CHAPTER IV: Somalia Country Study

A. Location and Description

Somalia is located in the northeastern section of Africa known as the Horn of Africa. It occupies a land area of approximately 637,600 square kilometers (185,655 square nautical miles), which is slightly smaller than Texas. The country consists of the area comprising the former colonies of Italian and British Somaliland. The south and east coast were formerly under Italian administration, and the area along the Gulf of Aden coastline was the British colony. The country is shaped like the figure “7”, or an open jackknife.

The northern and eastern boundaries of Somalia are the Gulf of Aden and the Indian Ocean respectively. The total coastline is approximately 2,500 kilometers (1,350 nautical miles) with 1,000 kilometers (539 nautical miles) bordering the Gulf of Aden and 1,500 kilometers (809 nautical miles) bordering the Indian Ocean.

The border with Djibouti is 58 kilometers (31 nautical miles) long. It begins along the Gulf of Aden and runs on a straight line southwesterly to the Djibouti-Ethiopia-Somalia tri-point located at Madaha Jalelo, a hill.

The border with Ethiopia is approximately 1,600 kilometers (863 nautical miles) long. Beginning at Madaha Jalelo, the border runs in a southeasterly direction.

The border between Somalia and Kenya is 682 kilometers (368 nautical miles) long. At the Kenya Ethiopia-Somalia tri-point, the boundary runs southwest in straight-line segments to the town of El Wak. It then runs north to south and then southeasterly to the Indian Ocean.

B. Weather and Climate

As a result of Somalia’s geographical position, the climate of southern Somalia is equatorial, while the north is generally described as subtropical. The country is uniformly hot, with the most oppressive heat occurring along the northern coast during the summer. Rainfall varies greatly in both total amount and reliability throughout the country. Humidity is high along the coast and in the south, and somewhat lower in the northern highlands.

During the winter season, late December through February, high-pressure cells over Arabia result in northeast winds over much of Somalia. Occasional cyclonic storms may arise over the Red Sea and Gulf of Aden during this period, blown to the southwest by the winds generated by these high-pressure systems.

In the spring, starting in mid-March, most of southern Somalia is under the effect of the inter-tropical convergence zone (ITCZ). Winds are generally southerly or southeasterly during this period. Northern Somalia and the Gulf of Aden generally have northwesterly winds during this time.

April is the onset of the southwest monsoon over southern Somalia. Low pressures over India and Pakistan result in moisture laden, southeasterly winds moving onshore over the coastal regions of Somalia. The ITCZ proceeds northward over Somalia during this period. By June, the entire country is under the effect of the southwest monsoon.

Starting in September the northern coastline comes under the influence of dry, stable air resulting from high-pressure systems over the Middle East and Asia. During this period southern and central Somalia are under the effect of the southward movement of the ITCZ, resulting in unstable weather.

    1. Precipitation: There is a marked variability in the amount and reliability of precipitation throughout the country. Precipitation increases toward the south, with a large area of the south receiving in excess of 58 centimeters (23 inches) in most years. The north coast generally receives less than 10 centimeters (four inches) per year. The interior plateau receives 25 to 48 centimeters (10 to 19 inches) per year. The southwest monsoon, beginning in April, is responsible for most of the precipitation.

    2. Temperature: Temperatures in Somalia are relatively uniform throughout the year because of the equatorial location and lack of significant mountain ranges. The average annual temperature for most coastal locations is 80^oF, although the northern coastal region has temperatures approaching 113-115�F during June and July. Winter temperatures in this region may reach as low as 54-57�F.

C. Topography

Most of Somalia is desert or semi-desert; drought is a year-round threat. Approximately 60 percent of Somalia is savannah woodlands, which is used as rangeland and as the primary local source of fuel. Only about 13 percent of the land can be cultivated, and much of that is not farmed on a regular basis. Cultivation of arable land occurs primarily in southern Somalia. Somalia has rich fishing grounds and the longest coastline in Africa.

Mountains are limited to the northern part of the country, while the entire southern and eastern sections consist of a narrow coastal plain and a large interior plateau. Extensive undulating plains, which are interrupted occasionally by areas of dissected terrain and isolated hills, characterize much of Somalia. The country can be divided into four distinct geographic regions: the Guban, a plain along the northwestern coastal area extending north into Djibouti; the Northern Somali Mountain area in northern Somalia; the Somali Plateau, subdivided into a northern and southern section, located along the Ethiopian border; and the Coastal Plains along the Indian Ocean shore.

