Somali farmer Fadumo Mohamed Ibrahim’s crops failed in the drought and she set out on foot for help.

Twenty-five days later, she and her daughter Khaliye stumbled into a settlement in the outskirts of Baidoa, a city in central Somalia, sick and exhausted.

“There is no health care in my village, my children have never been vaccinated,” the 30-year-old says.

Arriving at the crowded settlement of fragile plastic-roofed shelters, the camp leader and health outreach workers took her to a vaccination team in an early step to safeguard their health.

“We were told by householders to get a vaccine. They told us it was important,” she adds.

So-called ‘zero dose children’, those like Khaliye who have never received immunization of any kind, account for around half of vaccine-preventable deaths around the world.

New arrivals at Raama Cadey camp, which is home to 342 displaced families, are recorded by the camp leader Abdulkadir Abdinur Adan. He identifies their needs and reports them to a community outreach health team supported by the World Health Organization.

At a makeshift vaccination centre, with patio furniture set up in a stick-built shelter open to the elements, health workers don facemasks and rubber gloves, and vaccinate children against measles, polio, and pneumonia – often deadly diseases present in the growing settlements that ring the city.

A day after Khaliye received the shots, Fadumo hugs her tightly as she sits on the floor of a hut built at the crowded settlement, brushing off flies. “When we walked to Baidoa, the children were sick … It’s important to keep my children safe,” she says.

Decades of conflict and 5 consecutive years of drought have left 8.3 million Somalis – around half the population – in need of protection and assistance. Repeated crop failures and worsening food insecurity have put more than 1.8 million under 5s at risk of severe malnutrition and related health complications.

The drought-ravaged rural area surrounding the city of Baidoa, once dubbed the “breadbasket of Somalia,” is emptying out after years of crop failures. The number of displaced people has nearly doubled in Baidoa to 660 000 in 2022, from 350 000 in 2018, with hundreds of people arriving at dozens of camps ringing the city each day.

“They have lost their livelihoods and have no source of income at all,” says Abdulkadir Abdinur Adan. “Every day they are 3 to 5 new households arriving on foot or in vehicles,” he adds.

Women, children and men crowd into single-roomed shelters made from thorn trees and roofed with cloth and plastic sheeting, which dot the mud and rock-strewn terrain, 2 or 3 paces apart. Residents have limited access to clean water for cooking or washing, and share just 10 latrines between them. One recent day, all were shuttered with padlocks.

“If you are in an IDP camp where people are living in crowded settings with limited or compromised access to water, sanitation and health services, you are more exposed to diseases that you would be in a village, that’s for sure,” says Joaquin Baruch, an epidemiologist with WHO during a recent visit to the camp to meet with community leaders and outreach health teams.

“Having outreach workers conducting immunization campaigns, it’s a huge investment in health … Without it, you spend your whole time doing outbreak control. It saves many lives,” he adds.

The already elevated risk from infectious diseases in the camp setting are further exacerbated by the poor health of families and children who frequently reach displacement camps around the city on foot, dehydrated and underweight.

“They really are more at risk from disease because of malnutrition,” Baruch says. “Most of the deaths are actually caused by a weakening of the immune system. If you are in a poor state, you are more susceptible to diseases,” he adds.

Nationwide, WHO has vaccinated more than 3.2 million children in recent months for measles, around 3 million have been treated with vitamin A and deworming tablets, and nearly one million in a cholera vaccination drive.

The importance of immunization has become clear to mother-of-4 Barwago Isgowe Ibrahim, who arrived at Raama Cadey 3 weeks earlier.

She explains that she previously lost a son, aged 2, to illness in her home village, which had no health centre or access to medical treatment.

She ensured that her 3 surviving children, all aged under 5, got immunized.

“There are so many diseases here, it’s important to get vaccinated,” she says, clutching her surviving son Abdullahi Dero Ali to her chest. 

The 2-year-old has a fever and is sweating and listless, but she has some confidence that he will recover.

“Vaccines will protect him,” she says.

About two thirds of these zero dose children live in marginalized communities and last year, through community outreach centres and an accelerated campaign, WHO identified and vaccinated nearly 85 000 zero-dose children in the country.

By reaching out to these zero-dose children, WHO is giving them not only a new life and new hope for the future, but reaching the missed communities they are a part of. This way the immunization gaps and vaccine inequity that is seen in the country will be addressed.

Distributed by APO Group on behalf of World Health Organization Regional Office for the Eastern Mediterranean.