Besides smallpox, malaria epidemics posed the most persistent health hazard to the population. Geographically, malaria epidemics were most common in the southern grazing area–that is, the South and Southwest–along the Ethiopian border. The other geographical zones were affected unevenly. The coastal plain, “Guban” (burned land), for instance, was too dry to be a source of malaria epidemics. The mountain escarpment, in contrast, had from the 1930s onwards, according to the director of the East African Malaria Unit in 1949, D. Bagster Wilson, a “moderately high level of endemic malaria . . . associated with the small water collections along the stream beds.”23 Endemic malaria in the mountain region, according to Wilson, was “sufficiently high for a certain amount of immunity to be acquired.”24 It was in the southern grazing area, however, that “epidemic occurrence of malaria”25 was most persistent. The “annual epidemic (in the southern region), which is usually in one part or another or even the whole of these grazing areas, is essentially attributable to breeding in the rain pans, large or small, that form in hollows to which drainage from the surrounding ground runs.”26 After the rains there is usually an interval of about a month before mosquitoes become noticeable, then “epidemic malaria may become apparent.” But he was unsure about the “genesis of epidemics in the wide area to the south, in which they are likely to occur.” This issue, he admitted, “is more obscure.”27 After all, the mountain escarpment received more rain, and had more water than the Haud. In addition, since epidemics were frequent in the region, why did the people not acquire immunity to it?28 The process of transmission of malaria infection in the country also puzzled Glasgow and MacInnes–two medical practitioners in Somaliland. They concluded that perhaps a key factor in the spread of the regular epidemics in the country were the “exceptional aggregations of a nomadic population around residual water.”29
Frederick Dunn recently pointed out that malaria transmission “depends upon the complex interaction of parasites; vector mosquitoes; physical, socioeconomic, and environmental factors; and human biology, demography, and behavior.”30 Rainfall is not the only determining factor in malaria epidemics. Equally important were the “number of persons harboring malarial parasites,”31 and the introduction of infection into new areas by migrants. Since immunity to malaria is species-specific,32 the introduction of new species often leads to epidemics. Two examples would be used to elaborate the argument: the 1949 and 1951 epidemics. In 1949, for instance, an epidemic swept the country, which followed the 1947-1949 drought. The 1947 drought “continued until the end of March (1949)” and “as a result livestock, especially sheep and goats, suffered in all districts and crop planting was retarded.”33 Shortly after the beginning of the rains, a malaria epidemic raged throughout the southern region. In Duruksi and Yooboros “epidemic conditions were just rising,” in Morodi Qadr the “epidemic was in full swing,” in El-Dab the “epidemic was waning,” and in the “whole area between Ainabo and the southern border a severe epidemic was in progress.”34
The 1951 malaria epidemic also followed on the heels of the 1950 drought–which is well known in Somali oral traditions as “Seega Case” (Season of Red Winds). The severe conditions created by the drought–“large numbers of stock died, leaving those dependent upon them for sustenance, destitute and starving”35 –were further aggravated by a locust invasion. By October 1950, a relief camp for drought victims was opened at Erigavo, which fed 150 destitute persons, and by the end of October, two other camps were opened for destitute persons at Garadag, and El-Afweyn. The total number of inmates of the camps (all three) by the end of October was 1,700. The number of people seeking help steadily grew. By the end of the month, the medical department and the government realized that a “major crisis was imminent and that a coordinated measures for famine relief were necessary.”36 The medical department followed a simple policy: only women, children, and the infirm were admitted to the camps. The men were given employment in either famine relief work, or on road building. By early 1951, other camps were opened at Badhan, Burao, and Berbera, and the number of inmates reached 9,000. By the middle of the year, 10,000 people were cared for in the camps. The drought-affected most severely infants and the young who suffered the highest mortality rate. The causes of death were “extreme malnutrition with concomitant diarrhea”37 and terminal gastro-entritis “associated with the general malnutrition.”38 The average death rate between February and April 1951, in the Erigavo and Badhan camps, for instance, was 10-12 per week per thousand inmates. In other camps, the rate of death was lower. In the El-Afweyn camp, the death among children was half the rate of the Erigavo and Badhan camps.39 About 1,000 people died in the camps, or 10 percent, mostly children.40 Towards the end of March, the summer rains brought the land back to life, and as a result, the people began to leave the camps in large numbers. By the end of the year there were only 2,000 people in all the camps.41
The 1951 malaria epidemic followed on the heels of the 1950 drought. The summer rains began in mid-March 1951, and at the end of May, a general increase in the incidence of malaria was reported, and in July, a malaria epidemic reached peak level. It declined slowly in August and came to an end at the beginning of September. Overall, 2,329 cases were admitted to hospital. Medical officers estimated a mortality rate of one or two percent of the total population.42 The high rate of death “was intensified by the generally poor state of nutrition of the people following the famine.”43 Droughts always preceded the malaria epidemic.
[su_button url=”https://saxafimedia.com/epidemics-public-health-late-colonial-somaliland/4/” style=”soft” size=”12″ wide=”yes” center=”yes” text_shadow=”0px 0px 0px #FFFFFF” rel=”lightbox”]CONTINUE READING ON THE NEXT PAGE >[/su_button]