    1. The Guban

    The low-lying country from the western boundary with Djibouti, and extending eastward along the Gulf of Aden, is locally referred to the Guban. The extreme northwest section of the Guban is covered with barren lava fields originating in Djibouti, with additional lava flows immediately west of Berbera. The lava plain ends in a series of low hills and merges into an alluvial plain. The plain is up to 80 kilometers (43 nautical miles) wide from north to south near Seylac and extends eastward to beyond the town of Berbera. The plain becomes narrower as it extends in an eastward direction, at the town of Bullaxaar, subsequently to widen again around Berbera. This plain rises gently up to the piedmont area of the Northern Somali Mountain region.

    2. Northern Mountains

    The highest elevations in Somalia are found in the Northern Somali Mountain region located along the Gulf of Aden, stretching from the Somali-Ethiopian border in the west to the coast of the Arabian Sea in the east. In places, the mountains are in close proximity to the shore along the Gulf of Aden. The average elevation for this mountain range is about 2,000 meters (6,561 feet). At its highest point, Shimber Berris, located about 19 kilometers (10 nautical miles) northwest of Erigavo, is 2,410 meters (7,906 feet). A fault zone delineates the northern front of the mountains. The boundary of the uplifted area is separated from the Gulf of Aden by a coastal plain varying in width from 60 kilometers (32 nautical miles) in the west to less than 1 kilometer (.5 nautical miles) in the east.

    Dry watercourses, locally called tugs, dissect the mountainous region. These are dry for most of the year, but usually contain water for several hours after a rain. Many of the tugs form deep gorges and gullies. The gorges’ alignment is predominantly north to south. The tugs provide the water and the fluvial deposits for the geographic region lying south of the mountain belt, the Northern Somali Plateau.

    3. The Somali Plateau (Subdivided)

    Northern Somali Plateau. The plateau, located in northern Somalia just to the south of the Northern Somali Mountain region, consists primarily of alluvial plains. The Somali refer to this region as the Haud. The Haud plains are wide and open, nearly level, and slope gently to the south. The elevation changes over a distance of about 300 kilometers (161 nautical miles) from an average of 1,200 meters (3937 feet) near the northern mountains to about 700 meters (2297 feet) at the boundary with Ethiopia. Curious features of this landscape are the anthills and termite mounds. Termite mounds can reach a height of 8 meters and stand as hard, irregular pillars. Anthills are found only in areas where there is limestone with a thin covering of alluvium.

    Southern Somali Plateau. The Southern Somali Plateau region is located between the Webi Shabeelle and the Webi Jubba; “Webi” meaning seasonally flowing river in Somali. The plateau is comprised of gently undulating limestone surfaces with occasional, isolated low hills. The plateau extends eastward from the Ethiopian border. Where the plateau reaches the coastal plains in the east, crystalline rocks replace the limestone surface. The change from plateau to coastal plain is almost unnoticeable except north of Webi Shabeelle, where there is a short steep escarpment.

    4. Coastal Plain

    The Coastal Plain area stretches from the southern tip of Somalia along the Indian Ocean as far north as Hurdiyo. The plains become progressively narrower as the Northern Somali Plateau reaches closer to the coast in the northern areas. North of Hurdiyo the plateau reaches the coast.

    The Coastal Plain is a low-lying area with elevations below 300 meters (984 feet). The two major rivers cited above, the Webi Shabeelle and Webi Jubba, traverse the plain. These rivers are flanked by natural levees. On the plain, flanking the rivers, are numerous depressions called descecks, which fill with water during the rainy season and during floods.

    The Coastal Plain region, on which Mogadishu lies, is the largest geographic region in Somalia. The plain is “emergent,” gradually uplifted along most points along the Indian Ocean. As a result, beaches along the coast are often short and steep with irregular formations near shores and backed by cliffs of coral or limestone on the backshore. The coastline is often terraced, and unstable “blowout” dunes up to 50 meters (164 feet) high are scattered along the entire length of the coast from Kenya northward almost to the Gulf of Aden. As one moves inland from the coast, the terrain gradually ascends in a series of undulating stabilized dunes and sandy plains, interrupted only by the shallow but wide flood plain of the Webi Shabeelle.

