From left: Peggy Clark, Mary Robinson, Walid Abdelkarim and Geoff Dabelko

Ministries of health are the backbone of a country’s health system, creating policies and providing services to reach the most vulnerable populations. But what if a country does not have a health ministry? Or a government for that matter?

The health outcomes for people living in a failed state were clearly on display Monday at Aspen Global Health and Development’s “Lessons from the Crisis in Somalia.” Part of the 7 Billion: Conversations that Matter Series, the event was spurred by Mary Robinson’s, President of the Mary Robinson Foundation—Climate Justice, recent trip to Somalia. She had previously visited the country as President of Ireland during the 1992 famine affecting the horn of Africa and told the audience, “What struck me going back was that everything was worse.”

Women and children were the ones Robinson saw taking the brunt of the brutal conditions. While en route to visit Dadaab, a refugee camp just across the Kenyan border, Robinson passed women walking incredible distances with their children in search of assistance.   As Robinson spoke further with these women she discovered that not one of them had less than six children.

This high birth rate is both cause and consequence of the humanitarian crisis. There are more children to support and to feed in poor conditions where access to family planning is critically low, trapping women in a cycle of poverty and hardship. Geoff Dabelko, Director of the Environmental Change and Security Program at the Woodrow Wilson Center and a featured panelist, said that only 1.3% of women in Somalia are using modern methods of contraception. Planning and spacing pregnancies is almost impossible.  Access to reasonable health care paired with education could dramatically decrease the birth rate there, relieving pressure on women. However, there is no government to provide these services.

Walid Abdelkarim, Principle Officer and Team Leader for Somalia and Support to the African Union for the United Nations Department of Peacekeeping Operations, illustrated to the audience at the event the important role a government plays in protecting its population against famine. Abdelkarim, who led Robinson around Somalia on her first visit, described how neighboring countries that were hard hit with famine in 1992 along with Somalia have not been as harshly affected as Somalia in 2011. Abdelkarim was clear on the reason why, “Kenya and Ethiopia have ministries that prepare for famine. They have introduced measures such as food reserves and family planning programs. Making contraceptives available has reduced vulnerability for these populations.”

As a failed state, Somalia lacks the mitigating ability of governance, “Why are they worse than other countries on the horn at the end of the day? Other countries enact coping mechanisms. Somalia cannot because they have no government, “ Abdelkarim  told the audience.

Abdelkarim’s comments emphasize the importance of building a functioning government in Somalia to be stewards and protectors of the public’s interests. Since there are no stewards or protectors currently, conditions are worsening particularly for the women that Robinson met on the road to Dadaab who do not have champions within a ministry pushing for more access to reproductive health services.

Investment in Somalia is needed. But investing in famine relief should move past just food, Abdelikarim said.  "Agricultural reforms, good governance and strengthening of infrastructure and health systems are vital, but they will not stand if women are not prioritized in humanitarian relief efforts, and given the chance to be central players in trade, pricing, accounting, education, and health."  Until that happens, these women and children will continue to suffer the most.

Video of the event can be found here.