The Threat of Infectious Diseases in Somalia

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Abstract
The Four Horsemen of the Apocalypse -- War, Famine, Pestilence, and Death -- ride the arid plains of Somalia. Despite the protection offered by modern chemoprophylaxis, immunization, and preventive medicine, military personnel safeguarding food delivery in Operation Restore Hope are threatened by exotic infectious diseases rarely seen by U.S. physicians. Some require prompt treatment to prevent death ( Table 1 ). Many other infections acquired in Somalia will appear soon after exposure, some will become evident after the troops return home, and others will remain latent unless host immunity is compromised. Physicians caring for Somalis, particularly displaced persons in refugee camps, are confronted with a substantial risk of contagion exacerbated by overcrowding, poor sanitation, malnutrition, inadequate immunization, and the absence of rudimentary health care and arthropod-vector control. The ebb and flow of refugees and the long-term absence of comprehensive health reporting require that estimates of the risk of disease be based on isolated studies and historical accounts.

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