D. Vegetation

Climate, elevation, man, and soil affect the vegetation in Somalia. Climate has the most pronounced effect, with annual rainfall being the dominant climatic factor. More specifically, due to the importance of precipitation, this dictates the types of vegetation capable of surviving the harsh environment common throughout the country. Elevation is also a controlling factor in determining the type of vegetation found in an area due to the various temperature ranges, particularly colder temperatures, which are common to mountainous regions. Cold temperatures, coupled with a paucity of water, create the harshest conditions for vegetation. Besides climate and elevation, human activity also contributes to controlling or modifying the vegetation regimen in the region. Over one-half of the population is nomadic animal herders, and their overgrazing herds of goats, sheep, camels, and cattle have caused widespread change in vegetation throughout the country. This has led to the increasing problem of decertification, especially during periods of drought of recent years. Aside from human activity, the soil will affect the occurrence of a particular type of vegetation.

The coastal areas in Somalia are strongly affected by the intrusion of salt from the ocean. Subsurface movement of ocean water and its subsequent rising to the surface, coupled with evaporation, causes the deposition of salts on the surface. The intrusion of saltwater is aided through the extensive use of ground water, little precipitation, and destruction of ground cover due to overgrazing. The salt flats are entirely void of vegetation.

Irrigation projects have also modified vegetation in Somalia. There are large irrigation projects along the Webi Jubba and Webi Shabeelle. Agriculture products, such as bananas and papayas, are grown in the region. Rice is also cultivated in the vicinity of the Webi Shabeelle.

    1. Natural vegetation types in the four geographic regions:

    The Guban area has broadleaf evergreen vegetation. This region is characterized by dry climatic conditions. The vegetation includes acacia trees, about three meters (10 feet) high, scattered throughout the region, with thorny acacia bushes and other shrubs. Grasses grow sporadically in the region. Tall tamarisk trees grow along dry river courses as well as in large tug beds. The smaller tug beds only support grasses and brush along their banks. The sand dunes in the Guban area support bunch grasses. Low sand dunes support grasses or salt bushes, but not both.

    The northern mountain vegetation is mainly controlled by elevation and secondarily by precipitation and soils. The northern mountain region has three distinct regimes depending on altitude: open woodland, shrub evergreen, and juniper. The open woodland consists of acacia trees that range in height up to eight meters. Interspersed with these trees are low shrubs. The acacia trees are found up to 1,500 meters (4,921 feet) in elevation. Above 1,500 meters (4,921 feet), vegetation changes to needle leaf evergreen shrubs ranging from one meter (3 feet) to four meters (13 feet) in height. The acacia open forest that stood in large segments of northern Somalia has died off and now remains as a dead forest, giving the area a bleak appearance. The death of these trees is due to drought and overgrazing.

    The shrub evergreen vegetation gives way to juniper at the highest elevations in the mountain areas. The juniper trees grow close together. The scrubs form locally dense thickets in scattered pockets throughout the area. Trees are generally more than eight meters (26 feet) tall, but local inhabitants cut the forest for poles. This area has also been heavily grazed.

    The Northern Somali Plateau is characterized by open spaced bush-type vegetation. Its mixed deciduous vegetation consists of acacia and commiphora. This region has experienced overgrazing to such a degree that large areas are devoid of trees. The result is that significant areas are devoid of vegetation. Shrub vegetation that remains in this area varies in height from one meter (3 feet) to five meters (16 feet). Occasionally a tree may reach a height of 10 meters (32 feet).

    Throughout the northern plateau area, there are places where pools of water form after rain. These pools may vary from a few meters across to several hundred meters. These pools generally last for a day or two. The soil in these pools is usually gray, sandy clay, which will crack when dried. The small temporary pools support grass clumps from one meter (3 feet) to two meters (2 feet) in height. The larger pools are known locally as “ballehs.” These may retain water throughout the year, although the water level drops. The dry balleh floor does not support any vegetation. Along the edges, however, bunch grasses and scattered acacia trees grow.

