COVID-19 cases are rising sharply in Somalia as clinics, hospitals, prisons, and communities brace themselves for what could be a surge in people falling sick to the virus.

Over 500 cases of COVID-19 have been confirmed in Somalia, mostly in and around the capital Mogadishu, since the first case was confirmed six weeks ago. The International Committee of the Red Cross (ICRC) fears that the true caseload could be much higher, and more people will likely get sick in the coming weeks.

“We are concerned about the increased number of cases and unfortunately, we consider we haven’t seen the peak and we will still see a large number of cases being confirmed in the coming weeks,” said Ana Maria Guzman, the health coordinator for ICRC in Somalia.

Somalia’s health care system has been gutted by decades of violence and underinvestment. Only 50 percent of people in urban areas are estimated to have access to medical care. This drops to just 15 percent in rural areas. Intensive care capacity is limited at best and most hospitals lack regular electricity supply, let alone ventilators.

“People are dying,” said Dr. Mohamed Yusuf, the director of Madina Hospital in Mogadishu. “Deaths are being reported in the different regions—people who didn’t come from abroad and are locals. I think you can imagine how short a time it’s taken for the disease to spread…The problem that exists is that we don’t have enough equipment to respond to the problem. Today in Mogadishu, there is no place that you can say is ready.”

Hospitals and clinics in Somalia are racing to put in place preventive measures against COVID-19 such as temperature checks and handwashing at entrances and triage systems to ensure suspected cases are quickly isolated. However, at nearly 50 cases being confirmed a day in the last week, what capacity exists to treat severe cases will quickly be overrun.

The challenges of curbing the spread of COVID-19 in Somalia are immense. Conflict and climate shocks have uprooted hundreds of thousands of Somalis from their homes. Many of them live in overcrowded displacement camps or shoulder-to-shoulder in overcrowded settlements around urban areas. Physical distancing is impossible, and many do not have soap or water to wash their hands regularly. This creates fertile conditions for the virus to spread.

While COVID-19 threatens the health of communities in Somalia, it also poses a tremendous risk to those living in the country’s detention facilities. As is the case in displacement camps and densely populated urban neighbourhoods, physical distancing and handwashing are luxuries that prisoners cannot practice.

The ICRC recently provided soap and other hygiene and sanitation equipment to prisons around the country to prevent COVID-19. Ali Ahmed is one of the detainees in Mogadishu Central Prison who the ICRC trained in COVID-19 prevention.

“Following the outbreak, we have been shown how to wash our hands and I took part and understood it,” Ali said. “Now that supplies were given to us, inside are my brothers, [and] I’ll show them how to use them. I’ll show them how to wash your hands when you’re entering the room…And we pray to God to prevent us from the disease, so it doesn’t come here.”