Supporting medicine at a distance for delivery of hospital services in war-torn Somalia: how well are we doing?

We describe an innovative strategy implemented to support national staff at Istarlin Hospital in the conflict setting of Somalia; and report on inpatient morbidities, mortality and adverse hospital exit outcomes. This was a retrospective analysis of hospital data for 2011. Of 8584 admitted patients, the largest numbers were for lower respiratory tract infections (LRTI) (2114; 25), normal deliveries (1355; 16) and diarrhoeal diseases (715; 8). The highest contributors to mortality were gunshot wounds in surgery (18/30; 60), LRTIs in internal medicine (6/32; 19) and malnutrition in paediatrics (30/81; 37). Adverse hospital exit outcomes (deaths and absconded) were well within thresholds set by Mdecins Sans Frontires. With a support package, satisfactory standards of care were met for hospital care in Somalia.