Somalis are used to hardship. Hunger, disease and violent death have brooded over their desiccated land ever since the first clans reached the Horn of Africa more than a millennium ago.

It is not in the Somali national character, enameled by suffering, to complain. Setbacks are shrugged off and mortality contemplated with disdain. “I never saw a Somali who showed any fear of death,” wrote Gerald Hanley, the Irish author, who lived among them in the Forties.

Yet, even for the hardiest, the past decade has been testing.


Somalia is a nation of nomads. Of every five Somalis, four are pastoralists, moving their flocks and herds with the weather.

Such a life is fragile. When the rains fail, as they often do, the livestock sicken and die. Competition between Somalia’s myriad clans and sub-clans often leads to conflict, but in barren times the clan is also a great source of strength: water, grazing and breeding stock are shared in order to save the community’s lives.

Hunger, Disease And Violence Is Somalia The Worst Place In The World To Be A Child
The droughts have been so long and so relentless that even the old men say they cannot remember a time of such climate-related wretchedness CREDIT: EDUARDO SOTERAS JALIL

But twice over the past ten years, the droughts have been so long and so relentless, failing over successive seasons, that even the old men say they cannot remember a time of such climate-related wretchedness.

Across great swathes of Somalia, 80 percent of livestock has died as pasture withered and wells dried under skies that remained remorselessly blue — a cull, blamed on a deadly combination of climate change and overgrazing, that is unprecedented in living memory.

When animals die in such vast numbers, all go hungry — but Somalis, deprived of their livelihoods, know that it is their children, denied adequate sustenance, who are the least likely to survive.

There are many reasons why life is so precarious for Somali children.

There is no one alive as tough as the Somali nomad Gerald Hanley

Decades of civil conflict since the country’s implosion in 1991 have stunted development. For more than 20 years, Somalia did not have a government at all, depriving much of the population of life-saving services, from basic sanitation to rudimentary health care.

Insecurity worsened in recent years by the Islamist militant group al-Shabaab taking over substantial pockets of the country, meant that aid agencies often struggled to reach the most vulnerable communities.

As a result more than half of Somali children are unvaccinated, a figure that is one of the highest in the world and which also closely matches the number of children not in school.

Yet it is almost certainly the widespread drought of recent years that explains why Somalia emerged this year as the world’s deadliest place to be a child, a country where, according to UNICEF and the World Bank, one in seven children will not live to see their fifth birthday.

The arid bushland outside Dudubka, a village in the Sool region of Somaliland, once teemed with livestock. Now, save for a few hardy camels looming out of the harsh white light that bathes the plains, the landscape is bereft of life.

Hunger, Disease And Violence Is Somalia The Worst Place In The World To Be A Child
The drought has been particularly devastating in isolated places like Dudubka CREDIT: EDUARDO SOTERAS JALIL

Somaliland, a former British colony, broke away from the rest of Somalia in 1991 and has generally been much more stable, although there has been a surge of violence in the Sool region this year.

But the drought has been just as devastating, particularly in isolated places like Dudubka, which has no roads leading to it, just hard-to-find tracks cut through the scrub.

With no places of entertainment and just a smattering of shops, it is more a transient frontier settlement than a village, a place of respite for those too ill, too young or too old to sustain the demands of nomadic life.

In the past year, it has also been a refuge, not just for herders with a link to Dudubka who lost their livestock but for relatives and strangers too.

In the past 18 months, Dubdubka’s population has doubled, growing from 108 families before the drought to 228 since straining the village’s already scarce resources.

It is only in the most desperate times that the countryside empties and villages like Dudubka fill to overflowing. Nomads do not opt for a sedentary life out of choice.

“There is no one alive as tough as the Somali nomad,” wrote Hanley, recalling a wounded Somali soldier who walked 14 miles through the bush “holding his guts in his hand.”

[su_pullquote align=”right”]You can tell when the animals are going to die. They start bleeding through the nose. Then you know there is nothing you can do. Anisa Jama Hussein[/su_pullquote]

Anisa Jama Hussein and her husband were not pushed to quite such extremes, but they did walk for three days to reach Dudubka, carrying their youngest children the whole way. Weak and emaciated, Halimo, who was two, and his four-year-old sister Katra were barely alive when they reached the village, their three older siblings, all malourished, trailing exhaustedly behind.

