title: Supporting 'medicine at a distance' for delivery of hospital services in war-torn Somalia: how well are we doing?
abstract: BACKGROUND
  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.
  
  
  METHODS
  This was a retrospective analysis of hospital data for 2011.
  
  
  RESULTS
  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 Médecins Sans Frontières.
  
  
  CONCLUSIONS
  With a support package, satisfactory standards of care were met for hospital care in Somalia.
authors.affiliation: Médecins Sans Frontières, Belgium, Somalia Mission Coordination, Nairobi, Kenya.
authors.forename: Abdisalan M
authors.initials: AM
authors.lastname: Maalim
authors.forename: Rony
authors.initials: R
authors.lastname: Zachariah
authors.forename: Mohamed
authors.initials: M
authors.lastname: Khogali
authors.forename: Johan
authors.initials: J
authors.lastname: Van Griensven
authors.forename: Rafael
authors.initials: R
authors.lastname: Van den Bergh
authors.forename: Katherine
authors.initials: K
authors.lastname: Tayler-Smith
authors.forename: Walter
authors.initials: W
authors.lastname: Kizito
authors.forename: Bienvenu
authors.initials: B
authors.lastname: Baruani
authors.forename: Abdirahman
authors.initials: A
authors.lastname: Osoble
authors.forename: Faiza
authors.initials: F
authors.lastname: Abdirahman
authors.forename: Latifa
authors.initials: L
authors.lastname: Ayada
authors.forename: Abdinoor H
authors.initials: AH
authors.lastname: Mohamed
mesh_terms: D000328:Adult; D002648:Child; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D003967:Diarrhea / Q000628:therapy; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007630:Kenya; D044342:Malnutrition / Q000401:mortality / Q000628:therapy; D011247:Pregnancy; D015397:Program Evaluation; D012141:Respiratory Tract Infections / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D012998:Somalia / Q000453:epidemiology; D017216:Telemedicine / Q000379:methods*; D014857:Warfare; D014948:Wounds, Gunshot / Q000401:mortality / Q000628:therapy
keywords: Conflict; Hospital outcomes; Operational research; Somalia