    The vegetation of the Southern Somali Plateau is predominantly bunch grasses with scattered acacia trees in areas that have a moisture source, such as watercourses. Very little agriculture is practiced in the area due to sparse precipitation.

    The Coastal Plains are divided into two separate zones. Short grasses interspersed with isolated trees and brush vegetation characterize the northern section, located north of the Webi Shabeelle. Along the tugs some tree growth occurs. The grassland in this area is used for grazing. In the areas along the Webi Shabeelle and Webi Jubba, dense vegetation is found along the river channel. South of the river, typical savannah vegetation takes over, characterized by grass-covered areas with trees growing along the river channels and near sources of water.

    2. Cultivated Cropland

    Cultivated cropland is confined to two areas: the hills and high plains north and west of Hargeysa and the land along and between the Webi Shabeelle and the Webi Jubba. Agriculture along the two rivers is based on controlled irrigation or field inundation during high water periods. Primary crops are bananas, sorghum, and millet. Bananas are a major source of export income for Somalia. Other crops consist of corn, wetland rice, beans, and sesame. Near Hargeysa and on the land between the two rivers, agriculture consists of small plots of crops sustained by natural rainfall. Other crops grown include groundnuts, cowpeas, mung beans, and corn.

E. Drainage

Somalia has only two perennial rivers, the Webi Shabeelle and Webi Jubba. The rivers originate in Ethiopia and flow southward into southern Somalia. The Webi Jubba is more than 150 meters (492 feet) wide and unfordable during high water levels that occur from May through June and September through November. The river is fordable in places during the other months when the low water period prevails. In the driest years, the Webi Jubba is fordable throughout its course and dries up for short periods south of Baardheere. The Webi Shabeelle flows south from Ethiopia to Balcad, about 30 kilometers (16 nautical miles) north of Mogadishu. The banks of the Webi Shabeelle at Beled Weyne vary in height from two to six meters (6 to 19 feet) depending on the water level of the river. The terrain directly adjacent to the river is relatively flat, although the terrain rises rapidly to the north. The Webi Shabeelle runs through a large swampy region near the coast through numerous natural channels and diversions for 360 kilometers (194 nautical miles) to a confluence with the Webi Jubba at Jilib. During the high water season, this portion of the Webi Shabeelle floods extensively. The river is not perennial in this area, but dries up for about two months during the dry season. The Webi Shabeelle is unfordable in much of its course from the Ethiopian border to Balcad during the high water periods.

Except for the Webi Shabeelle and the Webi Jubba, all streams are intermittent. Watercourses are widely separated and usually contain water for only a few hours following a rainstorm. Water levels rise rapidly and flashfloods occur. Streams are most likely to have water during April, May, October, and November. Stream banks are low and sandy or clay on the plains and deeply entrenched between high, steep rocky banks in the hills. Bottoms generally consist of boulders in the hills and sand and sandy gravel elsewhere. From the Webi Shabeelle north to Garoowe, drainage is disorganized and rainwater sinks into the ground after flowing a short distance. Few watercourses reach the sea.

In the Northern Somali Mountains and the Guban, streams flow northward or into the Gulf of Aden. Stream channels and waterholes are usually dry and carry water only for periods of a few hours to a week after heavy rains during July and August. When streams are flowing, they are fairly deep and swift in their upper courses and broad, shallow quagmires in their lower courses. Stream banks are usually high, steep, and rocky in upper courses and generally low, ill defined, and sandy in lower courses. Bottoms consist primarily of boulders, cobbles, and gravel in the upper courses and sand and sandy gravel in lower courses.

F. Cross-Country Movement (CCM)

Suitability for cross-country movement in Somalia is heavily dependent on weather. During the dry conditions that prevail most of the year, cross-country movement conditions are good in nearly all of Somalia. The only severe restrictions that may be encountered are the steeper slopes of the mountains in the north and the escarpments facing much of the East Coast. During wet periods, movement of personnel on foot would be limited for periods of hours to days by flowing streams. However, only the Webi Jubba and the Webi Shabeelle pose long-term obstacles. Throughout the year personnel on foot must take great care, especially in low light conditions, to avoid thorn bushes. Thorns up to eight centimeters (3 inches) long can cause serious injury, even penetrating the sole of a combat boot. Dense thickets of thorny shrubs and cactus may obstruct movement locally. In populated areas, closely plated hedges of thorn bushes marking borders of fields and fencing livestock would hamper travel. During dry periods in most locations, wheeled and tracked vehicles can cross most of the country, but they would be impeded significantly by rocky ground and sand dune fields in the Guban, by moderate to steep slopes and stream channels in the hills and mountains, and by steeply cut banks and sandy beds of intermittent streams. Under wet conditions, wheeled and tracked vehicles would be slowed or obstructed in most areas.

