Last updated: June 2022

Based on available COI, the general situation regarding the elements mentioned above is assessed below. The contents of this section cover the topics of food security, housing and shelter, hygiene, basic healthcare, and means of basic subsistence for the cities:


Last updated: June 2022

Food security

[Socio-economic 2021, 1.1.2, 1.3.1]

The majority of the population in Mogadishu is affected by food insecurity with highest malnutrition rates among IDPs. In December 2020, it was reported that a persistently critical level of acute malnutrition prevailed among IDPs in Mogadishu since 2019 due to high morbidity and effects on household incomes. In March 2021, it was reported that 125 000 people, per month, receive food assistance since July 2018. However, an all-time high with regard to food security complaints and information requests was reported in April 2021. This relates to the elevated number of new displacements and coincides with increases of IDP numbers.

Insufficient food production in the country leads to high food prices. Moreover, the city’s supply from local producers is vulnerable to climate change, from which food security suffers in time of droughts. In 2020, the largest locust swarms in 25 years hit Somalia’s agriculture and drove Somalia into severe food insecurity.

Housing and shelter

[Socio-economic 2021, 1.1.2, 1.3.2]

Mogadishu is located in an area affected by recurrent flash floods. Reportedly housing conditions in Mogadishu were challenging. Informal housing is widespread. The federal government is unable to meet the shelter needs of the most vulnerable residents.

Due to scarcity of land, access to land and housing was constrained in urban areas. The growing influx of IDPs as well as of returnees from neighbouring countries has further constrained access to land in Mogadishu.

Prices for housing varied significantly between safe and unsafe areas. Reportedly people coming from outside of Mogadishu were charged a higher rent than locals.

Tenants need a local male person to vouch for them before a new rental arrangement is made. Single women encounter difficulties when renting their own apartment. Living alone is not customary and might be criticised as westernised. Moreover, single young men are particularly disadvantaged in accessing shelter due to stereotypical views of them as drug-takers, potential Al-Shabaab members, or people likely to cause trouble. For people living with disabilities, provisions were almost non-existent across all the housing categories. Therefore, they are generally entirely reliant on family members for support. Ethnic minorities outside of the clan system, such as Bantu, experience significant discrimination and tensions surrounding security of tenure or evictions.

IDP sites in Mogadishu are estimated between 500 and 1 500. Displaced people were mainly living in self-established camps at the fringes of Mogadishu. Housing consisted predominantly of corrugated metal sheet shacks or temporary shelters made of sticks, plastic and fabric inhabited by IDPs. Many dwellings of IDPs lack adequate protection from rain. In IDP camps, the ‘camp leader’ or ‘gatekeeper’ decides who is allowed to settle in the camp, register newcomers and identify the spots where they can set-up huts.

In Mogadishu the majority of residents at IDP sites do not belong to one of the dominant clans in the city. Poverty drove also non-IDP residents into informal settlements in Mogadishu. Spiking land and real estate prices in Mogadishu result in large-scale evictions. For more information on evictions, see section Article 15(b) QD.


[Socio-economic 2021, 1.3.3]

Reportedly 67% of households in Mogadishu had access to improved sanitation. Only 2% of households lacked access to water and even 96% of households had access to piped water at home. However, it was reported that access to water, sanitation and the level of hygiene was not adequate in IDP settlements and that for IDPs and residents of informal settlements it was difficult and expensive to access water. Sanitary or latrine facilities are often lacking in informal settlements.

As access to safe water is challenging, water-borne diseases are common across the city. Floods compromised sanitation and increased the number of cholera cases. In times of droughts less water for hygiene and sanitation was available and water contamination increased.

Basic healthcare

[Socio-economic 2021, 1.3.4]

While most of Somalia’s health facilities are located in larger cities including Mogadishu, experts have described the healthcare situation in the capital as ‘worrisome’ or even absolutely insufficient. There are no more than 1 000 to 1 200 beds for the city’s population estimated between 1.7 and 2.6 million. Many Mogadishu residents are therefore unable to access medical care.

Medical services available in Mogadishu are reportedly of ‘poor quality’ both in the public and the private sectors. Although basic drugs are available, their proper storage is difficult and fatalities have been reported from normally easily treatable diseases such as measles, malaria or cholera.

The private health care system is the dominant health care system in Mogadishu. Public hospitals quite often have to send their patients to private facilities because they lack the necessary equipment and expertise. While private healthcare facilities provide specialised and, at times, advanced treatment, several sources have emphasised that the health sector is highly unregulated and that the types of services and their quality are unknown.

While healthcare in Somalia is generally not free of charge, services in public hospitals are mostly cheaper than in the private healthcare sector. If drugs are available, they are distributed free of charge. The cost of private healthcare was unaffordable for a large part of the population.

The majority of funding comes from international donors and does not necessarily match the needs of the Somali health authorities.

