages and wastes before
disposal.
The project proposal is aimed to rehabilitation and expansion of hygiene and sanitation facilities
in Hargeisa hospital in order to cover the growing present and future demand of the hospital
with special consideration to the population growth.



Objectives
Improve the present and future hygiene and sanitation demand in Hargeisa general Hospital.


Activities
Mobilization resources
Rehabilitation of present latrines according to Hospital hygiene and sanitation standards.
Construction of new latrines with appropriate hospital hygiene and sanitation facilities
Rehabilitation/construction of hand washing facilities in different wards
Rehabilitation/construction of sufficient septic tanks for different wards.
Rehabilitation/construction of incineration facilities
Rehabilitation/construction of water supply facilities
Training of Hargeisa hospital staff in hygiene and sanitation.




Project Budget
Sno Descriptions Unit QTY Rate Amount
1.0 Mobilization/clearance
1.1 Mobilization of material and equipment Ls 1 360 360
135

1.2 Demolishing of old latrines wall Ls 1 950 950
1.3 Demolishing of old covering septic tank Ls 1 1680 1680
1.4 Demolishing of old chamber and old drainage
pipes.
Ls 1 470 470
1.5 Demolishing of floor cement for latrines Ls 1 480 480
1.6 Site clearance and remove garbages Ls 1 380 380
Sub-total $ 4320
2.0 REHABILITATION WORKS
2.1 Rehabilitation of old latrines for ward at walls,
doors, windows, water pipes, w. closets
No 16 380 6080
2.2 Rehabilitation of old bathroom at walls, doors,
windows, water pipes, showers.
No 12 260 3120
2.3 Rehabilitation of old manhole and drain pipe No 18 60 1080
2.4 Rehabilitation of old construction septic tank. No 4 980 3920
2.5 Rehabilitation of old water pipes and hand
wash for wards
No 8 560 4480
Sub-total $ 18680
3.0 NEW CONSTRUCTION WORKS
3.1 New construction of latrines of wards No 24 840 20160
3.2 New construction of bathroom of wards No 18 560 10080
3.3 New construction of hand wash and facilities of
wards
No 18 380 6840
3.4 New construction of manhole and new
drainage pipes of wards
No 24 120 2880
3.5 New construction of masonry septic tank of
wards
No 4 2400 9600
3.6 New construction of elevated steel water tank No 8 540 4320
136

for each ward
3.7 Provide and install new water pipe line system
or each ward
No 8 780 6240
3.8 Provide and install of electrical system Ls 1 1260 1260
3.9 Construction of incineration facilities No 5 840 4200
Sub-total $ 65580
4.0 Finishing and clearance Ls 1 640 $ 640
Total $ 89220
5.0 Contingency 5% $ 4461
GRAND TOTAL $ 93681

Mohamoud sh. Farah
Chairperson of SPDO.

References:
1. Annual Editions: Environmental 2009/2010: twenty-Eighth Edition
2. Regional Organization for the Conservation of the Environment of Red Sea and Gulf of
Aden (PERSGA), June 1999.
3. Clashing Views on Environmental Issues by Thomas A. Easton; 13
th
edition.
4. Country Environmental Profile for Somalia, From 1
st
March 2006 to 31
st
August 2006:
IUCN Eastern Africa Regional Office, Nairobi, Kenya.
5. WHO Mission Report on: Pesticide Incident in hargeisa, Somali Republic of Somaliland
October, 6-15, 2003: World Health Organizational Office for Eastern Mediterranean.



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