A. Demographics

All figures are 2001 estimates unless otherwise noted.

Diseases of Potential Risk: These diseases also warrant force protection emphasis. They are assessed to have lower likelihood to degrade operations because they generally affect smaller numbers of personnel or cause mild symptoms. Other diseases assessed as potential risk are those likely present at unknown levels, which under conditions favorable for transmission could degrade operations.

B. Food-borne and Water-borne Diseases of Greatest Risk

Sanitation is extremely poor throughout the country, including major urban areas. Local food and water sources are heavily contaminated with pathogenic bacteria, parasites, and viruses to which most U.S. service members have little or no natural immunity. Diarrheal diseases can be expected to temporarily incapacitate a very high percentage of personnel within days if local food, water, or ice is consumed. Hepatitis A, typhoid fever, and hepatitis E can cause prolonged illness in a smaller percentage. The diseases of greatest risk are listed first, in descending order of expected impact.

    1. Diarrhea - bacterial

    Risk Assessment:

• An operationally significant number (potentially over 50 percent per month) of personnel consuming local food, water, or ice could be affected.
• Typically mild disease treated in outpatient setting; recovery in less than 72 hours.

    2. Hepatitis A

    Risk Assessment:

• An operationally significant number (as high as 2-10 percent per month) of personnel consuming local food, water, or ice could be affected.
• Typical case requires convalescence over 7 days.

    Transmission Comments: May also be transmitted person-to-person under conditions of poor hygiene and sanitation.
    Typical Incubation Period: 28 to 30 days (maximum range: 15 to 50 days).
    Risk Period: Year-round.
    Risk Distribution: Countrywide (including urban areas).
    Surveillance and Survey Data: Most Somalis contract hepatitis A virus infection during childhood. The seroprevalence of hepatitis A was estimated at 96 percent in 1999. A 1992 survey detected antibodies for hepatitis A virus among 90 percent of Somalians tested.

    3. Typhoid/paratyphoid fever

    Risk Assessment:

• An operationally significant number (as high as 2-10 percent per month) of personnel consuming local food, water, or ice could be affected.
• Febrile illness typically requiring 1-7 days of supportive care with subsequent return to duty.

    Typical Incubation Period: 8 to 14 days (maximum range: 3 to 30 days).
    Risk Period: Year-round.
    Risk Distribution: Countrywide (including urban areas); elevated risk in populated areas with poor sanitation.
    Drug Resistance: Regionally, resistance to the standard therapeutic agent chloramphenicol has been reported.
    Surveillance and Survey Data: The carrier rate probably is high.

    4. Diarrhea, cholera

    Risk Assessment:

• A small number (potentially as high as 1 percent per month) of personnel consuming local food, water, or ice could be affected.
• Diarrheal disease of variable severity; may require 1-7 days of supportive care.

    Typical Incubation Period: 2 to 3 days (maximum range: 1 to 5 days).
    Risk Period: Year-round.
    Risk Distribution: Variable; as of March 2001, districts officially reported by the World Health Organization (WHO) as “infected” were Baidoa, Bardera, Belet Uen, Bossaso (11-17-XXN 049-11-XXE), Bur Hakaba (02-47-XXN 044-05-XXE), Johar (02-46-XXN 045-31-XXE), Kismaayo (00-22-XXS 042-32-XXE), Marca, and Mogadishu.
    Drug Resistance: Resistance has been reported to the standard therapeutic agents macrolides, tetracyclines, and TMP/SMX.
    Surveillance and Survey Data: Between October and December 2000, 272 cases (14 deaths) were reported in Boroma, Awdal region. Vibrio cholerae 01 Ogawa were isolated.

