"A true doctor? that does not exist." Implications of War on the Physical and Mental Health of Somali Elders in Mogadishu, Somalia: A Mixed Methods Study Open Access

Jama, Fowzio (Spring 2022)

Permanent URL: https://etd.library.emory.edu/concern/etds/kp78gh58q?locale=en


Background: The rising number of elderly populations in low-middle income countries and humanitarian settings is partly due to the growing number of aging populations globally. In humanitarian settings, this population faces mobility limitations and threats to their safety and security. There is limited information on the health-related challenges experienced by the elderly during humanitarian crises. This research specifically seeks to understand the health-related challenges faced by the elderly in Mogadishu, Somalia, where internal conflict has existed since the collapse of government in 1991. Participants reported the implications of civil war on their physical and mental health, conditions that are exacerbated by the lack of accessible and affordable healthcare services.

Methods: This is a mixed-methods cross-sectional study design. A survey was distributed to adults aged 50+ in the Abdulaziz district between January 9th - January 12, 2021. Descriptive statistics were used to document prevalence of disease, socio-demographic factors, and social support. In-depth interviews were conducted with 16 of the survey respondents during the months of June and July of 2021.

Findings: Survey study participants reported a high burden of disease with 84% having at least one chronic condition. Health conditions reported include hypertension (24%), gastritis (23%), diabetes (17%), and enteric infections (12%). Almost one-fourth (53%) of participants lacked functional and emotional support. Emergent themes from qualitative results indicted challenges of managing conditions due to limited proficiency in medical knowledge and beliefs embedded in cultural traditions, such as the assumption that antibiotics treat every illness, and that sickness is a form of atonement. Participants shared how the war led to chronic grief, social isolation, and poor sleep and appetites. Participants also reported feelings of anxiety related to the inability to afford medications and scarcity of affordable quality care. Coping mechanisms include accessing more affordable pharmacy-based care and reliance on strangers instead of family in crisis situations.

Interpretation: The elderly population in Somalia suffers from a high prevalence of non-communicable disease and poor mental health. The elderly population has significant unmet healthcare needs and limited access to social support. This work highlights the gap in the care of elderly in a conflict setting. 

Table of Contents

Chapter 1: Introduction 1

Chapter 2: Literature Review 5

Chapter 3: Methods 13

Chapter 4: Results 20

Chapter 5: Discussion 36

Conclusion: 41

References: 45

Appendix A: 48

Appendix B: 52

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