Sickness and starvation stalk Somalia's children in the ‘City of Death'

Telegraph

2 days ago

At a stabilisation centre in Baidoa, southern Somalia, Amina anxiously watches over her one-year-old son, Shariif, who is suffering from a deadly combination of severe malnutrition and multiple health complications.
Skinny and underdeveloped for his age, Shariif sits blank-faced and still on Amina's lap, a pale mosquito net hanging over them like a cloud.
'He was so sick, I thought I would have to give up on him,' Amina, 22, says. She walked several miles from a displacement camp to get medical help.
'I prepared myself for the worst,' she says. 'I prayed to God.'
After twelve days of treatment, Shariif is now ready to be discharged. Doctors say they were able to save him only because of the specialised care offered at this main stabilisation centre.
Once known as the 'City of Death', Baidoa is the epicentre of Somalia's neglected and under-reported humanitarian crisis. When rains fail, or funding falters, the fragile infrastructure and sprawling camps quickly become the front line of hunger.
All along the colourless walls of the clinic, there are metal beds with mothers wrapped in long, vibrant hijabs, holding tiny malnourished infants.
The children are those too sick to be treated anywhere else – suffering from severe malnutrition coupled with deadly illnesses like diarrhoea, pneumonia, malaria or anaemia.
Yet, in the coming weeks, this vital lifeline may close its doors.
It is one of more than 120 health facilities across Somalia that are at risk due to cuts in international aid, according to Save the Children. Some have already shut, services have been scaled back, and supplies of medicine and therapeutic food are running perilously low.
President Donald Trump's administration abruptly froze large chunks of foreign aid in January and it was fragile places like Somalia that suffered first. Lifesaving projects were shuttered almost overnight, with vulnerable women and children paying the heaviest price.
The US Agency for International Development (USAID) was the world's biggest aid donor, accounting for around 40 per cent of the global humanitarian system and a fifth of development assistance.
The Lancet warned last month that the cuts could cause more than 14 million preventable deaths by 2030 – a third of them among children under five.
For those who were already living on the edge, the threat is real and immediate.
Shariif has already been admitted twice in the past few months for lifesaving nutritional care.
'He is much stronger than he was, but he needs therapy food,' said Dr Mustafa Mohammed. 'After this month, I don't know if he will have it.'
While Trump's cuts have been felt deeply across the globe, Somalia is among the most aid-dependent countries on Earth.
The country lies at a grim crossroads of deep poverty, protracted conflict and climate change, which brings both severe droughts and floods.
Large parts of Somalia remain under the control or influence of Al Shabaab, the al-Qaeda-linked militant group that has waged an insurgency for nearly two decades.
In areas under their rule, there is no access to healthcare or education, and farmers are burdened by crippling taxation.
This year, the conflict has intensified – deaths from fighting are soaring as the militants advance on multiple fronts. Foreign troops are poised to withdraw, or face an uncertain future, amid a refusal by Washington to guarantee financial support.
There are growing fears among observers that Mogadishu could fall to Al Shabab, leaving the fate of one the world's oldest state-building projects hanging in the balance. A key town fell to the rebels this week.
Meanwhile, local forces, backed by US and UAE airpower, have been waging an all-out war against ISIS in Puntland, a semi-autonomous region in the north.
The day before The Telegraph visited Baidoa, clashes erupted following an Al Shabaab suicide car bomb, with 15 were reportedly killed in the fighting.
Repeated famines have ravaged the country, driving millions into overcrowded displacement camps where poor sanitation means disease is rife. Nearly a fifth of the population are internally displaced.
Baidoa is scattered with hundreds of camps that house more than 800,000 people – clusters of patchwork tents, cobbled together from scavenged and donated material.
They are cramped and dangerous, and subject to tribal law.
Amina and Shariif live in a camp after fleeing Al Shabaab rule. She has no income and is dependent on humanitarian assistance like cash, food and healthcare.
That support has now all but dried up.
Moazzam Malik, CEO of Save the Children – the largest NGO provider of health and nutrition services to children in Somalia – told The Telegraph that it was the abrupt and unpredictable nature of the cuts that hurt the most.
USAID previously funded about 65 per cent of Somalia's humanitarian aid, and StC now has a funding shortfall of around 20 per cent.