For two years the Jama family had tried to keep their herd — 300 sheep and goats, as well as 20 camels — alive as grazing vanished and the wells dried.

One by one, the animals dropped.

“You can tell when the animals are going to die,” Mrs. Jama recalled. “They start bleeding through the nose. Then you know there is nothing you can do.”

At first, members of their herding community did their best to help each other, sharing out what food there was, but soon everyone was in the same position, all engaged in a desperate struggle for survival.

“There was no place to run,” she said. “The whole country was in drought. We couldn’t save our animals and we didn’t know how to save ourselves.

“Our livestock were our only source of income and our only means of survival. We couldn’t give milk to our kids. We couldn’t give them food. Everyone was starving.”

Hunger, Disease And Violence Is Somalia The Worst Place In The World To Be A Child
Anisa Jama Hassan (pictured with her daughters Halimo, 2, and Katra, 4) walked for three days with her husband, carrying their malnourished children to Dudubka after drought killed their livestock CREDIT: EDUARDO SOTERAS JALIL

When the children of other herders began to die, and with her own becoming ever weaker through constant diarrhea, Mrs. Jama and her husband decided to make for Dudubka, the nearest place of place of refuge. All their camels were dead and only five of their 300 sheep had survived.

Once, a place like Dudubka would scarcely have offered a better prospect for survival for newly destitute families like Mrs. Jama, the chances of finding food in the villages being only slightly better than out in the wilds.

But a relief effort mounted by the government and aid agencies supplied emergency food. Save the Children, a charity runs a mobile clinic that still visits Dudubka twice a month.

But for the most malnourished children, even the medical care offered by mobile clinics can come too late.

Malnutrition is the biggest killer of children in Somalia, usually not because they starve to death but because their bodies are so emaciated their immune systems become too weak to fend off disease.

The Jama family were just in time. Hawa Salah’s son Ahmed was not.

Hunger, Disease And Violence Is Somalia The Worst Place In The World To Be A Child
Mrs Salah became malnourished during pregnancy after drought killed her livestock. She gave birth to a severely malnourished boy who died after four months. The boy was called Ahmed CREDIT: EDUARDO SOTERAS JALIL

Like the Jamas, Mrs. Salah, who is 25, watched her family’s herd slowly die. But as the drought reached its climax, she feels pregnant. With food, particularly the type of nutritious sustenance a pregnant woman needs, ever scarcer, she became malnourished and anemic herself.

When Ahmed was born, prematurely, last November, he was already frail. The breast milk she produced was never going to be enough for him, however much she wailed.

“He was so tiny, so light” she recalled.

Although she reached Dudubka shortly after giving birth and Ahmed was given supplementary food by Save the Children, he never really thrived, sometimes growing a little stronger only to weaken again.

For four months, he clung doggedly to life. “Then, one morning, we woke up and he was just dead on the bed,” Mrs. Salah said.

The rains finally came this year, but for Dudubka’s new residents it was too late. With no breeding stock left, none can replenish their herds, leaving them dependent on food doled out by aid agencies to survive.

The charities do what they can to keep Dudubka’s children alive.

Hunger, Disease And Violence Is Somalia The Worst Place In The World To Be A Child
Two workers of the charity Save the Children are pictured at a mobile clinic that the organization has in Dudubka CREDIT: EDUARDO SOTERAS JALIL

In a corner of the village, a rudimentary shelter erected from wood and covered in orange and green tarpaulin serves as Save the Children’s mobile clinic.

When the charity’s medics arrive for their twice-a-month visits, children from the village and settlements within a few hours walk queue to be vaccinated, weighed and measured.

Spotting malnutrition early means a child is much more likely to survive, says Guled Hussein, Save the Children’s local nutrition officer, as a colored measuring tape is wrapped round a toddler’s forearm.

Those severely malnourished are often already sick, most frequently with pneumonia, the single biggest killer of children under the age of five in both Somalia and Somaliland.

