By Shaheen BiBi, MSF Midwife Activity Manager, Bay Regional Hospital
She was carried on a makeshift stretcher, the afternoon sun scorching the roof of our maternity ward as she was brought in. For two days, her family and a traditional birth attendant had tried everything they knew to help her deliver. Only when she began to bleed heavily did her husband decide to bring her to MSF-Supported Bay Regional Hospital. By the time she reached us, she was unconscious. We did everything we could. Her baby made it, but she didn’t. She died a day later.
Each day, I see what happens when women cannot reach care in time. It is not because they do not want to come. It is because the journey, both the physical one and the one shaped by decisions made by others, is long and difficult.
In Somalia, families often try to manage childbirth at home first. This is what they know. This is what their mothers and grandmothers did. They call on traditional birth attendants, women in the community who have helped many mothers deliver. But when something goes wrong, when the bleeding does not stop or when the baby does not come, the family must make a choice. They must decide to make the journey to the hospital.
This journey is not easy. Around 70 percent of the women, we treat come from outside Baidoa town. Some travel thirty kilometres or more. In this region, thirty kilometres can take a whole day. The roads are rough. Insecurity and checkpoints slow the way. And for many families, there is the cost of transport, a cost they may not be able to afford.
Somalia has one of the highest maternal mortality rates in the world, around 563 deaths for every 100,000 live births. Only about one in three births is attended by a skilled health worker. There are only 1.5 midwives for every 10,000 people. What this means is simple: too many women give birth alone, or with help that cannot manage when complications arise.
What worries me now is that the few services that exist are at risk. Somalia’s health system depends almost entirely on external support. Recent funding cuts have already forced some health centres to close. The World Health Organization warns that more than 600 health facilities across the country could shut down. When that happens, women will have to travel even further, and some will not make it.
Baidoa is home to more than 700,000 people who have fled drought and conflict. They live in camps, far from their homes. The pressure on the hospital supported by us is enormous. Every day, we see women who have walked or travelled for hours while bleeding, or who arrive too late for us to save their babies.
Still, we are here. In 2025, our team at Bay Regional Hospital assisted close to 4,000 births. We treated 19,000 children for malnutrition. We provided tens of thousands of consultations, free of charge. Each number is a life, a mother who survived, a baby who took their first breath, a child who recovered.
Sometimes, even after a woman reaches us, we face difficult moments. When surgery or blood transfusion is needed, family members must give their approval for it. This can take time. Families want to do what is best, but they may not fully understand the urgency. They may be afraid or have misconceptions. We explain, we counsel, we wait. Sometimes, we wait too long.
What Somalia needs is not complicated, but it requires commitment. More midwives and health workers, trained and deployed to communities so women have support close to home. Roads and ambulances that work, so the journey to hospital does not take a day. Health centres that stay open, funded, and staffed.
Every mother has the right to give birth safely. Every baby has the right to take their first breath. The cry of a newborn in any maternity ward is a sound of hope. We must ensure that more mothers and babies in Somalia can hear it.
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Related:
- MSF in Somalia
- Somalia
