In Somalia, a staggering 99 percent of women between the ages of 15 and 49 years have undergone Female Genital Mutilation (FGM), a practice deeply rooted in cultural traditions and contributing significantly to the nation's high maternal mortality ratio of 621 per 100,000 births.[1][2] FGM is not only a form of Gender-Based Violence (GBV) but a critical health issue that often results in excessive bleeding, recurrent urinary tract infections, obstructed labour, fistula, and psychological trauma. The challenge of addressing FGM is compounded by misinformation, lack of medical professionals, insufficient health policies, and lax enforcement against its medicalization, with these issues further intensified by the COVID-19 pandemic.[3] In response, the World Health Organization (WHO) Somalia, with the support of the Somalia Humanitarian Fund (SHF) under the health cluster mechanism, has launched a comprehensive SHF Allocation Strategy aimed at combating GBV and FGM in emergencies through systemic change, policy development, and professional education, reaching around 2.2 million people with essential health services including FGM and clinical management of rape survivors. These initial steps are in line with the WHO Somalia’s Country Cooperation Strategy 2021-25 and Sustainable Development Goal (SDG) 5 – to achieve gender equality and empower all women and girls.

“The scope of WHO's contributions, in partnership with the Federal Ministry of Health, has been all-encompassing, including capacity building, development of guidelines, the introduction of a Female Genital Mutilation clinical handbook and guidelines for the management of complications, development of Clinical Management of Rape protocols, and an assessment of Gender Based Violence services in every State. I hope that our cooperation will be strengthened in the upcoming year.”

-Dr Zahra Ali Barre, Gender Based Violence Manager, Somalia Ministry of Health

How did Somalia, with the support of WHO, achieve this?

At just 17 years old, Amina's* life was profoundly transformed by child marriage and FGM. Her harrowing experience with infibulation, a traumatic childbirth, the development of a vesicovaginal fistula, extended labour, and the devastating loss of her baby, led to her ostracization from her community. Her story, as highlighted by PAC Somalia, starkly emphasizes the pressing necessity for wide-ranging actions to combat FGM and GBV.[4]

“There are many more women suffering from the aftereffects of child-marriages and maternal health complications across Somalia, but not everyone is lucky like me to have received medical and psychosocial support. I would urge WHO to step up their efforts to not only spread the word about available health services in an emergency country but should also open up more treatment centres across all major cities.”

-Amina*, a 17-year-old FGM survivor

Expanding its efforts beyond health sector policy, WHO engaged with a broad spectrum of stakeholders, using funds from the Somalia Humanitarian Fund to back GBV-focused health initiatives. This effort brought together a wide range of NGOs, both local and international, in addition to UN agencies such as the United Nations Population Fund (UNFPA) and the United Nations Children's Fund (UNICEF), all operating within a Health Cluster-coordinated program.

To comprehensively target GBV and FGM, WHO Somalia partnered with Somalia's Ministry of Health (MoH), on a series of strategic initiatives aimed at creating a supportive environment for change. This collaboration involved revising critical policies, including the Somalia National Health Policy and the Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCAH) Strategy, to incorporate GBV and FGM considerations comprehensively.

In a drive for evidence-based interventions, WHO and its partners revised and translated guidelines on FGM and clinical management of rape (CMR).[5][6] Following these revisions, WHO Somalia customized training manuals for emergency obstetric and newborn care with Somalia's Ministry of Health (MoH) to bolster the skills of health professionals to address GBV and FGM sensitively and effectively. WHO Somalia also integrated GBV training into the standard curriculum of Rapid Response Teams (RRTs). This training emphasized the LIVES approach (Listen, Inquire, Validate, Enhance safety and Support) for GBV survivors.[7] Concurrently, in collaboration with the MoH, WHO updated Somalia's midwifery curriculum to include GBV and FGM, complementing parallel revisions by UNICEF.

^{Master trainers with gender-based violence information, education, and communication (IEC) materials during the joint United Nations Population Fund (UNFPA) and World Health Organization (WHO) clinical management of rape (CMR) train-the-trainer (ToT) session in Hargeisa, Somalia}
Photo credit: WHO Somalia

To address the medicalization of FGM and improve the management of GBV, including CMR, WHO launched comprehensive training programs for healthcare professionals. These programs, informed by research from Somalia, Kenya, and Guinea, targeted midwives, nurses, and doctors. Facilitated by the Geneva Foundation GFMER through a cascade training model led by a Master Trainer, the programs engaged WHO staff, representatives from the Ministry of Health (MoH), and select NGOs.[8] Committed to ongoing development, WHO has established a dedicated team for continuous CMR training and is set to expand FGM training with the introduction of new guidelines.

To improve referral and reporting mechanisms for GBV, WHO has adopted tools like the Health Resources and Services Availability Monitoring System (HeRAMS) and IMMAP’s Report Hub.[9][10] Moreover, a national campaign has been launched using Somali language awareness posters along with the community health workers targeting both the health workers and the general public, aiming to elevate the understanding and awareness around GBV and FGM.

The RMNCAH strategy has made progress in addressing the medical and social challenges faced by women and girls in Somalia, thereby contributing towards the Sustainable Development Goals. However, there's an ongoing, crucial demand for sustained, all-encompassing initiatives. These require cooperative actions among stakeholders, the enhancement of healthcare workers' skills, psychosocial support for survivors, increased community awareness, reinforced legal support, and ongoing data collection and research.

Dr. Al-Umra Umar, RMNCAH Programme Lead at WHO Somalia, underscored the organization's commitment to women's empowerment, stating, “WHO is steadfast in its commitment to advancing women's roles within the health sector by continuing to fund essential training areas such as gender-based violence (GBV), mid-level management, and integrated management of newborn and childhood illnesses (IMNCI), alongside basic and emergency obstetric and newborn care (EmonC). These initiatives have been pivotal in empowering women in the health sector, and within decision-making bodies.” 

In alignment with this commitment, WHO, alongside UNFPA, UNICEF and the MoH, has crafted and funded the development and revision of Reproductive, Maternal, Neonatal, Child, and Adolescent Health Strategy for the 2023–2027 period. Aimed at improving health services and incorporating care for GBV and FGM, this strategy is in urgent need of financial backing for its effective and sustained implementation. 

*Name has been changed to protect privacy.