Time Zone: +3 hours. No daylight saving time in 2008.
Tel. Country Code: 252
USADirect Tel.: 0
Electrical Standards: Electrical current is 220/50 (volts/hz). European Style Adaptor Plug. Grounding Adaptor Plug D.
Travel Advisory - Somalia
Sub-Saharan Africa has the highest incidence of insect-transmitted diseases, such as malaria, and all travelers need products to prevent mosquito and tick bites. I recommend all travelers use a combination of DEET or Picaridin repellent on their skin and Permethrin fabric insecticide on their clothing for greater than 99% protection against mosquito and tick bites.
Dr. Rose Recommends for Travel to Somalia
• There is no U.S. Embassy in Somalia. U.S. citizens who plan to enter Somalia despite the Travel Warning are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department• s travel registration web site and to obtain updated information on travel and security within Somalia. Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate. Travelers to Somaliland should register with the U.S. Embassy in Djibouti, and travelers to Puntland or southern Somalia should register with the U.S. Embassy in Nairobi.
The U.S. Embassy in Djibouti is located at Plateau du Serpent, Boulevard Marechal Joffre, Djibouti City; telephone  35-39-95. The after-hours telephone number is  35-13-43.
The U.S. Embassy in Nairobi is located on United Nations Avenue, Gigiri, Nairobi, Kenya; telephone ( (20) 363-6000; fax (254)(20) 363-6410. In the event of an after-hours emergency, the Embassy duty officer is available at  (20) 363-6170.
• There is no Canadian representation in Somalia. Coverage of Somaliland is provided by the Canadian Embassy in Nairobi, Kenya:
Canadian High Commission
Tel:  (20) 366 3000
Fax:  (20) 366 3900
• There is no British representation in Somalia. Coverage of Somaliland is provided by the British Embassy in Addis Ababa, Ethiopia:
Tel:  (11) 661-23-54
Fax:  11 661-05-88
HIV Test: Not required.
Required Vaccinations: A yellow fever vaccination certificate is required from all travelers arriving from infected areas.
Passport/Visa: Since the collapse of the central government in 1991, Somalia has been subject to widespread violence and instability. A Transitional Federal Government (TFG) was established in 2004 to guide the country through a transitional process designed to - result in a new constitution and elections in 2009. However, the TFG lacks governance capacity and exercises only limited control of Mogadishu and parts of southern and central Somalia. General insecurity and inter- and intra-clan violence frequently occur throughout the country, and attacks and fighting between anti-government elements and TFG and Ethiopian forces take place regularly in Mogadishu. The United States has no official representation in Somalia.
In 1991, the northwest part of the country proclaimed itself the Republic of Somaliland, and it now has its own regional governing authority; however, Somaliland has not received international recognition as an independent state. The northeastern section of Somalia, known as the semi-autonomous region of Puntland, has also made efforts to establish a regional governing authority. The economy was seriously damaged by the civil war and its aftermath, but the private sector is trying to reemerge. Tourist facilities are non-existent.
ENTRY/EXIT REQUIREMENTS: A passport is required for travel to Somaliland and Puntland. Both regions require a visa and issue their own at their respective ports of entry. For travel to other parts of Somalia, including Mogadishu, a passport is required; however, there is no established governing authority capable of issuing a universally recognized visa. Air and seaports are under the control of local authorities that make varying determinations of what is required of travelers who attempt to use these ports of entry.
Travelers may obtain the latest information on visas as well as any additional details regarding entry requirements from the Permanent Representative of the Somali Republic to the United Nations, telephone  (212) 688-9410/5046; fax (212) 759-0651, located at 425 East 61st Street, Suite 702, New York, NY 10021. Persons outside the United States may attempt to contact the nearest Somali embassy or consulate. All such establishments, where they exist, are affiliated with the TFG, whose authority is not established throughout Somalia.
Vaccinations: Recommended and Routine
Hepatitis A: Recommended for all travelers >1 year of age not previously immunized against hepatitis A.
Hepatitis B: Recommended for all non-immune travelers at potential risk for acquiring this infection. Hepatitis B is transmitted via infected blood or bodily fluids. Travelers may be exposed by needle sharing and unprotected sex; from acupuncture, tattooing or body piercing; when receiving non-sterile medical or dental injections, or unscreened blood transfusions; by direct contact with open skin sores on an infected person. Recommended for long-term travelers, expatriates, and any traveler requesting protection against hepatitis B infection.
Influenza: Vaccination recommended for all travelers >6 months of age who have not received a flu shot in the previous 12 months.
