Epidemics And Public Health In Late Colonial Somaliland

Epidemics

The 1943 drought created “famine conditions” throughout Somaliland particularly in the western districts (Hargeysa and Borama-Zeila). During the drought at least 60 percent of the sheep, goats, and cattle stock, and 10 percent of the camel stock including a “large proportion of calves”⁴ perished. In response to the crisis, the administration opened relief camps for “starving people” “on a small scale in Burao and Berbera,”⁵ and on an “an extensive scale” ⁶ in Borama and Zeila. Grain, for instance, “was issued to over 20,000 people in one day in Borama; while special arrangements were made in the hospitals at Borama and Zeilah to give milk and vitamin oils to children who were suffering from the effects of malnutrition and incipient starvation.” ⁷ Victims of the drought that migrated from Ethiopia introduced a smallpox epidemic into the western region. The “disease (smallpox) is endemic in Ethiopia,” the 1943 administrative report stated, and is introduced into the country through the “nomadic population of British Somaliland.”⁸ Ethiopia’s metropolitan centers had always been the source of smallpox epidemics for Somaliland. The disease becomes endemic only in large cosmopolitan centers from where it makes forays into areas where the people have no immunity.⁹ The epidemic broke out in January and continued to affect the victims of the drought in the camps until December. The “recorded cases” were as follows: 74 cases in January; 80 cases in February; 120 cases in March; 235 cases in April; 240 cases in May; 105 in June; 36 cases in July; 60 cases in August; 24 cases in October; 121 cases in November; and 61 cases in December. The highest rate of infection took place in April and May “chiefly at Borama and the Abyssinian frontier.”¹⁰ In November and December, in contrast, the highest “recorded cases” were confined mainly to Hargeysa. Probably there were many unrecorded cases in the interior.¹¹ As a rule, figures quoted by medical reports reflected only the number of people treated in hospitals. As the reports repeatedly asserted, hospital figures were necessarily misleading. Since “hospital figures deal more with the urban than rural population (they) give a very false picture of mortality (and morbidity) among the general population.”¹²

Two other smallpox epidemics broke out in the country in 1953-54 and 1959. The 1953-1954 epidemic was introduced from Ethiopia towards the end of 1953–a period in which the border area was unsettled because the Ethiopian government was attempting to assert sovereignty over the Ogaden and the Haud. As early as 1949, the British cabinet decided–once the whole idea of “Greater Somalia” under British rule was defeated by the other great powers, particularly the United States and the Soviet Union–to hand over the disputed territories (Haud and Ogaden) to Ethiopia. The agreement between the two nations was reached in 1953 but formally announced in 1954. Meanwhile, the Ethiopian government intensified its assertions of suzerainty over the Haud. The political instability in the Haud forced people to migrate to Somaliland, and so infected cases introduced the disease into the western region, which then spread eastwards. As one report put it, “the general tendency was for the disease, which continued to be a very mild form of Alastrim, to spread from the West and center of the country to the East and South and from towns to rural areas.”¹³ The epidemic reached its peak on 13 February 1954, when 88 cases were reported. Thereafter it began to decline. The last case reported was in 18 September 1954. Overall, 240 cases were treated in 1953 and 818 cases in 1954. Only 487 were admitted to hospitals. There was only one reported death: the patient suffered from a “severe and neglected cellulitis of (the) arm which was thought to have followed vaccination so that on the face of it an attack of Alastrim seems to have been the safer method of acquiring immunity.”¹⁴

The 1959 smallpox epidemic was also mild. The epidemic began in Ethiopia in August 1959, followed the railroad to Djibouti in September, and in “November 1959, it invaded Somaliland.”¹⁵ The outbreak was detected in late November, but was confined to the Borama district, and was “clearly . . . initiated by the entry of infected persons from the adjoining area of Ethiopia” and Djibouti.¹⁶ Overall, 94 cases were diagnosed in Borama and Hargeysa districts, of which seven died.¹⁷ There were probably many other cases in the interior. The speedy dissemination of the contagion from Ethiopia to Djibouti to Somaliland owed a great deal to improvements in transportation,¹⁸ which facilitated the movement of peoples and contagion. It was also facilitated by “fairly severe drought” in the country in 1959, particularly in the frontier region with Ethiopia, from November 1958 to April 1959, in which a “large number of stock were lost,” and in which pastoralists experienced “harsh conditions.”¹⁹ The drought forced the people to migrate across the frontiers and carry the disease with them. The impact of the epidemic, however, was limited. First, people acquired immunity to the disease because of the prevalence of the disease in the country since the early colonial period.²⁰ A 1946 report, for instance, noted the fact that “[e]xtensive epidemics of smallpox occur[ed] from time to time.” The report added that impact of the disease was limited by the acquisition of immunity. In 1946, according to the report, 40 percent of the population had immunity to the disease as a result of “a previous attack of smallpox or vaccination.”²¹ Second, public health policies mitigated the impact of the epidemic: on the one hand, infected cases were isolated in special hospitals and camps, and on the other water and food was carried to the people in the interior which limited mass migration.²² In Somali traditions, the drought is known as “gaadhi-ghaadhi saar” (truck placed upon a truck), which refers to the water containers carried by trucks into the interior.

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