Pneumonia, unlike measles, was not contagious, but like measles, it was “an annually occurring epidemic disease.”71 It begins to spread in December and reaches peak level in January and February. The “various contributory causes” to the disease are temperature72 as well as diet. The winter months (December to February) are “intensely cold,” but the pastoralists of the interior often use “thin cotton garment”73 –particularly the very poor–and so body temperature falls drastically. The winter months, in addition, “tend to be hungry ones when a state of semi-starvation may be widespread with a consequent lowering of the individual resistance to disease.”74 Water in these months “is also short so that stock have to be driven long distances to permanent wells to be watered and during this process the herdsmen are drenched. Inadequately clothed, exhausted, hungry, cold and wet it is hardly surprising that they succumb to pneumonia.”75 The disease, then, is of “multifactorial nature”76: temperature, food consumption, nature of work, and clothing, all played a role in its incidence. For instance, during the 1950 drought, 95 cases of death of lobar-pneumonia and 81 cases of death of broncho-pneumonia were reported in the camps.77 The hunger and the cold–which were most severe in winter–facilitated the spread of the disease. Meanwhile, as the disease was ravaging the hungry, the health of the people was further weakened by a “pandemic Influenza which swept the Camps in March 1951,” and which caused “considerable mortality amongst the very young and the very old.”78
Unlike pneumonia, influenza is contagious, but like pneumonia, it has multiple sources of infection, and in particular, three different causative myxoviruses–A, B, and C. The A and B “viruses are associated with sporadic epidemics among children and young adults and do not cause pandemics,” so that the mortality rate is usually low–about 1 percent.79 Since it is contagious and is spread by airborne droplets from person to person, it is most prevalent in overcrowded areas, though it does not require large populations to maintain itself.80 In Somaliland, it usually began in the coastal towns, moved to the relief camps and then spread to the interior towns. In 1951, it “caused very little mortality” even though it probably facilitated the mortality in people suffering from pneumonia.81 The disease continued to haunt the people albeit in a mild form particularly during droughts in 1956, 1957, 1958, and 1959.
In late 1955 three problems confronted the rural folk: drought conditions, a locust invasion that devastated pastures and crops, and an “outbreak of disease among the stock [which] caused very heavy losses in the herds.”82 These events “resulted in famine conditions in March 1956”83, particularly in the western region, where the rural folk “had little or no money to purchase food as their normal sources of income from hides and skins, were much reduced by stock losses and a fall in the price of skins.”84 Grazing was also poor in the eastern districts such as Burao and Las Anod where the pastoralists were “unable to live off their stock or obtain good prices for their animals.”85 The government did not open any relief camps in the eastern districts since the level of hunger was not extreme, but “introduced specials works” that employed “a great deal of extra labor” that gave the pastoralists the income “to buy food and avoid starvation.”86 In the western district, the medical department opened a relief camp in March at Abdulkader, a small village between Zeila and Borama. Two hundred eighty women and children were admitted in the camp who were “in the early stages of starvation,”87 though no cases of oedema or extreme manifestation of starvation were seen. The continuous loss of stock and the increase in the price of food led to the rise in the population of the camp. By June 1956, there were 400-500 poor women and their children. The men were provided with employment. By August, there were 700-750 people in the camp.88 Even though rains were good in late 1956, the camp remained open throughout the year. Indeed it was closed only March 1957. Meanwhile, the “famine conditions rendered the population more liable to infectious diseases”89 such as influenza. The 1957 “Asian Influenza pandemic invaded the Protectorate in June.”90 It spread from Aden to the coastal towns–Berbera, Heis, and Mait, and then “spread to all stations but retained its mild character,” and as a result, most of the infected cases were “treated at home.”91 By November, the epidemic died out.92 Overall, 2,459 cases were treated in hospitals.93 It resurfaced briefly towards the end of 1957 and “continued into the early part of 1958 but then died out.”94 Again it resurfaced in mid-1958 in the towns, where a total of 691 cases were reported.95 It went into remission, and then re-emerged as a “small epidemic” in the last few weeks of 1958 and up to January and February 1959, when 2,227 cases were reported. The context of its resurfacing in late 1958 and early 1959 was the drought of 1959, which forced many people to congregate in overcrowded areas.96
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