Meningococcal (Meningitis): Quadrivalent meningitis vaccine is recommended for those travelers anticipating living or working with local people, or if a current outbreak is reported. The risk is greatest in the dry season, but these may vary within a country and from year to year.
Polio: A one-time dose of IPV vaccine is recommended for any traveler >age 18 who completed the primary childhood series but never received an additional dose of polio vaccine as an adult. Available data do not indicate the need for more than a single lifetime booster dose with IPV (Inactivated Polio Vaccine).
Rabies: Rabies vaccine is recommended for: persons anticipating an extended stay; for those whose work or activities may bring them into contact with animals; for people going to rural or remote locations where medical care is not readily available; for travelers desiring extra protection.
Routine Immunizations: Immunizations against tetanus-diphtheria, measles, mumps, rubella (MMR vaccine) and varicella (chickenpox) should be updated, if necessary, before departure. MMR protection is especially important for any female of childbearing age who may become pregnant.
• In addition to tetanus, all travelers, including adults, should be fully immunized against diphtheria. A booster dose of a diphtheria-containing vaccine (Td or Tdap vaccine) should be given to those who have not received a dose within the previous 10 years.
Note: ADACEL and Boostrix are new tetanus-diphtheria-pertussis (Tdap) vaccines that not only boost immunity against diphtheria and tetanus, but have the advantage of also protecting against pertussis (whooping cough), a serious disease in adults as well as children. The Tdap vaccines can be administered in place of the Td vaccine when a booster is indicated.
Typhoid: Recommended for all travelers.
Yellow Fever: Yellow fever vaccine is required for all travelers >1 year of age arriving from countries with risk of yellow fever transmission including transit through such countries. The international yellow fever vaccination certificate becomes valid 10 days after vaccination and remains valid for a period of 10 years.
Hospitals / Doctors
All travelers should be up-to-date on their immunizations and are advised to carry a medical kit as well as antibiotics to treat travelers diarrhea or other infections; they should bring drugs for malaria prophylaxis, if needed according to their itinerary. Travelers who are taking regular medications should carry them properly labeled and in sufficient quantity to last for the duration of their trip; they should not expect to obtain prescription or over-the-counter drugs in local stores or pharmacies in this country - the equivalent drugs may not be available or may be of unreliable quality.
• Travelers are advised to obtain comprehensive travel insurance with specific overseas coverage. Policies should cover: ground and air ambulance transport, including evacuation to home country; payment of hospital bills; 24-hour telephone assistance. In the event of a serious illness or injury that can't be treated adequately in this country, the traveler should be flown by air ambulance to Nairobi, Kenya or Europe.
• The local medical facilities are inadequate. The State Department that you be evacuated to Nairobi, Kenya, in lieu of using Somali hospitals.
Destination Health Info for Travelers
A Country Profile: Somalia, a nation of 10 million people located on the strategically important Horn of Africa, fractured badly in the wake of a 1990 coup. The ensuing civil war created a humanitarian crisis as various warlords and their clan-based militia struggled for control of the country and the capital city of Mogadishu. Despite the establishment of a transitional government in 2004, the country continues to face civil strife with the emergence of struggles with Islamists from the south, who have seized control in towns and cities.
HIV/AIDS has not yet become a major crisis for Somalia, as UNAIDS estimated that in 2001 only one percent of Somali adults were HIV-positive. Malaria is endemic year-round throughout Somalia, and resistance to chloroquine and sulfadoxine-pyrimethamine has been reported to WHO. The malaria death rate in Somalia is 373 per 100,000 for children under five, and 81 per 100,000 for all ages. The tuberculosis death rate is substantially higher than in most of sub-Saharan Africa at 117 per 100,000 for all ages. (Source: researchafrica.rti.org)
Doctors Without Borders/Medecins Sans Frontieres (MSF) runs a humanitarian relief operation in this country.
MSF website: http://www.doctorswithoutborders.org/news/country.cfm?id=2267
AIDS/HIV: Both HIV prevalence rates and the numbers of people dying from AIDS vary greatly between African countries. In Somalia and Senegal the HIV prevalence is under 1% of the adult population, whereas in South Africa and Zambia around 15-20% of adults are infected with HIV. Most experts agree that the majority of HIV infections in Africa are the result of heterosexual transmission. Other sources of HIV include unscreened blood transfusions and contaminated needles and syringes. (Source: www.Avert.org)
• The threat of HIV/AIDS should not be a primary concern for the traveler. However, there may be a concern for a subset of travelers who may be exposed to HIV, the virus that causes AIDS, through contact with another person’s body fluids or blood. Although travel has contributed in a general way to the global spread of AIDS, fear of traveling because of this disease is not warranted.
