Tuberculosis (TB) is a major public health concern in Somalia, where an increase in cases year over year is causing a high death rate and disease burden. Limited awareness of the disease, long distances to health facilities and the use of traditional healers contribute to the prevalence of TB.

Since 2019, Médecins Sans Frontières (MSF) has been supporting drug-resistant TB (DR-TB) treatment facilities in the general hospitals of Hargeisa, the capital of Somaliland, and in Berbera, a city three hours to the northeast. People with DR-TB are referred to these two facilities from across Somaliland and neighbouring regions.

People often make difficult decisions about leaving their livelihood and families behind to begin treatment for DR-TB in a far-away facility. DR-TB treatment can last up to 20 months and patients are required to make daily trips to treatment centres, located in hospitals, to take their medication. It can be extremely difficult to complete the long treatment regimens without consistent encouragement and support, particularly when faced with personal hardships.

MSF is working with the Ministry of Health and the National TB Programme, to conduct awareness raising campaigns for those in remote areas, urban centres and sites for internally displaced people. These campaigns encourage testing and treatment for DR-TB.

Mohamed Muse*, 36, thought he had triumphed over TB after overcoming the disease two times before. Not long after his second TB treatment in Hargeisa, Mohamed fell ill again.

“I had a feeling that the symptoms were like previous TB infections,” says Mohamed. “I was not getting any better.”

“We didn’t have food, and the livestock were dying. A meal a day was hard to come by,” says Mohamed. “I looked for bus fare to go to Hargeisa for treatment. It’s hard to find a TB facility in my rural area or in nearby districts.”

Mohamed boarded a bus for the four-hour trip to Hargeisa alone and the following morning, he visited Hargeisa TB treatment centre. Mohamed was diagnosed with drug-resistant TB.

“I was heartbroken when I was diagnosed with TB for the third time,” says Mohamed. “I felt this time, I will not survive it. I was also shocked when I found out that the treatment usually lasts 20 months.”

“During the first weeks of taking the medication, I was nauseous, vomiting every time I swallowed a pill, and I developed skin rashes,” says Mohamed. “I also experienced depression, thinking about my family and the drought back home. At the TB treatment centre, I have food, a bed, and monthly stipends so I can buy nutritious food and drinks while I get better.”

Mahado Farah*, a 28-year-old mother of four, was diagnosed with DR-TB at the Berbera TB treatment centre. Mahado had been coughing heavily for weeks, thinking it was a flu. She grew worried as time went on with no improvement. She went to Hargeisa, Somaliland’s largest city, in search of further care.  After testing positive for TB in a private hospital, Mahado was referred to Berbera TB treatment centre, where she is currently in her third month of treatment.

“I was received very well in Berbera TB Hospital,” says Mahado. “All services here are free of charge. I am getting counselling, daily pills, and check-ups.”

“After three months of treatment, I now feel better,” says Mahado. “ I am getting used to the medicine - I have some joint tenderness so I cannot walk or carry heavy things. My husband took away all four of our kids when he heard about my illness. Thanks for being here in my hour of need. I will live to see my children again.”

Abdirahman Sugule* is 58 years old and lives in Berbera, where he used to work in a restaurant as a cook.

“For me, DR-TB started with a light cough and fever,” says Abdirahman. “I bought some antibiotics from the pharmacy, which relieved the pain temporarily. After three weeks, the cough became drier, and I started coughing blood, even sometimes bright red blood. My condition deteriorated and I fell unconscious.”

Abdirahman was brought to Berbera TB treatment centre where he was diagnosed with DR-TB. Now, after six months of treatment, he has regained his strength and almost all of his symptoms have gone.

“Although I have now tested negative and am being discharged, people may still believe I have a remnant of TB in my body and will avoid me,” says Abdirahman. “I feel I have a responsibility to dispel some myths about TB in the community.”

“As a TB survivor and with some basic knowledge of TB, I will be working to raise awareness about the disease,” says Abdirahman. “I want to help support others that have been recently diagnosed and are going through treatment.”