By Trisha de Borchgrave

The reasons why some African and Asian countries were largely spared the Covid pandemic’s first devastating wave of deaths last year are still up for debate.

What is clear, however, is that some countries with large informal economies, crowded city living and limited access to medical resources and health services, have been remarkably resilient so far. However, successive second and third waves of increasingly infectious Covid variants, are seeing numbers grow substantially.

Edna Adan Ismail is the founder and director of the Edna Adan University Maternity Hospital in Somaliland.

Now in her eighties, Adan has spent a life at the forefront of healthcare as a women’s health advocate, campaigner against female genital mutilation, World Health Organization representative and hospital director. She was also Somaliland’s first female foreign minister.

She believes that Covid’s less serious impact on young people may well have contributed to lower mortality rates across Africa’s large young populations. Centuries of exposure to non-sterile environments has led to stronger immune systems among the African young, Adan believes, alongside resilience to drought, famine and contaminated water.

But the young age quickly in Africa and preventable diseases such as tuberculosis that go untreated shorten lifespans. Vital organs susceptible to Covid, such as lungs, are ‘tired, damaged, fibrous and scarred’, and, as a result, many in their forties and fifties have succumbed to the pandemic.

For developing countries, the economic fallout from Covid can kill as many as the pandemic itself

On the morning we spoke, the nephew of a female hospital employee tested positive for Covid. ‘People can’t isolate one person in a small household,’ said Adan, describing the predicament most families face.

‘They have one bathroom they all use, one living room, while her nephew sleeps with other siblings. Now that she is a widow she has space in her bedroom for her cousins, and that’s all they have.”

As Adan says: ‘In Somaliland if you don’t work, you die.’

New waves of infection and the lack of vaccines reaching poorer developing countries such as  Somaliland could lead to the tragic outcomes seen elsewhere.

‘Yesterday, we finished three days of vaccinations,’ Adan says. ‘Somaliland has a population of four million.  The country received 30,000 vaccines – you do the maths. Nobody is selling us the vaccine and we don’t have the refrigeration or transportation to ensure it is safely administered.’

I ask her if people are adhering to social distancing guidelines, washing hands and wearing face masks. ‘Yes, but a packet of disposable masks costs $14 –  a princely sum. A family feeds itself on that for many days.’

Compounding the situation is drought. Adan shrugs and looks out of her office window. ‘The rains haven’t come, and the rainy season is over. People don’t have water to wash their hands with.’

As a trusted member of her community, Adan was asked to become a ‘Covid ambassador’, regularly broadcasting to a sceptical public on the safety issues of the pandemic, ‘explaining that this is not a western-led campaign, that washing hands is not about promoting the sale of soap, that masks are to stop my breath getting to yours, and yours getting to me, and that none of this is a way to impose control’.

Without vaccines, though, Adan can only hope for natural herd immunity

Considering the limited resources, what three things would she implement tomorrow that could help keep infection rates of the coronavirus down.

‘First, would be to stop the chewing of khat, which is sold openly on the streets. Second, I’d close down coffee shops. And third, I’d have hand washing stations scattered around the city, because people don’t have water.”

Without vaccines, though, Adan can only hope for natural herd immunity, keeping in mind there are many other healthcare issues that would help the economies and political stability of African countries.