• Transmission of HIV can be prevented by avoiding: sexual contact with a high-risk partner; injecting drug use with shared needles; non-sterile medical injections; unscreened blood transfusions.
Accidents & Medical Insurance: Accidents and injuries are the leading cause of death among travelers under the age of 55 and are most often caused by motor vehicle and motorcycle crashes; drownings, aircraft crashes, homicides, and burns are lesser causes.
• Heart attacks cause most fatalities in older travelers.
• Infections cause only 1% of fatalities in overseas travelers, but, overall, infections are the most common cause of travel-related illness.
• MEDICAL INSURANCE: Travelers are advised to obtain, prior to departure, supplemental travel health insurance with specific overseas coverage. The policy should provide for direct payment to the overseas hospital and/or physician at the time of service and include a medical evacuation benefit. The policy should also provide 24-hour hotline access to a multilingual assistance center that can help arrange and monitor delivery of medical care and determine if medevac or air ambulance services are required.
Animal/Marine Hazards: Snakes (vipers, cobras, black mambas, puff adders) are primarily found in the large arid regions of this country. Other animal hazards include centipedes, scorpions, and black widow spiders. Sea cones, sea urchins, and anemones inhabit the shallow coastal waters of Somalia and may pose a threat to swimmers.
Chikungunya Fever: This is a mosquito-transmitted viral illness that occurs in much of sub-Saharan Africa and is the cause of numerous epidemics. Symptoms include fever, headache, fatigue, nausea, vomiting, muscle pain, rash, and joint pain. Acute Chikungunya fever typically lasts a few days to several weeks, but as with dengue, West Nile fever, Onyong-nyong fever and other arboviral fevers, some patients have prolonged fatigue lasting several weeks. No deaths related to chikungunya infection have been conclusively documented in the scientific literature.
• To prevent this disease, and other arboviral illnesses, travelers should take measures to prevent mosquito bites. Insect-bite prevention measures include applying a DEET-containing repellent to exposed skin, applying permethrin spray or solution to clothing and gear, and sleeping under a permethrin-treated bednet.
Cholera: An outbreak was reported in March 2008 from southern Somalia, close to the Kenyan border town of Mandera, and a major cholera outbreak was also reported in February 2007, initially affecting the central Hiraan area, killing more than 100 people. Although this disease is reported to be active, the threat to tourists is relatively low. Cholera is an rare disease in travelers from developed countries. Cholera vaccine is usually recommended only for relief workers or health care personnel who are working in a high-risk endemic area under less than adequate sanitary conditions, or travelers who work or live in remote, endemic or epidemic areas and who do not have ready access to medical care. Canada, Australia, and countries in the European Union license an oral cholera vaccine. The cholera vaccine is not available in the United States.
• The main symptom of more severe cholera is copious watery diarrhea.
• Antibiotic therapy is a useful adjunct to fluid replacement in the treatment of cholera by substantially reducing the duration and volume of diarrhea and thereby lessening fluid requirements and shortening the duration of hospitalization.
• A single 1-gm oral dose of azithromycin is effective treatment for severe cholera in adults. This drug is also effective for treating cholera in children. (NEJM:http://content.nejm.org/cgi/content/short/354/23/2452)
Dengue Fever: Moderate risk of dengue exists in this country. Dengue fever is a mosquito-transmitted, flu-like viral illness widespread many countries in sub-Saharan Africa. Symptoms consist of sudden onset of fever, headache, muscle aches, and a rash. A syndrome of hemorrhagic shock can occur in severe cases.
• Dengue is transmitted via the bite of an infected Aedes aegypti mosquito. Aedes mosquitoes feed predominantly during daylight hours. All travelers are at risk and should take measures to prevent daytime mosquito bites. Insect-bite prevention measures include applying a DEET-containing repellent to exposed skin and applying permethrin spray or solution to clothing and gear. There is no vaccination or medication to prevent or treat dengue.
• A dengue fever map is at: http://www.nathnac.org/ds/c_pages/documents/dengue_map.pdf
Hepatitis: All travelers not previously immunized against hepatitis A should be vaccinated against this disease. Travelers who are non-immune to hepatitis A (i.e. have never had the disease and have not been vaccinated) should take particular care to avoid potentially contaminated food and water. Travelers who will have access to safe food and water are at lower risk. Those at higher risk include travelers visiting friends and relatives, long-term travelers, and those visiting areas of poor sanitation.