C. Vector-borne Diseases of Greatest Risk

The climate and ecological habitat support large populations of arthropod vectors, including mosquitoes, ticks, and sand flies. Significant disease transmission is sustained year-round and countrywide, including urban areas. Serious diseases may not be recognized or reported due to the lack of surveillance and diagnostic capability.

Malaria is the major vector-borne risk in Somalia, capable of debilitating a high percentage of personnel for up to a week or more. Dengue fever and Rift Valley fever are also major risks in Somalia. In addition, there are a variety of other vector-borne diseases occurring at unknown levels, which as a group constitute a very serious risk comparable to that of malaria. Personnel exposed to mosquitoes, ticks, and sand flies are at high risk during day or night, in both urban and rural areas. The diseases of greatest risk are listed first, in descending order of expected impact.

    1. Malaria

    Risk Assessment:

• An operationally significant number (as high as 11-50 percent per month) of personnel exposed to mosquitoes could be affected.
• Febrile illness typically requiring 1-7 days of supportive care with subsequent return to duty. Falciparum cases may require intensive care or prolonged convalescence.

    Transmission Comments: Relapses or delayed clinical symptoms are common with P. vivax and P. ovale, due to dormant parasite stages (hypnozoites) retained in the liver; delayed P. malariae symptoms may occur due to persistent low-level parasitemia.
    Agent/Subtype: P. falciparum; P. malariae; P. ovale; P. vivax.
    Typical Incubation Period: 7 to 14 days (maximum range: 7 to 30 days).
    Risk Period: Year-round; particularly in southern areas. Risk is elevated during and immediately after the rainy seasons (March through May/June and October through November), particularly in northern and central areas.
    Risk Distribution: Countrywide (including urban areas); elevated risk occurs along most riverine habitats, especially in the south.
    Vector Ecology: Principal vectors include An. gambiae and An. arabiensis (larval habitats include temporary pools), An. funestus (larvae occur in permanent/ semipermanent bodies of water), and An. merus (larval habitats include brackish water in coastal areas); all four species readily enter dwellings to feed on humans.
    Drug Resistance: Falciparum malaria strains are resistant to the standard therapeutic agent chloroquine (likely occurs in all malarious areas; reported from the areas of Mogadishu, Balcad, and Baardheere (02-20-XXN 042-17-XXE). Based on limited data from neighboring Kenya and Ethiopia, resistance also may occur to other standard therapeutic agents, including sulfadoxine/ pyrimethamine (Fansidar), mefloquine, and quinine. Vivax malaria strains resistant to primaquine have been reported. In 1993, a primaquine terminal prophylaxis failure rate of 16 percent occurred among a group of US military personnel returning from the Jubba River area. Additionally, a Belgian Army unit of 68 paracommandos in Somalia in 1993 reported relapses of 6 vivax malaria cases after prophylaxis, indicating resistance to primaquine.
    Surveillance and Survey Data: Foci of more intense vivax transmission occur, including the Jubba River Valley (a 24 percent attack rate for vivax malaria was reported among U.S. troops at Jilib along the Jubba River in 1993). Cyclic epidemics of P. falciparum reportedly occur every 3 to 5 years among central and northern area nomads, who lack sufficient exposure to maintain immunity.
    Comments: Countrywide, Plasmodium falciparum accounts for 95 percent of reported cases, followed by P. vivax, P. malariae, and P. ovale.

    2. Dengue fever

    Risk Assessment:

• An operationally significant number (as high as 2-10 percent per month) of personnel exposed to mosquitoes could be affected.
• Febrile illness typically requiring 1-7 days of supportive care with subsequent return to duty.

    Typical Incubation Period: 4 to 7 days (maximum range: 3 to 14 days).
    Risk Period: Year-round.
    Risk Distribution: Countrywide (including urban areas); risk likely exists countrywide but is elevated in the south, associated with increased vector populations.
    Vector Ecology: Vectored by Aedes aegypti mosquitoes, a peridomestic, daybiting, container-breeding species.
    Surveillance and Survey Data: In 1993, dengue fever was the primary arboviral disease confirmed among U.S. military personnel in southern Somalia (dengue virus serotypes 2 and 3 were isolated). In 1989, a limited survey of residents from Berbera, Woqooyi Galbeed Region, found that 59 percent had antibodies indicative of past infection, with 3 percent having serological evidence of recent infection. Serological results in 1987 suggested dengue 2 as the likely cause of febrile illness outbreaks in 1985, 1986, and 1987 among refugees in the northwest (Hargeysa vicinity).

