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History

Like many other African countries, the area inhabited by ethnic Somalis has experienced great divisiveness since at least the mid-1800's, when the area was carved into multiple territories. France controlled the north, now known as Djibouti, Britain and Italy colonized areas further south, and still other regions were under the rule of neighboring Kenya and Ethiopia. In 1960, the Italian and British areas were united into an independent Somalia, and in 1977 Djibouti became a separate nation after receiving independence from France. The regions of Kenya and Ethiopia which contain large numbers of ethnic Somalis are sources of border disputes presently.

The anti-colonial, pro-Soviet civilian government formed at independence was toppled in a coup led by General Mohammed Siad Barre in 1969. While popular at first, Barre's regime became increasing oppressive and autocratic, leading to the birth of clan-based opposition militias. In 1988, full scale civil war broke out, leading to Barre's exile in 1991. However, up to the present, the clans have continued the bloody war amongst themselves, with no government being established. The continuous warfare, together with border clashes, has brought the Somali economy to near collapse. Mass starvation has ensued, and the level of inter-clan violence has become extreme, with rape and torture commonplace. An estimated 400,000 Somalis died during this period, and at least 45% of the population has been displaced by the fighting. Humanitarian relief forces from the U.N. and the U.S. attempted to intervene, but by Spring of 1994 all foreign troops had been withdrawn due to the instability.

Beginning in 1991, at least one million Somalis fled to the neighboring countries of Djibouti, Kenya, Ethiopia, Burundi and Yemen, adding to the already overwhelming populations of refugees in the Horn of Africa. While most remain in refugee camps, some numbers have been repatriated, and several thousand have been resettled to the U.S. and Europe. In particular, certain clan-based ethnic groups, the Benadir and the Barawans, have been selectively resettled en masse.

Language

Somali is the common language of Somalia, and since Islam is so widespread, Arabic is spoken by many Somalis. Additionally, educated Somalis are frequently conversant in Italian, English, and/or Russian, depending on their experiences with the former colonial powers. Some Somalis near Kenya can also speak Swahili.

Social Structure

While Islam and the Somali language unite all of Somalia, the societal structure is markedly fractionated by membership in patrilineal clans (descent through male lines). There are a few main clans, and multiple subclans, sometimes with geographical and even social class orientation. For example, the Benadir clan group is comprised mostly of merchants and artisans living in southern coastal areas. Another recently arrived group, the Barawans, lived in the Kismayu area, where they were predominantly fisherman and small-scale artisans like shoe cobblers. Much of the current strife in Somalia is centered around clan disputes, as allegiance to the clan far outweighs allegiance to a united Somalia.

Religion

Somalis almost universally can be categorized by their strong adherence to Islam, the Sunni sect in particular. Accordingly, the Islam religion shapes many aspects of Somali culture. For example, there is strict separation of the sexes, and women, including sometimes prepubescent girls, are expected to cover their bodies, including hair, when in public; facial veiling is uncommon in the U.S. However, women in Somali culture have considerable status, and many resettled refugee women are highly educated and held professional positions inside Somalia.

Handshakes are appropriate only between men or between women. The right hand is considered clean, and is used for eating, handshaking, and the like; children are taught early to use only their left hand for hygiene during toilet training. Even in the U.S., Muslims prefer to wash with poured water after a bowel movement. Ritual cleaning of the body, especially before prayers, is dictated by Islam.

Devout Muslims pray five times a day to Allah; in reality, schedules in the U.S. do not always permit this. The most important holidays include Ramadan, where adherents fast from sunrise to sunset (pregnant women, the infirm, and children are typically exempt), and Eid, a social celebration which marks the end of the fast. Many religious holidays and events are marked by the ritualized sacrifice of a goat or lamb; sometimes resettled Somalis arrange for this practice through rural farmers. Islam particularly proscribes the consumption of alcohol and pork.

Birthdays are not particularly celebrated by Somalis, and it is not uncommon for people to not know the exact date of their birth. At the time of immigration, birthdays are typically rounded off to the nearest year, e.g. 1-1-98, 12-31-62, etc. Alternatively, the anniversary of family members' deaths are observed and celebrated.

