Polio outbreak in Somalia is symptom of global health inequality

Millions of the world’s most vulnerable children are falling through the cracks, even as child deaths are declining globally, warns World Vision.

The number of children who die before their fifth birthday has roughly halved over the past two decades, according to new UNICEF figures. But the most vulnerable children are being left behind.
Polio has broken out in Somalia, for example, with 160 cases reported over the last three months. The killer disease has been all but eradicated in many parts of the world, but children in fragile states like Somalia are still susceptible.

"The polio outbreak is a big blow to Somali children who have lacked health services over a long period of time as a result of the continued conflict and natural disasters,” said Tobias Oloo, World Vision’s polio emergency response manager in Somalia.

 "The rapid spread of this polio outbreak is a clear indicator that health services in Somalia are almost non-existent. The Killer Gap report released by World Vision warns that many of the world’s most vulnerable children still do not have access to live-saving health services.
 "It breaks my heart to imagine a child having to live with paralysis for the rest of their life, given that polio is preventable by administering an oral vaccine. Now is the time to take action to prevent this from happening to more children in Somalia."

World Vision’s Killer Gap report explains why millions of children are being denied the benefits of progress, despite the fact overall child mortality rates have been cut by almost half, to 6.6 million per year, since 1990, according to UNICEF, because many countries have unacceptable “health gaps”. 
“In achieving the global reduction in child mortality, governments are reaching those who are easiest to get to, but in many cases this has meant a devastating increase in the gap in access to health care between the health rich and poor, with the most vulnerable children bearing the brunt,” said Besinati Mpepo, the Child Health Manager at World Vision UK.

Somalia is a glaring example of the effects of health inequality. There was not even enough data from the struggling nation to rank it in the health equity index, yet we know from UNICEF’s report that children there continue to face a one in seven chance of dying before they reach their fifth birthday, from preventable illnesses such as pneumonia, diarrhoea and measles.

The top three reasons children fall through the cracks are:
• Children not registered at birth are invisible to the system.  More than 50% of children under five are unregistered and have no access to health services.
• Refugee children, displaced due to conflict or fragile contexts.  About half of the 45.1million people displaced in 2012 are children.
• Children with disabilities are hidden away and denied health access in some communities because of shame and fear of social stigma.
• Other children in the gap are vulnerable to child labour or trafficking, orphans and children who lose their mothers at childbirth.

Bangladesh and Peru, two of only eight developing countries to achieve the fourth Millennium Development Goal  of reducing child deaths by two-thirds by 2015, come in at rank 128 and 98 respectively in the Killer Gap ranking system, pointing to an unacceptably high number of unreached and marginalised children without good access to the health care that brings down mortality rates.

“We agree with UNICEF that accelerated action on MDGs is needed to reach these missing millions, but we think that with just over 800 days left to achieve the MDGs, governments should ensure that attention is given at the highest political level to close the health gap for women and children,” says Mpepo, “Information is power, so we’re asking governments to prioritise and invest in data collection systems that bring left out and vulnerable populations, especially women and children into the health network.”

With two years until the deadline for the Millennium Development Goals, World Vision is using UNICEF’s report as well as their own, to urge governments to finish the job and take every step possible to close the health gap in their countries. Looking ahead to the post-2015 development goals, the agency is calling on leaders to prioritise child and maternal health by including ambitious and visionary goals to end preventable child and maternal deaths and significantly reduce stunting.

• The Global Health Gap Index, in World Vision’s The Killer Gap report, ranks 176 countries based on four criteria measuring health outcomes.
• World Vision held a week of mobilisation – “Close the Gap” – in 52 countries, with public events to call on leaders to help close the health gap
• Close the Gap is part of World Vision’s five-year Child Health Now campaign, aiming to end preventable child deaths.
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