• Hepatitis E is prevalent in Somalia with a seroprevalence of >60% in the population and is a major cause of acute sporadic hepatitis in this country. Hepatitis E outbreaks have been reported in refugee camps, as well, and is a hazard to health care and relief workers. Transmission of the hepatitis E virus (HEV) occurs primarily through drinking water contaminated by sewage and also through raw or uncooked shellfish. In developing countries, prevention of hepatitis E relies primarily on the provision of clean water supplies and overall improved sanitation and hygiene. There is no vaccine.
• Hepatitis B is hyperendemic. The overall hepatitis B carrier rate in the general population is estimated as high as 19%. Hepatitis B is transmitted via infected blood or bodily fluids. Travelers may be exposed by needle sharing and unprotected sex; from non-sterile medical or dental injections, and acupuncture; from unscreened blood transfusions; by direct contact with open skin lesions of an infected person. The average traveler is at low risk for acquiring this infection. Vaccination against hepatitis B is recommended for: persons having casual/unprotected sex with new partners; sexual tourists; injecting drug users; long-term visitors; expatriates, and anybody wanting increased protection against the hepatitis B virus.
• Hepatitis C is endemic, with a prevalence of 0.9% of the general population carriers of the hepatitis C antibody. Most hepatitis C virus (HCV) is spread either through intravenous drug use or, in lesser-developed countries, through blood contamination during medical procedures. Over 200 million people around the world are infected with hepatitis C - an overall incidence of around 3.3% of the population of the world. Statistically, as many people are infected with HCV as are with HIV, the virus that causes AIDS.
Leishmaniasis: A hyperendemic focus of visceral leishmaniasis (kala-azar) persists along the Shabeelle River in the Giohar District in southern Somalia. Cutaneous leishmaniasis has not been reported but may occur in southern Somalia near the borders with Kenya and Ethiopia.
• The parasites that cause leishmaniasis are transmitted by the bite of the female phlebotomine sandfly. Sandflies bite mostly in the evening and at night. They breed in ubiquitous places: in organically rich, moist soils (such as found in the floors of rain forests), animal burrows, termite hills, and the cracks and crevices in stone or mud walls, and earthen floors, of human dwellings.
• All travelers should take measures to prevent sandfly bites. Insect-bite prevention measures include applying a DEET-containing repellent to exposed skin, permethrin (spray or solution) to clothing and gear, and sleeping under a permethrin-treated bednet.
Malaria: Risk is present year-round throughout this country, including urban areas. Risk of
transmission is highest in July and December, after the semiannual rains. The risk of malaria is greater in the south, particularly along the Shabeelle and Juba River valleys. There is limited malaria risk in the city center of Mogadishu. Falciparum malaria accounts for 95% of cases countrywide, but in 106 U.S. marines returning from Somalia in 1993 P. vivax accounted for 87% of cases.
Prophylaxis with atovaquone/proguanil (Malarone), mefloquine (Lariam), doxycycline, or primaquine (G6-PD test required) is currently recommended.
A malaria map is located on the Fit for Travel website, which is compiled and maintained by experts from the Travel Health division at Health Protection Scotland (HPS). Go to www.fitfortravel.nhs.uk and select Malaria Map from the Somalia page on the Destinations menu or A-Z Menu.
Malaria is transmitted via the bite of an infected female Anopheles mosquito. Anopheles mosquitoes feed predominantly during the hours from dusk to dawn. All travelers should take measures to prevent evening and nighttime mosquito bites. Insect-bite prevention measures include applying a DEET-containing repellent to exposed skin, applying permethrin spray or solution to clothing and gear, and sleeping under a permethrin-treated bednet. DEET-based repellents have been the gold standard of protection under circumstances in which it is crucial to be protected against insect bites that may transmit disease. Nearly 100% protection can be achieved when DEET repellents are used in combination with permethrin-treated clothing.
NOTE: Picaridin repellents (20% formulation, such as Sawyer Picaridin or Natrapel 8-hour) are now recommended by the CDC and the World Health Organization as acceptable non-DEET alternatives to protect against malaria-transmitting mosquito bites. Picaridin is also effective and ticks and biting flies.
• You should consider the diagnosis of malaria if you develop an unexplained fever during or after being in this country.
• Long-term travelers who may not have access to medical care should bring along medications for emergency self-treatment should they develop symptoms suggestive of malaria, such as fever, chills, headaches, and muscle aches, and cannot obtain medical care within 24 hours.
Meningitis: Quadrivalent conjugate meningitis vaccine is recommended for those travelers anticipating living or working closely with local people. The risk is greatest in the dry season, from November to May/June. Vaccination should be considered for all travelers venturing into epidemic regions at any time of year.
