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Dr Fatumo Abdi
Global Public Health Specialist
Founder, Nexora Global Strategies
I have seen many difficult things in my work, but nothing prepared me for a quiet, angelic-faced six-year-old boy I met during a whole school health screening programme in Hargeisa, Somaliland. He stood quietly in line, hands folded, tiny shoulders tense as moved across each table as he underwent a range of health and dental checks. Finally, he sat with the family doctor who asked if he had any health problems. He said his back hurt a lot and the doctor asked him to show him where the pain was. He turned around, raised his shirt and we froze. A 7cm section of his spinal column was protruding and visible outside his body. A white arc of bone sat exposed at the base of his back, something no child should ever carry. He had lived like this since birth.
His family, like so many in the region, had never been able to access the specialist care he needed. They were not neglectful. They were simply poor, overwhelmed, and invisible to a system that has no routine way of catching children like him. Without urgent intervention, he was facing the loss of his ability to walk. And yet he had gone six years without anyone in authority noticing or taking action.
That boy was not alone. A few days later, during another school screening, a seven-year-old girl swayed on her feet as she waited in line. Small for her age, trembling, her skin unusually pale. Minutes later, she collapsed. Her haemoglobin level was dangerously low. When I asked when she last ate, she whispered, “Yesterday morning.”
Her mother, exhausted and devastated, and equally emaciated sat nearby wringing her hands; she had a young baby wrapped and sleeping on her back and a toddler holding her hand. This wasn’t due to neglect, but out of hunger. Poverty is not a personal failure. It is a systems failure. And in that moment, it was written across the little girl’s body.
Then there was the ten-year-old girl from an IDP camp. Gentle, quiet, long eyelashes folding downward, with her eyes barely visible, because the muscles above her eyes had slowly contracted and tightened so completely. She was slowly going blind. Through the kindness of specialist doctors, we managed to secure free surgery to save her vision. News that should have been the happiest part of the story. But her father point-blank refused permission. Her mother had no authority to overrule him. He even refused the entreaties of local religious clerics. The girl’s sight, her future life and her independence were slipping away in silence.
These are just three children are among thousands we have screened in recent months, and they expose a truth that should trouble every single one of us: we have a silent but visible epidemic sitting in our classrooms.
Children carry the burden of untreated medical conditions for years. They suffer quietly, unnoticed, unmeasured, and grow into adults with long-term untreated health problems. We do not routinely check vision or hearing. We do not monitor nutrition. We do not test haemoglobin levels. We do not look for early signs of disability. We do not have school nurses. And we certainly do not have national referral systems that connect classrooms to health facilities.
But to me the screenings also revealed something far deeper. Over 90% of the children we examined also had significant tooth decay and allergies. Many were in daily pain but had normalised it. A generation raised on cheap imported sweets, yet without the basic dental hygiene education that every child deserves. Something so easily preventable, yet so widespread.
We didn’t stop at screening. Every teacher in the schools we visited received comprehensive first aid training, along with full first aid kits to use in an emergency. Many of these teachers had never been trained before, yet they are the adults who spend the most time with our children. Giving them knowledge was giving children safety.
We also held health education sessions for parents. These covered mental health, autism, hand hygiene, nutrition and the early signs of serious illness. Parents listened closely, took notes, asked brave questions and shared their fears. We gave each child local nutritious porridge and fresh fruit, more if they were anaemic or and more oranges if they had scurvy due to lack of vitamin C found in citrus fruits. Mothers came up to me afterwards with tears in their eyes, showering me and the 60-strong team with prayers and blessings. They had nothing else to offer us except gratitude. It was enough.
For the girls, we quietly and sensitively distributed menstrual health packs. Stories of girls missing school every month because of lack of pads are not statistics. They are real, painful barriers to education. A nurse sat with each girl individually, showing her the contents of the pack, explaining how to use each item with dignity and care. Girls who would normally be embarrassed or fearful were finally given information, privacy and respect.
I brought the principles I learned in the UK; prevention, early detection, integrated referrals, evidence-based practice back home with me, but not as theory, rather as a promise. Access to school health is the backbone of child wellbeing. It protects learning, reduces long-term health costs, and gives children the dignity of being seen. Bringing that model into the Somali region as a whole is critical.
The truth is clear. We can prevent the preventable. We can treat the treatable. We can protect children before suffering becomes permanent. The Horn of Africa is not short of intelligence, compassion or resilience. It is short of systems. And systems can be built.
Every child should receive at least one full health screening per year. Every school should have access to a trained nurse, of which we have a surplus. Teachers should be empowered with basic health knowledge and compassion. Parents should receive regular health education. No girl should miss school because of her period. No child should lose their ability to walk or see because the system never checked.
The children we meet are not statistics. They are the heartbeat of this region. They carry possibility, brilliance and dreams that are far bigger than their circumstances. When we protect their health, we protect our future.
The time has come for Government of Somaliland to prioritise Child Health, to develop a comprehensive school health policy that guarantees every child access to basic health and dental services. Not as charity. Not as a one-off campaign. But as a national commitment to the future of the country.
The question stands before us: will we build a health system that safeguards the health & wellbeing of the next generation? Or will we endanger the future of the nation?
About the Author
Dr Fatumo Abdi is a global public health and policy specialist and the Founder of Nexora Global Strategies. She has developed and led strategic health and humanitarian programmes in both the UK and across Africa. Dr Abdi has advised governments, academia and regional institutions, and worked with international media to spotlight issues affecting local communities. Her work centres on diplomacy, equity, systems strengthening and shaping evidence-based policy. She is also the first Somali woman to earn a PhD in the United Kingdom.
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