South-central Somalia, affected by one of the most long lasting crises, is facing mounting political turmoil and violence, resulting in an increasing influx of refugees into northern Kenya. In addition, together with the other countries of the Horn of Africa (Djibouti, Eritrea, Ethiopia and Kenya), Somalia has been affected by a severe drought in 2006, which has further strained the already exhausted livelihood strategies of the population. Life expectancy is 48 years. One in four children dies before the age of five and 1600 women per every 100 000 live births die because of pregnancy-related causes. Diarrhoeal diseases, respiratory infections and malaria are the main causes of death among children, accounting for more than half of all deaths. The major underlying causes of diarrhoea are the lack of access to safe water, poor food and inadequate domestic hygiene.
Cholera is endemic and claims hundreds of lives annually, particularly in densely populated areas. Despite the number of polio cases dropping from 185 in 2005 to 30 between Janaury and September 2006, the outbreak has spread across the country, affecting 14 out of 19 regions. Every effort is being made to ensure that immunization campaigns are synchronized with other Horn of Africa countries to halt the spread of the virus.