When death is imminent, a Muslim cleric, a sheik, is summoned to pray for the person's soul and recite special versus from the Koran. After death, the body is ritually cleansed and clad in white clothes for burial.

Please see Religions for further discussion of Islam.

Traditional Medical Practices

There are traditional medical practitioners in Somalia, especially herbalists, bone-setters and religious practitioners. Herbal medicines are widely used in Somalia, especially for chest and abdominal symptoms; the herbal pharmacopeia is vast, and some recipes are closely guarded by practitioners. Healers treat psychosomatic disorders, sexually transmitted diseases, respiratory and digestive diseases, and snake and other reptile bites.

Another common practice is termed "fire-burning," where a special stick is burned and then applied to the skin. Concepts involving spirits, such as "evil-eye," where excessive praise or attention can attract evil spirits to a infant or child, can be viewed as causing illness. Ritualized dancing is used mostly for psychosomatic disorders, and Koranic cures as well. There is understanding about the communicability of some diseases, such as tuberculosis and leprosy, and isolation is sometimes performed.

Prenatal, Childbearing and the Postpartum Period

Somali families are typically large; seven or eight children is considered ideal. Contraception, and similarly, abortion, are anathema to most Somalis, given the strong Muslim belief that pregnancy is a blessing from God and should not be interfered with. Even sexing of the fetus is not encouraged, as it is God's will and cannot be changed. Prenatal care is sought by refugee Somali women here, although there is a marked preference for female examiners. Most women fear Caesarean section delivery, the perceived method of choice for American women, as it is thought that the surgery may impede subsequent pregnancies and render to postpartum mother infirm. Alternatively, many women are concerned that episiotomies or even natural childbirth could damage the infibulation (see below) and must be repaired.

There is a culturally-sanctioned 40 day abstinence period, "afatanbah," in the postpartum, when the mother remains in her household and is assisted by female relatives and neighbors. Amulets made from garlic can be worn by the mother and newborn to ward off evil spirits during this period, and incense is burned for the same purpose. There is traditionally a naming ceremony during this period, but hospital procedures requiring birth certificates have changed this practice.

Breast-feeding is the norm, in Somalia and in the refugee community here, sometimes for two years or longer. However, early supplementation with animal milks in Somalia or formula in the U.S. is not uncommon, and at least some women believe erroneously that colostrum is not healthy for the newborn. Infant care includes massages and warm water baths. Traditionally, an herb called malmal mixed into a poultice is applied to the umbilicus for a week or so; some researches report the availability of this herb in the U.S.

Women's Health Issues

Similarly, the common practice of female genital cutting (FGC) is certain to create controversy here in the U.S. An estimated 98% of Somali girls 8-10 years of age undergo FGC, usually Type III (or infibulation), which consists of the removal of the clitoris, the adjacent labia (majora and minora), followed by the pulling of the scraped sides of the vulva across the vagina. The sides are then secured with thorns or sewn with catgut or thread. A small opening to allow passage of urine and menstrual fluid is left. An infibulated woman must be cut open to allow for intercourse on her wedding night, and the opening may then be closed again afterwards to secure fidelity to her husband."female circumcision," where the clitoris and part of the labia is excised, ostensibly to keep women pure and chaste. Web sites concerned with the issue include http://www.fgm.org/ and http://rainbo.org. For a more extensive discussion and current classification of FGC, readers are also referred to the section on Refugee Women in this site.

Resettled refugees are warned of the illegality of this practice in the U.S., and Somali caseworkers here are quite emphatic that it is not being performed here. I have heard, however, some discussion that some girls would in the future be sent to Somalia for the procedure.

Benadir Refugees

Somalian refugees from the Benadir ethnic group have recently been resettled to the U.S. in large numbers, and a detailed discussion of this particular group follows.

The Benadirs are a Somali ethnic group from the Benadir region of Somalia: the southern coastal region including Mogadishu. Unlike most Somalis, who are nomadic, the Benadir have a long history as urbanized merchants and artisans. The Benadir exhibit strong clan allegiance, through intramarriage and self-governance. They are devout Sunni Moslems, and are well known for their peace-loving, non-violent ways. For all these reasons, the Benadirs consider themselves a different, elite, class from other Somalis; consequently, they have been the targets of jealousy and animosity for centuries.