IDP’s access to healthcare is reportedly limited, contributing to high morbidity and death rates among some IDP populations in Mogadishu. Mobile health services serve some outskirt camps on weekly or bi-weekly basis, but neither these services nor diagnosis or medication are regular.

It has also been reported that there is ‘particularly acute’ shortage of mental health specialists.

No clan-based discrimination with regard to access to healthcare has been reported.

Healthcare services have been scaled down by nearly half as a result of night-time curfews and other restrictions linked to the COVID-19 pandemic.

Regarding COVID-19, Mogadishu was one of only a few places where a COVID-19 response was rolled out. A lack of hospitals treating COVID-19 patients was reported with only one facility dedicated to the treatment of COVID-19 cases. A lack of medical equipment also reportedly prevails, with only three private hospitals having oxygen plants.

Means of basic subsistence

[Socio-economic 2021, 1.3.6]

Urban wage labour is less dependent on climate or seasonal conditions. In Mogadishu, 64% of households were engaged in wage labour. Employment opportunities in Mogadishu were limited.

There were no precise statistics on unemployment, but the figure was estimated to be high.

Most poor households in urban centres like Mogadishu (these include IDP households, the non-IDP urban poor and/or migrants from rural areas) have to rely on casual labour to secure an income. Many in Mogadishu lived from small-scale sales at markets or worked at restaurants and tea shops. Women selling fruit at markets usually earn a maximum of 1-2 USD per day while the average income of a Bajaj driver was reportedly approximately 15-20 USD per day.

The steady influx of displaced people from the countryside has resulted in increased competition for urban livelihoods. Vulnerable and uneducated persons are particularly affected by severe lack of access to the labour market in urban settings.

Public health measures to contain the spread of COVID-19 have severely impacted people’s income and livelihoods. The level to which people were affected economically, depended on the type of livelihood or other daily activity such as education or household responsibilities. Woman-owned businesses have been especially hard-hit. Furthermore, remittances from family members and relatives (though not accessible for most IDPs) playing a significant role as a coping mechanism in Somalia, decreased during the pandemic.


Last updated: June 2022

Food security

[Socio-economic 2021, 2.1.2, 2.3.1]

The livelihoods of agro-pastoral and riverine households are largely dependent on climatic conditions. Puntland has been affected by climatic shocks in recent years, alternating drought and floods, as well as the Gati cyclone in Bari in November 2020. Puntland is among the parts of Somalia facing critical water shortages.

In addition, the depreciation of the Puntland Somali Shilling had an impact on food prices. IDPs in Garowe and in Bosasso were affected by acute malnutrition at a ‘critical’ level.

Housing and shelter

[Socio-economic 2021, 2.3.2]

Most people in Garowe live in stone/brick houses on a land of 20 metres by 10 metres or 30 metres by 30 metres. In IDPs sites in Garowe district, the types of shelters were either traditional huts (88%), out of mud and stick walls with roofs out of corrugated iron sheets (64%), or shelters constructed using shelter kits (60%).

In Garowe city specifically, land tenure has become highly insecure. Illegal land expropriations were widespread in Puntland’s major cities and land grabbers present themselves as legitimate landowners to IDPs from whom they demand rent, using coercive force.


[Socio-economic 2021, 2.3.3]

Poor and over-priced domestic water quality has been reported in Puntland. The piped water system (public private partnership) covers around 90% of the urban area however, residents also rely on hand dug shallow wells and berkads (reservoirs). However, the water is generally saline and does not meet World Health Organisation’s standards.

In April 2021 UNOCHA reported that most water points across Puntland had dried due to persistent dry conditions, Garowe counting among the worst affected districts. Water shortages had led to population displacements in Puntland at the beginning of 2021.

The lack of an adequate sewage system in Garowe city as well as the insufficient collection of waste and the mislocation of dumping sites further threaten[ed] water resources, health and hygiene within the population.

Women and girls in Puntland, especially for the IDP communities, could face risks when trying to access WASH facilities, for example because of the distance of toilets from camp inhabitants and poor lighting. Unavailability of proper menstrual and other hygiene supplies has also been reported.

Basic healthcare

[Socio-economic 2021, 2.3.4]

UN-Habitat mentioned in 2019 that the condition of health services in Garowe city was insufficient and found that ‘the WHO minimum standard for health care services (20 physicians per 100 000 people) is not met, and numerous clinics are forced to close.’ The growing margins of the city were even more underserviced regarding health care.

Garowe General Hospital (GGH) is the central and public facility regarding healthcare in Garowe. Private hospitals, small private clinics and pharmacies are reportedly also available.

Healthcare is not free in Garowe. However, the costs in the public hospital in Garowe are lower than other private or public hospitals.

Means of basic subsistence

[Socio-economic 2021, 2.3.6]

Around 25 - 35% of the urban population of Garowe are poor. There is little humanitarian aid offered to IDPs who do not belong to Puntland by patrilineal descent.

