With Dr Felicity Nicholson. For up-to-date information on health issues across Africa, click here.
Like most of sub-Saharan Africa, Somaliland harbours an array of tropical diseases of varying degrees of severity and inconvenience. Although there’s a fair possibility that you will become ill at some point on your trip, the cause is most likely to be either straightforward travellers’ diarrhoea or a cold, and provided you receive the necessary immunisations before you travel, the only major cause for concern once you are in the country is malaria, which can be combated to a large extent by taking sensible precautions.
Within Somaliland, there are private clinics and/or hospitals in all the larger towns, but they tend to be under-equipped and overcrowded, the main exception being the private Edna Adan Maternity Hospital in Hargeisa. Pharmacies are also present in all the larger towns, and they are usually quite well stocked and staffed by an English-speaking pharmacist. You should be able to buy such commonly required medicines as broad-spectrum antibiotics and Flagyl in any sizeable town. If you are wandering off the beaten track, it might be worth carrying the obvious with you. As for malaria tablets, whether for prophylaxis or treatment you would be wise to get them before you go as not all tablets are readily available.
Preparations to ensure a healthy trip to Somaliland require checks on your immunisation status: it is wise to be up to date on tetanus, polio and diphtheria (now given as an all-in-one vaccine, Revaxis, that lasts for ten years), and hepatitis A. Yellow fever is not considered a risk in Somaliland, and therefore vaccination would only be suggested if the traveller is entering Somaliland from another yellow fever country such as Ethiopia.
Make sure all your immunisations are up to date, including tetanus, polio and diphtheria (now given as an all-in-one vaccine, Revaxis, that lasts for ten years), and hepatitis A. Yellow fever is not considered a risk in Somaliland, and therefore vaccination would only be suggested if the traveller is entering Somaliland from another yellow fever country such as Ethiopia. Immunisation against cholera, typhoid, rabies, meningitis and tuberculosis might also be advisable.
The biggest health threat at lower altitudes is malaria. There is no vaccine against this mosquito-borne disease, but a variety of preventative drugs is available, including mefloquine, malarone and the antibiotic doxycycline. If you are visiting a malarial area, it is normal to start taking these at least two weeks before your trip and to continue for at least a month after you get home. The most suitable choice of drug varies depending on the individual and the country they are visiting, so visit your GP or a travel clinic for medical advice. If you will be spending a long time in Africa, and expect to visit remote areas, be aware that no preventative drug is 100% effective, so carry a cure too. It is also worth noting that no homeopathic prophylactic for malaria exists, nor can any traveller acquire effective resistance to malaria. Those who don’t make use of preventative drugs risk their life in a manner that is both foolish and unnecessary.
Though advised for everyone, a pre-exposure rabies vaccination, involving three doses taken over a minimum of 21 days, is particularly important if you intend to have contact with animals, or are likely to be 24 hours away from medical help.
Take a small medical kit with you. This should contain malaria tablets and a thermometer, soluble aspirin or paracetamol (good for gargling when you have a sore throat and for reducing fever and pains), plasters (band-aids), potassium permanganate crystals or another favoured antiseptic, iodine for sterilising water and cleaning wounds and sunblock. As restaurant meals in Somaliland tend to be based around meat and carbohydrate, some people may like to carry vitamin pills.
Prolonged immobility on long-haul flights can result in deep-vein thrombosis (DVT), which can be dangerous if the clot travels to the lungs to cause pulmonary embolus. The risk increases with age, and is higher in obese or pregnant travellers, heavy smokers, those taller than 6ft/1.8m or shorter than 5ft/1.5m, and anybody with a history of clots, recent major operation or varicose veins surgery, cancer, a stroke or heart disease.
Travel clinics and health information
A full list of current travel clinic websites worldwide is available on w istm.org. For other journey preparation information, consult travelhealthpro.org.uk (UK) or wwwnc.cdc.gov/travel (US). Information about various medications may be found on https://www.netdoctor.co.uk/health-services/a28163609/travel-vaccinations/. All advice found online should be used in conjunction with expert advice received prior to or during travel.
The first question to pass through the mind of many prospective visitors to Somaliland will be: ‘Is it safe?’. To be honest, this question has no definitive answer. Officially, Somaliland is part of Somalia, undoubtedly one of the most lawless and dangerous countries in the world. As of early 2018, the US Department of State website and the British Foreign Office warns against travel in Somalia and Somaliland, citing bombings, kidnappings, illegal roadblocks and potential terrorist attacks as reasons to avoid all but essential travel.
In practice, however, Somaliland functions as a completely separate country to Somalia or Puntland, and it is universally regarded to be far safer than either of these fractious neighbours. Within Somaliland itself, there have been infrequent instances of foreign aid workers being killed or kidnapped since independence in 1991, acts perpetrated by Al-Shabaab and other external groups hoping to destabilise their peaceful neighbour, but such incidents are evidently on the decrease.