When massive internecine warfare erupted in 1990, the unarmed and non-aligned Benadir were caught in the middle. They suffered greatly at the hands of the other Somali clans: homes and businesses were destroyed, women were raped in front of male relatives, and countless were slaughtered. Those that could fled Somalia, for Kenya, Ethiopia and Yemen, and many died on the high seas during flight. Because of their vulnerability, even among other Somali refugees, the U.N. established a separate Benadir refugee camp, Swaleh Nguru, in Kenya.

With the camp population exploding (approximately 22,000 in 1996), health conditions deteriorating, their homes and livelihoods destroyed, and the likelihood that they could never repatriate to Somalia without persecution, resettlement overseas became the only durable solution for the Benadir plight. Since Spring of 1996, about 3,000 Benadir refugees have been resettled in about 20 sites throughout the U.S. Of these thousands, there are about a dozen major clans and many more subclans; family name usually corresponds to clan membership. The elder clan leaders serve as the cornerstone of Benadir society and should be included in all decisions surrounding Benadir resettlement.

Benadir refugees on the whole possess cultural characteristics that may complicate their resettlement experiences. Chiefly, they may be reluctant to be resettled in larger Somali communities, especially since persecuting clans may be represented. In our experience in Dallas, we have seen several different organizations coming forward claiming to be the representatives of the Somalian community. Similarly, clan allegiance is so entrenched that secondary migration from the resettlement site frequently occurs. Likewise, many Somali refugees claimed fictitious family relations, such as disguising second wives as sisters or daughters, or even convenience marriages, when it was perceived to improve their acceptance for resettlement. Many of these artificial families immediately scatter to other areas to rejoin clan members upon arrival. Furthermore, there will inevitably be frustration over the downward economic mobility Benadirs will initially face in starting over in the U.S. workforce.

Somali families are particularly large, sometimes ten or more individuals; housing laws in the U.S. will require these large extended families to divide into two or more apartments. And finally, Muslim proscriptions governing the interaction between the sexes will lead many Somali women to prefer female interpreters and health care providers.

Health Risks in Refugees from East Africa (Also see the Infectious Diseases web site for updates and details)

  • Malnutrition
  • Intestinal parasites (Enterobius, Trichuris, Strongyloides, and Ascaris)
  • Filariasis
  • Leishmaniasis
  • Hepatitis B
  • Tuberculosis
  • Low immunization rate
  • Dental caries
  • Typhoid fever
  • Malaria
  • Trachoma
  • Syphilis
  • Dengue fever
  • HIV infection
  • Diarrheal illnesses
  • Hansen's disease

Recommended Laboratory and Other Tests for Refugees from East Africa

  • Nutritional assessment
  • Stool for ova and parasites
  • Hepatitis B surface antigen
  • Hemoglobin or hematocrit
  • VDRL
  • HIV
  • PPD
  • Peripheral smear for malaria should be considered

Other problems that practitioners should be especially alert to are cervical cancer, ectoparasites, and post-traumatic stress disorder.

There were reports of malaria and a measles outbreak in the refugee camps in Kenya, but treatment was initiated before resettlement. Another concern for the resettlement providers is the common practice of corporal punishment of children, and less frequently, wives. Careful counseling in orientation must be provided to explain the legal ramifications and definitions of abuse in this country.

Author: Lance A. Rasbridge, Ph.D.

Thanks to Mohammed Farah and other anonymous reviewers from the Somali community.

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References

Ackerman, L. K. (1997). Health problems of refugees. Journal of the American Board of Family Practice, 10(5), 337-348.

Gavagan, T. & Brodyaga, L. (1998). Medical Care for immigrants and refugees. American Family Physician, 57(5), 1061-1068.

Lewis, T. (1996). Somali Cultural Profile. Seattle: Ethnomed Web Site.

Mypist, E. (1995). Notes on Benadir Refugees. Mombasa: United Nations High Commissioner for Refugees.

Putman, D.B., and Noor, M.C. (1993). The Somalis: Their History and Culture. Washington: The Refugee Service Center, Center for Applied Linguistics.

United States Catholic Conference 1996 Benadir Refugees from Somalia. Washington: Refugee Information Series, Migration and Refugee Services.