1,491 prosthetic and orthotic devices, 775 crutches, 128 wheelchairs and 15,247 physiotherapy sessions. These are devices and services offered to people living with disabilities this year across three rehabilitation centres in Somalia. The facilities located in Mogadishu, Galkacyo and Hargeisa are run by the International Committee of the Red Cross (ICRC) and the Somali Red Crescent Society (SRCS). In a country that has endured more than three decades of conflict, physical rehabilitation is critical and offers hope to the casualties whose abilities have been adversely affected by the ongoing conflict.

To mark this year’s International Day of Persons with Disabilities, we sat down with Daniel Du Toit Botes, the ICRC’s Physical Rehabilitation Program Manager to find out more about what the situation is like in Somalia.

Daniel Du Toit Botes – Physical Rehabilitation Program Manager, Somalia

Q1. How long have you been in this field Daniel?

I have worked in the physical rehabilitation field for 15 years with just over two years with the ICRC in Somalia. I started doing it voluntarily at a private prosthetic and orthotic firm in my hometown in South Africa while in high school to see if the profession was a fit for me. As a university student, I did an internship in a private firm while studying to get more practical experience. I’ve been with the organization for more than six years and Somalia is my fourth mission with the organization.

Q2. How, then, would you describe the physical rehabilitation situation in Somalia?

In Somalia, the physical rehabilitation needs are tremendous and cannot be met by the available resources and manpower. To provide some perspective, an estimated 15% of the Somali population, that’s two in every 10 people, have some form of impairment accompanied by various barriers that ultimately lead to having a disability. If we estimate the Somali population to be around 16 million, then, more than two million people have some form of disability of whom over 80,000 have a physical disability and require interventions such as prosthetic limbs, orthotic braces, mobility aids and physiotherapy exercises. About 2% of the Somali population, that’s over 300,000 people, require a wheelchair and 0.1% of newborn babies – one in every thousand – require clubfoot treatment.

Now, to address these needs, a total of 32 rehabilitation centres are required with a workforce of about 720 rehabilitation staff. The reality in Somalia is very different. Only four rehabilitation centres exist in the country, three of which are owned by the SRCS and supported by the ICRC. The centres provide specialized services with a workforce of approximately 52 rehabilitation staff.

In 2021, approximately 16.4% of the country’s needs were met by the four rehabilitation centres combined. Unfortunately, we also know that only 5% of people entitled to a wheelchair received one. That is, an appropriate wheelchair that meets their needs and living environment, provides a proper fit and support, is safe to use and durable.

Q3. What are the common impairments you see at the centres?

This may vary depending on the area and the external factors that exist such as conflict, drought, malnourishment, displacement, and disease outbreaks. The number of people who need rehabilitation services is directly proportional to the number of external factors they are exposed to.

The most common causes of disability at all three centres are due to gunshots, explosions, mines, bites, diseases, road accidents and burns. Amputations, nerve injuries, cerebral palsy, spinal cord injuries, joint problems, fractures, children with clubfoot, chest problems, and lower back pain are some of the common conditions across all three centres. These are not in any specific order and will vary depending on the place and external factors that exist in the area.

Q4. Where does physical rehabilitation fit in health care and is there a referral system in place?

Physical rehabilitation is part of the health continuum of care process that any person may require throughout their lifetime. Especially those affected by armed conflict and/or disability. The continuum of care can be described as referral processes a person is taken through to reach an end goal which may be restored health, independence, partaking in sports, being social with friends, returning to work, and/or accessing education. To reach this goal a person may need to receive treatment from several professionals in each step of referral. This depends on the nature of the injury or degree of disability.

If someone steps on a landmine and loses a lower limb, the continuum of care process for this individual will typically look as follows: injury by a landmine, first aid and prehospital emergency treatment, evacuated to hospital, surgery, psychological support, referral to a physical rehabilitation centre, physical rehabilitation, vocational training, and finally socio-economic reintegration.

In Somalia, there are constant referrals between the different health programmes to ensure the continuum of care for each case. The Physical Rehabilitation Programme receives referrals from the First Aid and Pre-hospital Emergency Programme, the Primary Health Care Programme, the Hospital Programme, and its network of organizations for persons with disabilities. We also rely on word-of-mouth referrals and campaigns launched by SRCS to raise awareness. The Physical Rehabilitation Programme has provided sensitization and prevention training to healthcare staff to identify possible cases for referral to the closest physical rehabilitation centre within the vicinity.

Q5. Any future plans for the rehabilitation programme?

At the moment, we are running a pilot programme to increase access to persons with disabilities in remote areas of the country that need rehabilitation services but do not have the means to reach the centres. This is done in collaboration with the SRCS centres and with the help of their broad network of branches throughout the country. They identify cases based on a set of criteria and refer them to the rehabilitation facilities. The ICRC covers the cost of transportation, food, and accommodation. This support is very specific and expensive therefore, we target the most vulnerable and give priority to those affected by armed conflict and other situations of violence. Women, children and the elderly with long-term impairments are among the poorest and most marginalised in any community. They often have been overlooked due to the barriers they face. Interactions between impairments and barriers that these affected communities face cause them to have a disability when compared to others.

Next year, we will also run a pilot programme in collaboration with our Economic Security team to support people with disabilities set up small businesses and offer them training on how to run them.  This coupled with sport for people with physical disabilities, another initiative we aim to start next year, will ultimately enable socio-economic reintegration, thereby closing the loop in the continuum of care cycle.