“Seven months ago, my wife gave birth to twin boys,” says Kalimow Mohamed Nur, a father whose twins are under treatment at the Bay Regional hospital in Somalia, supported by Médecins Sans Frontières (MSF) in Baidoa, the capital city of Bay region. “She experienced excessive bleeding during delivery, but I had no money to take her to the hospital. Our village lacks a free health facility.”

“While caring for her at home, our two boys also fell ill,” he says. “I had to take a loan of about US$130 and travelled 300 kilometres from my village to Baidoa to seek free care.”

Kalimow's wife survived the bleeding and after seven months he managed to bring his sons for treatment. But there are hundreds of women and children who still cannot seek medical care in Baidoa, Bay region, which is located in Somalia’s South West state. The persistent conflict in the region means a precarious situation for anyone in need of critical healthcare.

Women and children have to undertake arduous journeys of hundreds of kilometres to reach medical facilities. Pervasive insecurity along the way frequently obstructs their access, leading to critical delays that exacerbate health conditions and tragically, sometimes, cause death. Those who are able to afford it navigate the risks of getting caught in violence and pay a large amount of money for transport to reach the few fully functioning health facilities.

Barriers to accessing medical care

A significant portion of people in the Bay region and its surrounding areas live in poverty, which makes it difficult for them to afford healthcare services and transportation to reach secondary healthcare services. The cost of transportation, that can be up to $300, can be prohibitive. This forces people to delay or forgo essential medical care, including many women in their reproductive age, leading to high rates of illness and death from preventable diseases.

People in the region have been facing significant health and humanitarian challenges due to prolonged conflict, chronic instability, and climatic shocks that have led to severe droughts and flash floods. The crumbled healthcare system further exacerbates the situation, leaving women and children most vulnerable and depriving them of basic health services.

Cultural norms and traditional practices also play a substantial role in healthcare access. In many families, men make the healthcare decisions. Their consent is crucial to carry out any medical procedure and women often lack autonomy over their own health. This delay in decision-making can lead to late arrivals at medical facilities. 

Additionally, a general mistrust of modern medical practices coupled with health awareness rates hinder the adoption of preventive and curative healthcare measures.

“There has been a widespread belief that undergoing surgery would result in their children being exchanged with others, leading many to refuse hospital treatment,” says Habiba Mohamed Abdirahman, a traditional birth attendant in Baidoa. “Moreover, common misconceptions about blood donation include fears about health risks associated with donating blood, concerns about religious or cultural taboos, and misunderstandings about the medical process.”

The main causes of death for pregnant women are blood-pressure-related complications, haemorrhage, and sepsis. All these conditions can become deadly if not treated in a timely manner and late access to healthcare increases the chance of death for both mother and baby.

Concerns grows over maternal and child health

Most maternal and paediatric deaths stem from delays in seeking care: delays in deciding to seek safe delivery services, delays in reaching a health facility, and delays in receiving prompt and suitable care upon arrival at a facility. These challenges experienced by women in Bay and the surrounding region contribute to the maternal and child mortality rates. 

Somalia has one of the highest maternal mortality rates globally, with 621 deaths per 100,000 live birthsData available here: https://data.worldbank.org/indicator/SH.STA.MMRT?locations=SO, and one of the highest child (under five years) mortality rates, with approximately 106 deaths per 1,000 live birthsData available here: https://data.unicef.org/country/som/.

The healthcare infrastructure in the region is underdeveloped and suffers from a critical shortage of trained medical professionals. The few facilities that exist in Baidoa and at the periphery are often overwhelmed, particularly during emergencies and disease outbreaks. The region's healthcare system struggles with limited resources, including human and financial resources, essential medications and medical supplies. 

Ongoing conflict further complicates the delivery of healthcare as it remains out of reach for the majority of people in conflict-affected and inaccessible areas.

Investment needed in the Bay region’s healthcare infrastructure

“The current state of maternal and child health in the Bay region calls for immediate attention,” says MSF’s head of programme in Somalia, Dr Pitchou Kayembe. “MSF calls upon national authorities and international organisations to invest more in strengthening the health system, both at basic and specialist levels, by allocating enough resources to improve access to healthcare for women and children in Bay region.”

“Maternal and neonatal deaths can be averted by making it possible for pregnant women to access antenatal care closer to their homes, reducing late referrals for complicated cases and increasing the number of women delivering in a health facility by raising awareness about available services,” they say. “At the same time, vaccination coverage and nutrition screening and support must be expanded. This is only possible through increased financial support, community engagement, and improved cold chain infrastructure.”

Since 2018, MSF has been supporting the Bay Regional hospital in Baidoa, providing a range of medical services to improve maternal and child health and respond to disease outbreaks. We provide comprehensive emergency obstetric and neonatal care, ensuring safe births and offering both inpatient and outpatient care for pregnant women and their newborns. The teams assist in approximately 200 deliveries each month. Additionally, MSF runs seven outreach sites near camps for people who are internally displaced, to provide basic healthcare and ensure timely referrals to specialist services. 

The challenges in accessing healthcare for women and children in Baidoa are multifaceted, involving security, economics, culture, as well as infrastructural barriers. While the efforts of MSF and other organisations have significantly improved healthcare access and outcomes, continuous support and enhancement of these programs are essential.

Strengthening the healthcare system, increasing health literacy, and addressing socio-economic barriers can pave the way for better health outcomes for the women and children of Baidoa. The continued support of the international community is essential to sustain, expand and decentralise health services.