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Response to Cholera Outbreaks, Somalia, 2017-2019: Challenges, Interventions and Lessons Learnt

Background: Somalia reported repeated cholera outbreaks between 2017 and 2019. These outbreaks were attributed to the presence and occurrence of multiple risk factors for cholera, which made response challenging.

Aims: To describe the challenges faced by Somalia in responding to cholera outbreaks between 2017 and 2019 and provide lessons for Somalia and other countries with a similar context on how to better prepare for future outbreaks.

Methods: We reviewed outbreak response reports, surveillance records and preparedness plans for cholera outbreaks in Somalia from January 2017 to December 2019 and other relevant literature. We present data on cholera-related response indicators including cholera cases and deaths and case fatality rates in the 3 years. Qualitative data were collected from five focus group discussions and 10 key informant interviews to identify challenges, interventions and lessons learnt from the Somali experience.

Results: In 2017, 78 701 cholera cases and 1163 related deaths were reported (case fatality rate 1.48%), in 2018, 6448 cholera cases and 45 deaths were reported (case fatality rate 0.70%), while in 2019, 3089 cases and four deaths were reported in Somalia (case fatality rate 0.13%). The protracted conflict, limited access to primary health care, and limited access to safe water and proper sanitation among displaced populations were the main drivers of repeated cholera outbreaks.

Conclusions: Periodic assessment of response to and preparedness for potential epidemics is essential to identify and rectify gaps within current systems. Somalia’s experience offers important lessons for countries experiencing complex humanitarian emergencies that may help prevent and control future cholera outbreaks.

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