Indeed, the last such incident occurred in 2008, when Hargeisa and Bosaso were hit by six co-ordinated suicide bombings. Since then, Somaliland has attracted a significant trickle of travellers from across the Ethiopian border, and the impression of every foreigner we met travelling or working in Somaliland is that the visitors have little to worry about in terms of security, provided that they stick to regularly visited sites such as Hargeisa, Berbera and Las Geel, and ask local advice before heading further off the beaten track. That said, the enduring instability of the entire Somali region precludes too many glib reassurances.
Also bearing on the issue of safety is the official requirement that all foreigners moving outside Hargeisa must be accompanied by an armed member of the Special Protection Unit. The official line seems to be that this is an ultra-conservative precaution against the devastating effect the killing of a foreigner would have on Somaliland’s petition for international recognition. But it wouldn’t be necessary, surely, unless there was a genuine risk associated with travel outside the capital?
Perhaps, or is it simply misplaced paranoia? It has even been suggested that the SPU policy exists at the instigation of foreign UN and NGO workers with a vested interest in maintaining Somaliland’s official high-risk status (it means that salaries are higher than in a more stable country). What can be said with confidence is that it is increasingly common for the Chief of Police in Hargeisa to issue a written waiver of SPU protection to backpackers upon request – an anomaly from which you can draw your own conclusions!
Whatever the actual risks associated with travel in Somaliland, the reality is that if you get into any sort of trouble there you’ll be a lot more isolated than would normally be the case. There will be no embassy to help bail you out, since Ethiopia is the only country in the world with formal diplomatic representation in Hargeisa. Furthermore, most travel insurance policies explicitly exclude cover for countries subject to the FCO or US State Department travel warnings quoted above, in which case you will also be uninsured.
Security issues aside, Somaliland is largely free of more conventional crime, such as pickpocketing, mugging and theft from hotel rooms. Indeed, we have heard of no such incident involving a traveller anywhere in Somaliland, and would regard the country to be as safe as anywhere we have visited in that respect. All the same, there is a significant disparity in wealth between most locals and visitors, so it might be viewed as tempting fate to wander along unlit streets alone at night or to carry large sums of money or valuables publicly. And on the basis that it is preferable to err on the side of caution, below are a few tips that apply to travelling anywhere in Africa.
- Most casual thieves operate in busy markets and taxi parks. Keep a close watch on your possessions in such places, and avoid having valuables or large amounts of money loose in your daypack or pocket.
- Keep all your valuables and the bulk of your money in a hidden money belt. Never show this money belt in public. Keep any spare cash you might need elsewhere on your person.
- A buttoned-up pocket on the front of the shirt is one of the most secure places, as money cannot be snatched from it without the thief coming into view.
- Where the choice exists between carrying valuables on your person or leaving them in a locked room, we believe that the latter option is generally safer, assuming that the room is absolutely secure. However, some travellers’ cheque companies will not refund cheques stolen from a room, or might reject the claim on a technicality, for instance if the door wasn’t damaged during the robbery.
- Leave any jewellery of financial or sentimental value at home.
Women travellers generally regard sub-equatorial Africa as one of the safest places to travel alone anywhere in the world, and Somaliland is probably no exception when it comes to gender-specific risks. That said, single women are advised to avoid hotels listed in the budget or shoestring category, in particular those with shared showers and toilets, which are highly unlikely to be frequented by local women. Likewise, it is unusual for local women to eat alone in restaurants, and female travellers who do so might become targets of unwanted curiosity or flirtation. Many female travellers to relatively conservative countries consider it to be a good idea to pretend you have a husband at home or in another town – and, ideally, a wedding ring as ‘proof’ of your status.
The biggest restriction on women travellers to Somaliland is the need to adhere to smothering local dress codes in all public places. For local women, the standard items of clothing are a loose-fitting all-enveloping ankle-length dress called a direh, and a bonnet-like headscarf called a hijab that covers every last hair on their head. Some women also wear the more severe abaya, a long black or multi-coloured garment, reminiscent of a nun’s habit, that leaves only the eyes, hands and feet exposed. Female travellers should dress similarly, at the very minimum wearing a loose ankle-length skirt, a top that is sufficiently baggy to mask the shape of their breasts, and a loose headscarf. Aside from being offensive to local sensibilities, any attire tighter or more revealing than this might, in a Somali context, create an unwanted impression of availability.
Any act of male or female homosexuality is a criminal offence. Offenders risk imprisonment or, in extreme cases, capital punishment. That doesn’t mean that homosexuality doesn’t exist, but out of necessity it is very clandestine. Setting aside the rights and wrongs of the matter, Somaliland clearly isn’t a destination suited to single travellers in search of anything approximating a gay scene (or, for that matter, any other form of secular nightlife), and at risk of stating the blindingly obvious, gay couples who do visit the country should exercise maximum discretion.