    3. Rift Valley fever

    Risk Assessment:

• During irregular peaks of transmission, an operationally significant number (potentially 2-10 percent per month).
• Potentially very severe disease sometimes requiring intensive care; fatalities may occur; convalescence may be prolonged.

    Transmission Comments: May also be transmitted through direct contact with infected animals.
    Typical Incubation Period: 3 to 12 days.
    Risk Period: Year-round.
    Risk Distribution: Countrywide (including urban areas).
    Vector Ecology: May be transmitted to humans by several species of culicine mosquitoes.
    Surveillance and Survey Data: Serologic evidence of past infection with Rift Valley fever was detected in 7 percent of samples from residents of Berbera in 1989.
    Outbreak Information: An outbreak late in 1997 and early in 1998 in southern Somalia (Gedo, Hiiraan, and Shabeellaha Hoose Provinces) and northeast Kenya resulted in an estimated 89,000 human cases and hundreds of human deaths. This is thought to be the largest outbreak ever to occur in eastern Africa.

D. Sexually Transmitted Diseases of Potential Risk

This analysis focuses on exposure to commercial sex workers (CSW), a high-risk group for sexually transmitted disease worldwide. The sub-Saharan Africa region has the most widespread HIV/AIDS epidemic in the world, affecting all segments of the population. Heterosexual contact is the predominant mode of transmission. Carrier rates for hepatitis B are also high. Though the immediate impact of these diseases on an operation is limited, the long-term health impact on individuals is substantial. Gonorrhea, chlamydia, and other infections also are extremely common, and may affect a high percentage of personnel who have sexual contact. Other diseases that often are common in CSWs include chancroid, herpes, lymphogranuloma venereum, syphilis, and venereal warts.

    Hepatitis B

    Risk Assessment:

• A small number (potentially as high as 1 percent per month) of personnel having unprotected sexual contact (particularly with commercial sex workers) could be affected.
• Typical case requires convalescence over 7 days; chronic infection with liver damage may occur.

    Typical Incubation Period: 60 to 90 days (maximum range: 45 to 180 days).
    Risk Period: Year-round.
    Risk Distribution: Countrywide (including urban areas).
    Surveillance and Survey Data: A limited 1995 study found hepatitis B virus carrier rates of 19.1 percent in blood donors, 5.6 percent in hospitalized children, and 21.3 percent in hospitalized adults in Mogadishu. In 1993, surveys of Somalians found the hepatitis B virus (HBV) carrier rate to be between 10 and 27 percent.

E. Animal-contact Diseases of Greatest Risk

    Rabies

    Risk Assessment:

• Infrequent or sporadic numbers of personnel with direct contact (bites or scratches) with local animals could be affected.
• Very severe illness with near 100 percent fatality rate.

    Typical Incubation Period: 21 to 56 days (maximum range: 9 to 180 days).
    Risk Period: Year-round.
    Risk Distribution: Countrywide (including urban areas).
    Surveillance and Survey Data: Reports indicate that rabid dogs frequently attack humans in market areas; several reported attacks in the market places in Mogadishu occurred early in 2001. According to preliminary reports, more than 60 percent of dog/fox bite victims in Shabeellaha Hoose develop rabies and die. In 1998, more than 25 dog bite victims in Qoryoley district (near Mogadishu) developed rabies. Stray dogs likely are the primary reservoir and the main source for human exposure; also likely enzootic in wildlife populations, including hyenas, jackals, and foxes.
    Outbreak Information: An outbreak in Mogadishu occurred between January and March 2001 resulting in at least 7 clinical cases; stray dog attacks on humans were reported before the outbreak. Although only 7 clinical cases were reported, other cases likely occurred. Packs of stray dogs have roamed free in the area since 1991 due to uncontrolled chaos.
    Comments: Most rabies exposures result in death; rabies vaccine is not routinely available.