Thanks to a high energy supplementary food called Plumpy’Nut, given out to all children diagnosed at the clinic as malnourished, survival rates have improved. The high-energy sachets, containing a calorie-heavy peanut-based paste, is easy to administer and because children like the taste they can regain weight rapidly.

But in a nomadic society, monitoring children over several months can be difficult because some families leave the village for other settlements in between visits by the mobile clinic.

“A mother brings in her malnourished child for treatment, but we can’t keep track of them,” Mr. Hussein said. “They turn up at another mobile clinic in another village a month later without any records.”

Hunger, Disease And Violence Is Somalia The Worst Place In The World To Be A Child
A young mother receives rations of Plumpy, high-energy sachets of food for malnourished children, containing a calorie-heavy peanut-based paste CREDIT: EDUARDO SOTERAS JALIL

Save the Children has trained community volunteers to try to track the movement of nomadic families. Next door to the clinic, other volunteers train Somali women in techniques that could often save lives.

Mothers are taught how to use the colored tape measures so they themselves can see if their children have become malnourished. The importance of hygiene, breastfeeding and vaccinations are also emphasized.

Such interventions are saving lives, but even if there were no drought, both Somalia and Somaliland would struggle to bring down child mortality rates.

When a mobile clinic visits a village like Dudubka, the sickest and most malnourished children can be driven to the colonial-era hospital in Burao, the nearest substantial town.

But the hospital is several hours drive away, and with few cars available, getting to the hospital in time to save a child’s life is difficult.

Burao has the only referral hospital for 1.5 million people living in Somaliland’s three eastern regions.

[su_pullquote]A healthy child might be able to fight off these diseases, but it is much harder for a malnourished child

Dr. Abdullahi Ali, pediatrician [/su_pullquote]

On a bed in the hospital’s small pediatric ward, Asha Mahmoud cradled her three-year-old son, Awal, painfully thin and visibly suffering.

He had been ailing for weeks, Mrs. Mahmoud said, vomiting, listless and running a fever — but because they lived 12 hours drive away from the hospital reaching it seemed an almost impossible task.

“We waited for days and days before a vehicle finally came,” she said.

It is, according to Abdullahi Ali, one of Somaliland’s few pediatricians, all too common a story.

“Most of the people here are from the bush,” he said. “It is very difficult for them to reach here, and those that don’t manage it, their children often die.”

Nearly all the children on the ward came from families who had lost most of their livestock. Many were malnourished as a result, making them more susceptible to disease, but hunger alone was not the only issue.

Marwo Mohamed’s eight-month-old twins were both suffering from acute diarrhea, probably caused after they were given formula made with contaminated water.

“In some areas, there is no safe water, so common parasitic infections abound,” said Dr Abdullahi. “A healthy child might be able to fight off these diseases, but it is much harder for a malnourished child.”

Hunger, Disease And Violence Is Somalia The Worst Place In The World To Be A Child
A young boy is weighed at Save The Children’s mobile clinic in the village of Dudubka, Somaliland CREDIT: EDUARDO SOTERAS JALIL

A campaign to encourage exclusive breastfeeding for the first six months of life is underway in Somaliland, and is beginning to have an impact, doctors say.

But until malnutrition can be brought under control, Somaliland’s children will still die in terrifying numbers.

Lying silently, as though too exhausted to cry, on a bed in the corner of the pediatric ward, Mohammed Chamo seems to personify both the travails and spirit of his people.

He weighs barely 9lb, even though he is four months old. Born to a mother, Leila Saeed, half-starved herself when he was delivered, Mohammed’s short life has been a pitiful one.

He was just a month old when, his immune system weakened by hunger, a common cold turned into pneumonia. Untreated, pneumonia then became sepsis.

Sepsis anywhere in the world is a killer. A third of people who contract it die. In Somaliland, the chances or survival are much more remote.

Remarkably, Mohammed appears to be recovering. He has, though it is hard to believe when looking at him, gained weight, a testament to the indefatigability of Burao Hospital’s medical staff in an under-staffed hospital with almost no resources.

“He has a small body, but he has a big heart,” his mother said. “Such miracles give hope to us all.”

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