'Children and vulnerable mothers are dying as a result of the aid cuts,' he said. 'We have documented that in South Sudan and we strongly suspect the same is happening here in Somalia.'
A rise in deaths is difficult to quantify. Clinics closing or scaling back means fewer people receive care or have their deaths recorded. Ongoing conflict makes much of the country inaccessible to foreign organisations.
Yet when US-funded feeding centres shut their doors, babies wasted away in their mothers' arms while older siblings roamed markets begging for work.
Health facilities were left operating only a few days a week, forcing dangerously long waits for care. Aid workers said clinics ran low on therapeutic food and vital drugs, forcing staff to make impossible choices.
Vital outreach teams who had been making significant ground were disbanded, while doctors fear preventable diseases could gain ground, preying on bodies weakened by hunger.
In Baidoa alone, Malik said, two-thirds of the charity's staff have already lost their jobs.
'There's every risk that these cuts could also stoke instability and tip over into conflict,' Malik continued. 'There's every risk that people could take desperate measures and look to migrate to places where they believe they can have a better future.'
The Telegraph visited a number of facilities around Baidoa, but they and the displaced people we spoke to could not be named for safety reasons.
Doctors said that around 30 per cent of local health services have already closed because of funding shortfalls, with another 30 per cent running at reduced capacity.
'It has affected women and children particularly badly,' he Dr Suleiman Adam, whose health centre used to open six days a week, but now operates only two. 'If a sick child spends three days waiting to see a doctor, that leads to potentially life-threatening complications.'
Dr Adam used to see seven to ten malnutrition cases daily, now he sees twenty and the caseload is becoming imaginable. Despite lay-offs, some health workers are working unpaid to assist.
'Death rates have increased,' he said. 'We used to be able to receive people from the poorest areas. Now they come, see the clinic is closed that day, and go back. They die in their tents.'
Nearly 4.4 million people – close to a quarter of Somalia's population – are facing severe hunger, a figure expected to rise as aid cuts bite deeper and if there are further failed rains – Somalia endured its worst drought on record between 2021 to 2023, with an unprecedented five consecutive failed rainy seasons.
The International Committee of the Red Cross reported 'surging' cases of severe malnutrition among children arriving at their centres across Somalia.
In March, the European Commission's Food Security Portal raised its 2025 forecast for acutely malnourished children in Somalia by 47,000 to 1.8 million. UNICEF estimates that almost half a million are at immediate risk of death without urgent care.
Malnutrition significantly raises the risk of disease, making children eleven times more likely to die from common childhood illnesses. Combined with the crushing impact of poverty, it can coincide with spikes in HIV, malaria, cholera, and respiratory infections.
It can deprive children of the ability to fully develop their brains and bodies, with many remaining shorter and physically weaker into adulthood. The younger the child is, the greater the impact will be.
Somalia was already one of the most dangerous places in the world to give birth, with a woman dying during one in every 162 deliveries.
At a malnutrition clinic, Bint Ahmed cradles her youngest son in her arms. He is malnourished with a skin infection behind his ear and she has brought him to see doctors.
At centres like this, mothers line up with their children to have them weighed in a bucket, and stretched out on wooden measuring boards. The dimensions of their tiny arms are recorded and they are given vaccinations.
In 2018, Bint Ahmed lost her first son to malnutrition. Each of her four subsequent children have needed nutrition support.
'I am so worried. My first child died and we may no longer get food for this one,' she said. 'I used to come here and get medication for him. They just give me a prescription now, but I don't have money to buy it.'
Doctors and midwives say they can no longer afford to feed non-critical patients, including new mothers who need nutrition to produce milk for their babies.
Baidoa's humanitarian workers say the fallout also has a social fallout – years of progress is being undone in education enrolment and gender-based violence.
With food and cash assistance programmes, poverty and crime have surged, including theft and violent robberies.
'Children of seven or eight walk around the market now asking for work,' said one aid worker. 'They no longer go to school and it has become a protection issue.'
Both of Baidoa's legal aid services, which used to help survivors of sexual violence seek justice, have closed. Support services that once provided legal help, psychosocial care and protection are vanishing.
It is leaving vulnerable women and girls without support or protection as violence and instability grow.
Outreach programmes to combat forced marriage and female genital mutilation have stalled.
'When people were getting assistance like cash and food, they would listen. But it is dangerous for our workers to visit these desperate communities now,' said gender-based violence case worker Samira Abdullahi Ali. 'These were not just projects. We are saving lives.'
