"Somaliland has one of the worst maternal mortality ratios in the world, estimated to be between 10,443 and 14,004 per 100,000 live births," said Ettie Higgins, head of the UN Children’s Fund (UNICEF) field office in Hargeisa, capital of Somaliland.
"The infant mortality rate is 73/1,000 while the under-five mortality [rate] is about 117/1,000. Fully immunized children represent a mere 5 percent. Environmental sanitation is highly challenged,” she said.
"There are a little over 100 doctors in the country, both in the public and private sectors, and about the same number of registered midwives," Higgins explained.
"Maternal mortality is the leading cause of death among women of reproductive age; it is caused mainly by haemorrhage, puerperal sepsis, eclampsia and obstructed labour," Higgins said, adding that women in Somaliland had a one in 15 risk of dying of maternal-related causes.
Abdillahi Abdi Yusuf, head of Somaliland's National Health Management and Information System (NHMIS) in the Ministry of Health, said acute respiratory infections accounted for 40 percent of child mortality in Somaliland, while acute watery diarrhoea and malnutrition accounted for another 40 percent.
"Diseases that can be prevented through vaccination, such as polio, diphtheria, tetanus, TB, measles and whooping cough cause 20 percent of children's mortality in Somaliland," Yusuf said.
According to NHMIS statistics, in 2011 “acute respiratory infections [excluding pneumonia] were the highest [cause of] morbidity in Somaliland's public health centres”. Other leading causes included “anaemia, urinary tract infections, watery diarrhoea, pneumonia, skin diseases, eye infections, trauma and burns, sexually transmitted infections and bloody diarrhoea”.
According to a UNICEF/Ministry of Health Multi-Indicator Cluster Survey (MICS), diarrhoea is the second-highest cause of morbidity and mortality in Somaliland due to poor sanitation and low rate of access to safe water supplies.
"In Somaliland, only 42 percent of the population have access to latrines and 41 percent have access to safe water supplies,” the survey said.
Yasin Nur Tani, a private doctor in Hargeisa, told IRIN: "I used to receive about 20 patients daily, complaining of different ailments; the most common disease is upper respiratory tract infections in all ages while skin disease is second and diarrhoea comes third. These are then followed by acute gastritis, intestinal parasites, gynaecological and obstetric diseases and other non-communicable diseases including hypertension and diabetes."
Somaliland health authorities, in collaboration with international aid workers, conduct a weekly surveillance of communicable diseases and take action as soon as possible.
"The Ministry's focus on the communicable diseases control programme identifies the control and the prevention of those diseases contributing to the highest burden of disease in the country; these include malaria, tuberculosis, diarrhoeal diseases, HIV/AIDS, meningitis and vaccine preventable diseases," a report by the Health Ministry states.