Somalia is suffering from an outbreak of measles that the World Health Organization and the U.N. children's agency labels "extremely alarming." UNICEF reported 1,350 suspected cases of measles in March and April, a figure four times higher than the same period last year. Another 1,000 cases were reported in May.
Many children in the country are malnourished and few have access to medical care, making an outbreak potentially dangerous for thousands of others. One additional danger that prevents early medical intervention is the belief by many parents that they should keep measles-infected children at home for a week for what they call an "incubation" period.
"Such delays cause clinical problems, including respiratory disorders, and in some cases they bring children malnourished who cannot survive without ventilation," Dr. Omar Abdi, a pediatrician at Banadir Hospital in Mogadishu, said in an interview on Tuesday.
Though mostly eradicated in the United States, measles remains a common disease in many parts of Asia, the Pacific and Africa because of a lack of vaccinations. Even the U.S., where the disease has technically been eliminated, has seen a record number of measles cases this year. The Centers for Disease Control and Prevention says the country has nearly 400 reported cases, more than twice as many as in all of 2013 and eight times as many as in all of 2012.
The measles is spreading in a handful of U.S. communities where pockets of unvaccinated people are found, the U.S. Centers for Disease Control and Prevention says.
In Somalia, the disease is spreading because of a lack of medical facilities. A measles vaccination costs only about $1, but millions of children remain exposed to the disease. Hunger and bad health add to the problem.
"We have a very high number of malnourished Somali children," said Sikander Khan, the UNICEF Somalia representative. "Malnourished children here are more susceptible to disease and are more likely to die or suffer lifelong disability such as blindness, deafness or brain damage as a result of contracting measles."
The World Health Organization says about 330 people, mostly children, die from measles every day globally. The Philippines is suffering from a severe outbreak this year. WHO says the country has about 40,000 cases.
The signs and symptoms of measles include inflamed eyes, a cough, sore throat, fever and a red, blotchy skin rash. There is no specific treatment for measles except to relieve symptoms with medications. But malnourished children are more likely to have severe cases and develop life-threating complications like pneumonia.
In Somalia, the belief that treatment should be delayed sometimes causes rifts inside families. Halimo Hussein brought her 4-year-old girl into the hospital after defying her husband's order to keep her child home for at least a week.
"I'm here against his will," she said. "He even threatened me with divorce for defying him."
Two decades of conflict has devastated Somalia's health sector. An estimated one in five children dies before his or her fifth birthday, and measles is one of the main causes. Vaccination in areas controlled by al-Shabab militants is difficult. Health officials estimated only 15 percent of children there are protected against the disease.
The World Health Organization and UNICEF say a nationwide campaign to vaccinate about 5 million children at a cost of $9 million needs to be conducted to prevent thousands of avoidable deaths.