'If you walk around the local markets,' one women's rights activist said, 'you hear women saying: 'Donald Trump caused these problems'.'
When Trump slashed foreign aid, he declared that America should stop spending on causes 'that are not fully aligned with the foreign policy of the President.' His retreat is part of a broader global pull-back.
France, Sweden, Belgium and Switzerland have all trimmed aid budgets in recent years. Germany has cut nearly €1 billion from humanitarian spending.
The UK, once the world's third-largest donor, plans to shrink its aid budget from 0.5 per cent to 0.3 per cent of national income by 2027, representing a cut of about £6 billion a year.
Even before Trump's sweeping reductions, the number of people the World Food Programme was able to reach a month in Somalia had been slashed by more than half.
Behind the figures lies a powerful political undercurrent – soaring inflation, ballooning debt and the cost of conflicts from Gaza to Ukraine have squeezed government coffers. Nationalist politics has fuelled scepticism about pouring money overseas.
Yet it is in stark contrast to attitudes of the past. In the 1990s, the US launched a military intervention, Operation Restore Hope, sending thousands of troops to protect food convoys when Somalia suffered an intense famine after the collapse of its government.
Images of skeletal children and bodies lining Baidoa's streets shocked the world.
'Back then, there was a sense of moral responsibility,' said Omar Mohammed, senior analyst at the International Crisis Group. 'Somalia was a test of America's role after the Cold War.'
The mission, however, ended in bloody disaster when eighteen US soldiers were killed in Mogadishu's Black Hawk Down battle. The scar still shapes American foreign policy today.
Now MAGA-era politics have turbocharged isolationism and hardened resistance to foreign aid, and to conflicts perceived as 'forever wars.'
'There's this narrative now that aid is wasteful or even harmful, and Somalia's caught up in that,' Mohammed said. 'People wonder why billions went into state-building with so little to show.'
Countries like Somalia have now fallen off the agenda, and Washington no longer sees Al Shabaab as an immediate threat to the homeland.
'It's become a niche interest,' said Mohammed.
Yet Dr Ali Said Fiqi, the acting President of the Baidoa region, warned that the shift could undermine US soft power and push disillusioned youth into crime or into the arms of extremist groups like Al Shabaab.
It could also drive more people to risk dangerous journeys abroad.
'Without humanitarian aid, people will be forced to go searching for a better life,' he said. 'These cuts will lead to more people trying to get to Europe. There's no future left for them.'
That comes with its own risks. Leila, 39, who was seeking help for her malnourished child in Baidoa, lost her husband six years ago after he attempted the migrant route to Europe.
'He couldn't find enough work here to feed us properly,' she said. 'I didn't hear anything for four months. Then we heard his boat had crashed and he had died,' she said.
She was left alone with four daughters.
It is the abruptness of Trump's sweeping aid cuts that threatens devastating consequences, with no one stepping in so far to fill the void. Yet many argue that simply plugging funding gaps will not be enough.
The entire aid system may need rethinking if fragile states like Somalia are to break free from chronic dependence.
The recent UN Development Conference in Seville ended without any solid commitments, with vulnerable women and children paying the price.
Malik, head of Save the Children, believes the traditional model of aid is broken.
The old donor-recipient approach, rooted in charity and voluntary pledges, no longer suits a world grappling with shared threats like conflict, pandemics and climate change.
Tens of billions of dollars have poured into Somalia since Operation Restore Hope, yet it remains a fragile state, with life expectancy under fifty and GDP per capita below five hundred dollars.
It is still one of the most dangerous and famine-prone places in the world, and the second most corrupt country in Africa, according to Transparency International.
Malik proposes a UN convention on international development to replace today's voluntary system with countries agreeing to mutual obligations and shared responsibility. It is about seeing aid as a global investment in security, prosperity and resilience.
'Negotiating that would be hard. It will take time,' he said. 'But this is the space we need to move into – where we live together on this planet and progress together.'
Such investment could also reduce migration pressures – a crucial political issue in an increasingly inward-looking world. Instead of Fortress Britain, Malik argues, we need to see that we are all connected and that investing in international cooperation is how we secure our future.
'This isn't just about money,' Malik said. 'This is a battle of ideas, it's about the shape of the world we want our children and grandchildren to grow up in.'