Many people work in employment, business and irregular casual labour and petty trades. Employment for many is instable. Due to the oversupply of labour, wage levels are depressed. Additionally, IDPs from southern Somalia who live in Garowe or nearby, as well as natural factors like droughts, burden the local economy. On the other hand, the existence of government offices, NGOs and UN agencies as well as universities and higher learning facilities in town have a positive effect on the local employment situation. In addition, there is much new construction going on, which creates jobs at least temporarily. Like in most other Somali towns, the service sector is offering considerable employment opportunities.

Generally, the informal sector remains the major driver of Garowe’s economy, with a share of over 69% of the district’s residents. Youth unemployment is very high. Young people often find only temporary or low-level jobs as cleaners or waiters.


Last updated: June 2022

Food security

[Socio-economic 2021, 3.3.1]

Water and food insecurity are reported to pose the most significant challenge for Hargeisa with 53.2% of the total households below the food insecurity line. Crop losses in 2020 and livestock prices were high across the country. The measures taken to limit the spread of COVID-19 such as restricting access to markets were particularly detrimental to poor households’ ability to cover daily food needs.

Housing and shelter

[Socio-economic 2021, 3.3.2]

Hargeisa experienced a rapid urbanisation in the past decades and saw land prices increase as well as the competition for access to land and housing. This urban reconstruction has had violent consequences including illegal land grabbing, and mass-scale evictions of the urban poor and displaced people.

Returnees and IDPs settled on large patches of uninhabited private or public land since the late 1990s. Their so-called camps or settlements are located at the outskirts of the city but also within the city centre. They attracted large numbers of people over the years, not only forcedly displaced people but also residents of Hargeisa who could not afford rising rents.

In the State House settlement in Hargeisa, less than 15% live in brick/masonry houses.


[Socio-economic 2021, 3.3.3]

Limited water and lack of sewage in Hargeisa lead to high costs of access to such utilities. Fewer than 1 in 100 households in Hargeisa has access to running water, with access dropping off sharply as one moves out from the city centre. 70% of the city’s population rely largely on water from tanker trucks and hand carts, paying at least four times the price of piped water per unit, creating an excessive cost burden that falls most heavily on the poorest.

Difficulties to stock trucked water and menstrual hygiene management items have been reported in Hargeisa.

Basic healthcare

[Socio-economic 2021, 3.3.4]

In Hargeisa, around 200 medical doctors are offering services for a population of roughly one million people or more which amounts to an estimated ratio of one medical doctor per 5 000 inhabitants or more. The desirable doctor-population ratio, according to the World Health Organization (WHO), is 1:1 000. It was reported that the healthcare system has never developed beyond providing the most basic functions, which leave it ill-equipped to deal with any significant challenges.

Among the central problems of the health system in Somaliland are: the low preparedness for emergency, the lack of personal protective equipment and life-saving equipment, the lack of proper training and experience of health workers and the lack of standard operation procedures and guidelines.

Health care in Hargeisa is essentially private. The Hargeisa Group Hospital (HGH), which is the national referral hospital in Somaliland, is called ‘public’ or ‘state’ hospital due to partly public funding. However, patients have to pay there for services. Regarding private hospitals, the admission fees and bed-costs are around 30% higher than in HGH. Payments for healthcare have to be managed privately while hardly anyone in Somaliland has health insurance.

The field of mental health care is underdeveloped in Somaliland, however, in Hargeisa there are some services. The main problem is the lack of qualified staff with only around five trained psychiatrists in Somaliland, two of whom are practicing in Hargeisa.

Means of basic subsistence

[Socio-economic 2021, 3.3.6, 3.4.2]

Hargeisa’s unemployment rate was 22.3% in total, with the youth unemployment rate being 37.6%. The informal economy continued to be a key source of livelihoods in Somaliland. Local employment decreased by more than 50% in Somaliland due to the COVID-19 impact.

Clan identity plays a crucial role in the social and economic life of residents in Hargeisa. Employment opportunities are to a significant degree influenced by kinship. Many IDPs are from the region (Somaliland). Their survival is guaranteed by relatives who pay for food etc. or through donations from international or local NGOs. IDPs who are from South-Central Somalia are dependent on humanitarian aid.

Women engaging in businesses might enter unsafe spaces and encounter structural barriers. They are more often confined to the informal sector than men. It is also reported that they enjoy relative freedom in Somaliland, including Hargeisa, to trade in the market, open small or also bigger businesses and travel.

The general circumstances prevailing in Mogadishu, Garowe and Hargeisa assessed in relation to the factors above entail significant hardship. However, they do not preclude the reasonableness to settle in the cities as such. A careful examination should take place, particularly when assessing the reasonableness of IPA to Mogadishu.

The person’s ability to navigate the above circumstances in the three cities will mostly depend on access to clan support and financial means and in individual cases, the reasonableness requirement may be satisfied. The impact of COVID-19 on the economic situation, as well as on the healthcare system, should also be considered.