While the impact of the COVID-19 pandemic has been well documented in high-income countries, much less is known about its impact on low-income and conflict-affected countries. Abdihamid and a team at LSHTM conducted a study in Mogadishu in Somalia and found an under-reporting of excess deaths and the contributing factors.
COVID-19 has affected countries across the globe; however, little is known about the impact on chronic humanitarian settings due to their weak health and data systems. Somalia had already been hit by widespread outbreaks of cholera and measles and food insecurity, before the COVID-19 pandemic. Anecdotal evidence pointed to a heavy burden in Somalia, but the official numbers did not confirm this.
Partnering with the Somalia Disaster Resilience Institute and Catapult Satellite Applications, they used remote sensing and geospatial analysis to count the number of burials in Mogadishu from January 2017 to September 2020. They compared the number of burials prior to COVID-19 with those in the pandemic period.
They also undertook a qualitative survey of key informants to understand community perception on COVID-19 mortality, as well as community practice during the pandemic and challenges associated with controlling the pandemic.
They found that burial rates increased during the pandemic period with a ratio to pre-pandemic levels averaging 1.5-fold and peaking at 2.2-fold. Furthermore, the excess death toll between January and September 2020 ranged between 3,200 and 11,800. While most of these deaths are likely to be due to COVID-19, they found that some may be attributable to the indirect effects of the pandemic, such as socio-economic disruptions or reduced access to health services. Key informant interviews revealed that preventative social measures such as lockdowns were not effectively implemented, health care equipment was inadequate and a scepticism about the existence of COVID-19 were contributing factors.
Impact and Outcomes
The research revealed that COVID-19 deaths in Somalia were substantially higher than reported. It also shed light on a health system struggling to deal with the increasing severity of the pandemic.
Their approach of integrated satellite imagery analysis, on the ground qualitative research and statistical methods, is a novel way to identify how many deaths could be attributable to the pandemic. This geospatial analysis is a promising tool that can be used in fragile or crisis-affected settings where populations remain vulnerable to renewed waves and new variants.
The data will be presented to key decision makers at Somalia’s Ministry of Health with recommendations, such as to adopt a shielding approach of vulnerable, to strengthen their surveillance, and prioritise social awareness.
“We conducted a similar study in Yemen, but for this study in Somalia we have supplemented with a qualitative component to identify the driving factors behind the epidemic. We suspect that even these numbers are an underestimation as there were limitations in the quality of the imagery. In the absence of well-functioning systems, we need to invest in setting up studies ahead of emergencies, so we can rapidly see the impact of drought, disease, war and conflict.”
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