From the Sheikh and Imam to the Nomad: Engaging a Network of Allies to End Polio in Ethiopia’s Somali Region

 

By Jasmine Pittenger, UNICEF consultant and writer

For many nomads in Ethiopia’s Somali Region, home is a hand-sewn tent.
For many nomads in Ethiopia’s Somali Region, home is a hand-sewn tent. To reach families that are constantly on the move, it is essential to tap into the nomads’ own communication networks. This house-marked tent shows children were reached with the polio vaccine during the campaign. Awbare woreda of the Somali Region, November 2014. © UNICEF Ethiopia/2014/Rozario.

The patches that make up the nomad’s tent say it all. Yellow, orange and red cloth is sewn together with broad stitches — even a pair of trousers is sewn into the mix. Yet the tent is greater than the sum of its parts. It protects a large family from scorching desert sun, from cold nights and rain.

When a polio outbreak struck the Horn of Africa in 2013, WHO and UNICEF with the help of the European Union had to find a way to reach every last child across Somalia, Kenya and Ethiopia. It was a daunting task to deliver multiple doses of OPV (Oral Polio Vaccine) into the mouths of some of the world’s hardest-to-reach children – from war-torn parts of Somalia to the diverse landscapes of Kenya and Ethiopia. Among the very hardest-to-reach are nomads in Ethiopia’s Somali region, which shares a porous 1,600 kilometer border with Somalia. Here, over 80 per cent of the 5 million people are nomadic, herding cattle, camels and goats across broad stretches of desert in search of water and pasture. For many families, home is a tent sewn together from patches of cloth and carried from one watering hole to another on the back of a camel.

To end the outbreak, it was crucial to deliver messages to families constantly on the move. Yet only 11 per cent of people here have access to newspapers or radio. How, then, do you inform families about polio’s risks and the need for children to take OPV? What is the patchwork that makes up this particular community? How do the nomads themselves pass on life-saving information, and receive it? And who is in a position to mobilize families?

One answer is with the Sheikhs and Imams. The Somali Regional Health Bureau and UNICEF reached out to the Somali Region’s IASC (Islamic Affairs Supreme Council). This part of Ethiopia is close to 100 per cent Muslim, and the IASC Sheikhs and religious leaders, are amongst the most respected and influential personalities amongst nomadic communities here. The communities have faith and belief in what they say, and seek out their teachings even as they’re on the move. Once the highest-level Sheikhs and Imams became engaged in warning parents about polio’s risks and the need for OPV, Islamic leaders at all levels got on board.

“We have partnered with UNICEF and WHO because we believe this is a noble cause that is completely in line with our religion, Islam,” says Sheikh Abdel Rahman Hassan Hussein, President of the IASC in Jigjiga, capital of the Somali region. “From the city to the most remote villages, you will find every person working in this project motivated and doing his/her best. They know they are doing something that almighty Allah will reward them for, at the last day. They know they are saving the lives of children and their future by protecting them from this disease, polio. We take every occasion to tell people about this – from Friday prayers to feasts.”

Another answer: children themselves. Messages about polio and OPV are also being taught in schools, including the religious schools or madrassas that many children attend.

School children
School children – like these, at a religious school near the border with Somalia – can be powerful advocates for polio eradication. Awbare woreda, Somali Region, 2014. © UNICEF Ethiopia/2015/Mohamed.

“How many drops of the polio vaccine must be taken, every time the vaccinators come, by each and every child in your home?” asks a teacher at a small IASC-run madrassa on the border with Somalia. “Two drops, two drops!” shout the school children. “How do you know when a child has been vaccinated?” “The finger! The mark on the pinkie finger!” Children clamor to show off where the ink-marks should go on their fingers. Children can be great transmitters of polio messages to their parents. Says 10-year-old schoolboy Hassan: “At home I tell my mother and father about the importance of immunisation to protect little ones under the age of five.”

Parents pay attention – especially when the messages their children bring home are backed up by their local Imams, clan leaders and female community mobilisers who work for polio eradication. In Lafa’isa kebele 04 in the Awbare woreda of the Somali Region, Mrs. Hibo Abdikarim Ibrahim, mother of one-and-a-half-year-old baby boy Mohamed-Amin Abdusalam Abdosh proudly shows his vaccination certificate:

Hibo Abdikarim Ibrahim proudly shows the vaccination certificate for her son
Hibo Abdikarim Ibrahim proudly shows the vaccination certificate for her son, Mohamed-Amin Abdusalam Abdosh, which is a record of his completed routine immunisation schedule. Lafa’isa kebele, Awbare woreda, Somali Region, November, 2014. © UNICEF Ethiopia/2014/Rozario.

“I am so happy my child is fully immunized now. Every National Immunisation Day I also immunize him to protect him from polio. I learned all of this from our lady community mobilizers and we heard the same message in the mosque.”

From Sheikh and Imam to female community mobiliser to clan leader from madrassa student to mother and baby – this is how a movement is built. Each forms a piece of the patchwork to protect children from polio. Just like each dose of polio vaccine, generously funded by the European Union, strengthens the immunity of the community.

Yet there is still much to be done. In the last campaign, 5 per cent of children reached were “zero dose” – they had never before received even a single dose of OPV. This is both hopeful, we are reaching children never reached before, and potentially troubling – are there further pockets of zero dose children we have not yet reached, who are entirely unprotected from polio? And while OPV and Routine Immunisation can go a long way toward protecting children from ten life-threatening, vaccine-preventable diseases, ongoing threats to child health and survival in Ethiopia’s Somali region, and across the Horn of Africa, are great.

Like the patches that make up the nomad’s tent, no single square of cloth is enough on its own. When we join together, from the Sheikh and Imam to the nomad to the international community, the whole is much greater than its parts. Together we can keep building a tent of protection to end polio and improve child health in the Horn of Africa – and to wipe the virus from the face of the earth for good. This can only be done with generous contributions from donors such as the European Union who have enabled the programme to reach the hardest to reach with life-saving polio vaccine.

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