Strengthening Maternal Health in Somalia: How the Damal Caafimaad Project Saves Lives

Mothers-to-be face some of the highest risks in the world; the World Health Organization reports that the maternal mortality rate in Somalia is 563 per 100,000 live births, compared to the world average of 197. Action Against Hunger is working with partners and the Government of Somalia to change that reality with the Damal Caafimaad project, ensuring women and children can access life-saving care.

What is the Damal Caafimaad Project, and What is Action Against Hunger’s Role In It?

Funded by the World Bank and implemented with partners like Action Against Hunger, the Damal Caafimaad project has been transforming care delivery in some of the most remote and crisis-affected areas since 2021. By tackling systemic barriers, Damal Caafimaad improves both the availability and quality of health services, with a long-term goal of reducing preventable maternal and child deaths across Somalia.

Action Against Hunger works closely with a wide range of stakeholders in the project like the Government of Somalia and community leaders to ensure the solutions are locally owned and led. For this project, we are working in over 92 facilities in the Bay and Bakool regions of Somalia to support health systems strengthening with activities like:

• Expanding maternal, neonatal, and child health services, including emergency obstetric care, family planning, and newborn intensive care.
• Increasing immunization coverage, nutrition support, and disease surveillance.
• Providing care for survivors of gender-based violence.
• Rehabilitating facilities to ensure functionality and patient safety, including water, sanitation, and hygiene (WASH) infrastructure.
• Integrating social safeguards into healthcare, with strong emphasis on community engagement and the inclusion of minority groups and persons with disabilities.
• Complementing the health supply pipeline through procurement and distribution of medical supplies as per the Somalia Essential Medicines lists.
• Enhancing regional and district health management structures through improved coordination, joint supportive supervision, and capacity‑building training.

Action Against Hunger’s deep ties to local communities make it a vital partner to the Damal Caafimaad project. With nine mobile health teams reaching remote areas, Action Against Hunger reaches people who might otherwise go without care and, when needed refers them to Damal Caafimaad-supported facilities. A wide network of about 384 trained community health workers active across ten regions further strengthens this link by raising awareness, detecting malnutrition, and connecting patients with hospitals and clinics. This community-based approach helps bridge the gap between families and the formal health system, ensuring that lifesaving care reaches even the hardest-to-reach households.

A Mother’s Story: Maryan’s Fight for Life

At 38 weeks pregnant, Maryan Moalin Abdullahi, a 39-year-old mother arrived at Bayhaaw General Hospital in Bay region in critical condition. She was struggling to breathe, and her blood pressure was dangerously high. Maryan had come from Saakow, Middle Juba, one of the poorest regions in Somalia and where access to healthcare can be limited. Her relatives pooled money so she could be brought by auto rickshaw (or tuk-tuk) over 150 miles to receive care.

The Bayhaaw General Hospital is supported through the Damal Caafimaad project, the Government of Somalia’s flagship program to expand access to essential health services for women, children, and displaced families in underserved regions.

Once Maryan arrived there, the medical team immediately placed her on oxygen and IV fluids and administered vital medications. Still, her condition continued to worsen, and they prepared her for an emergency Caesarean section.

“I was terrified when I arrived, unsure if I would survive,” Maryan recalled. “But the care I received gave me hope and strength to keep fighting.”

Maryan and her baby survived the delivery, but both were in critical condition. Maryan was diagnosed with a chronic heart condition that had worsened during pregnancy, and she had to be treated in the ICU. Her baby boy, Abdullahi Ali, was born prematurely and weighed only four pounds. He was cold, had difficulty breathing and his blood sugar was low. Abdullahi Ali needed intensive neonatal care including oxygen and glucose to survive.

With quality treatment and support from medical staff, both mother and child recovered. Abdullahi Ali’s weight rose to 5 pounds within a week, and Maryan’s condition improved. Now, they are comfortably at home. Abdullahi Ali is breastfeeding well and growing stronger by the day. Maryan’s husband, Ali, is grateful for the care they received: “Seeing my wife and son overcome such a difficult time is a blessing. The hospital’s care saved their lives.”

Maryan is still on medication for her heart condition and has regular follow-up visits. Her ongoing treatment is managed in Saakow with the help of Action Against Hunger community health workers.

“We closely monitor her progress,” said Dr. Abdullahi Hassan Hussein, a physician at Bayhaaw General Hospital who was involved in Maryan’s treatment. “We stay in contact with the family, and our community health workers keep the hospital informed from within the community.” His work, along with that of other health staff, is made possible through the Damal Caafimaad project, which supports training and salaries, ensuring that health professionals can continue serving families in some of Somalia’s most underserved areas.

Maryan’s story is just one example of how investing in maternal health saves lives. Since January 2025, Bayhaaw General Hospital has performed four safe Caesarean deliveries and supported over 670 births. The hospital is one of 56 facilities in Bay region strengthened through Damal Caafimaad with equipment, supplies, staff training, and salaries. Together, these investments are giving mothers the chance to survive childbirth, babies the chance to thrive, and families the chance to hope for a healthier future.

The Future of Healthcare in Somalia

Somalia has made important strides in expanding access to healthcare despite decades of conflict and crisis. Investments like the Damal Caafimaad project have strengthened public health facilities, trained health workers, and provided vital equipment and medicines to communities that were once out of reach. Through these efforts, Somalia has seen dramatic increases in the quality, availability, and uptake of care. For example:

• The Maternal Mortality Ratio (MMR) has nearly halved since 2000, reports the WHO.
• Child immunization rates have risen from 24% in 2012 to 70% in 2024, according to UNICEF.
• A 2023 study found that healthcare seeking for children under five with diarrhea has jumped 49% between 2006 and 2020 in rural areas.

These achievements are building a foundation of trust in the health system and demonstrating that, with the right support, Somalia can make lasting progress in reducing preventable deaths.

However, Somalia’s gains are now at risk. This year, international budget cuts to humanitarian aid threaten to reduce the very resources that have made these improvements possible. Six health facilities and 15 mobile health teams supported by Action Against Hunger were closed due to USAID funding cuts. Without these options for care, more people are relying on Damal Caafimaad clinics, and their capacity is strained. For mothers and children in particular, these cuts could mean longer journeys to reach care, increased risk during childbirth, and more preventable loss of life. Without sustained investment, the trajectory of Somalia’s health system could shift backwards, putting vulnerable families in even greater danger.

Fortunately, The World Bank confirmed that the Damal Caafimaad project will continue through December 2025, and there is significant hope for an extension beyond December. While the project has already made significant progress in improving the quality and access of care in Somalia, there is still much work to be done — about 70% of the project’s supported facilities need further rehabilitation. Action Against Hunger is eager to continue partnering with the project and strengthening Somalia’s health system. With sustained support, Somalia can move closer to a future where every mother like Maryan can give birth in a safe environment, and every child like Abdullahi Ali has the chance to grow up healthy and strong.