Other Diseases/Hazards: African tick typhus
• African tick-bite fever
• Filariasis (occurs in southern Somalia, in the area between Kenya and the Indian Ocean)
• Histoplasmosis (common)
• Leptospirosis (high incidence)
• Q fever
• Rabies (transmitted primarily by dogs but also by foxes, cats, camels, donkeys, hyenas, badgers, and jackals)
• Tick-borne relapsing fever (endemic),
• Typhus (louse-borne; increased risk in those having contact with refugees)
• Murine typhus (flea-borne)
Poliomyelitis (Polio): Polio remains persistent in sub-Saharan Africa and is active in Somalia with 10 cases officially reported in 2007. The outbreak is most intense northeastern Somalia near the Ethiopian border, where 33 cases were reported in 2006.
• All travelers should be fully immunized. A one-time dose of IPV (Inactivated Polio Vaccine) is recommended for any traveler >age 18 who completed the primary childhood series but never received an additional dose of polio vaccine as an adult.
Rabies: Rabies is widespread, but the incidence is not clearly determined. Rabies is transmitted primarily by dogs, but also by foxes, cats, camels, donkeys, hyenas, badgers, and jackals.
Rabies vaccine is recommended for: persons anticipating an extended stay; for those whose work or activities may bring them into contact with animals; for people going to rural or remote locations where medical care is not readily available; for travelers desiring extra protection.
• Pre-exposure vaccination eliminates the need for rabies immune globulin, but does not eliminate the need for two additional booster doses of vaccine. Prompt medical evaluation and treatment of any animal bite is essential, regardless of vaccination status. Note: If adequate rabies treatment is not available locally, immediate medical evacuation is advised to a facility that can provide treatment.
Rift Valley Fever: From December 2006 to February 2007 a total of 114 cases of Rift Valley Fever, including 51 deaths, were reported in Somalia. Most cases occurred in Lower Juba and Gedo regions.
Rift Valley fever is a viral infection that affects both cattle and people. It is usually transmitted by mosquitoes, but may also be acquired by direct exposure to infected animals or by consumption of unpasteurized milk. Most cases occur in livestock workers. Symptoms include chills, fever, headache, muscle aches, nausea and vomiting. Most people recover uneventfully in about a week. Approximately 1% of patients die of the disease.
Further information: http://en.wikipedia.org/wiki/Rift_Valley_fever
Schistosomiasis: Year-round risk of urinary schistosomiasis, primarily in the valleys of the Giuba and Shabeelle Rivers in southern Somalia.
• Schistosomiasis is transmitted through exposure to contaminated water while wading, swimming, and bathing. Schistosoma larvae, released from infected freshwater snails, penetrate intact skin to establish infection. All travelers should avoid swimming, wading, or bathing in freshwater lakes, ponds, streams, cisterns, aqueducts, or irrigated areas. There is no risk in chlorinated swimming pools or in seawater.
Travelers' Diarrhea: High risk. Over 250 cases of acute watery diarrhea, including 11 deaths, have been reported from the Gedo Region since the end of January 2008. Outbreaks of watery diarrhea are widespread in this country. Most of these cases are probably due to cholera. All water supplies in this country are potentially contaminated and travelers should observe all food and drink safety precautions. Outside of hotels and resorts, we recommend that you boil, filter or purify all drinking water or drink only bottled water or other bottled beverages and do not use ice cubes. Avoid unpasteurized dairy products. Do not eat raw or undercooked food, especially meat and fish. Peel all fruits.
• Good hand hygiene reduces the incidence of travelers’ diarrhea by 30%.
• A quinolone antibiotic, or azithromycin, combined with loperamide (Imodium), is recommended for the treatment of diarrhea. Diarrhea not responding to antibiotic treatment may be due to a parasitic disease such as giardiasis, amebiasis, or cryptosporidiosis.
• Seek qualified medical care if you have bloody diarrhea and fever, severe abdominal pain, uncontrolled vomiting, or dehydration.
Tuberculosis (TB): Tuberculosis is highly endemic in Somalia with an annual occurrence was greater than or equal to 40 cases per 100,000 population. Tuberculosis (TB) is transmitted following inhalation of infectious respiratory droplets. Most travelers are at low risk. Travelers at higher risk include those who are visiting friends and relatives (particularly young children), long-term travelers, and those who have close contact, prolonged contact with the local population. There is no prophylactic drug to prevent TB. Travelers with significant exposure should have PPD skin testing done to evaluate their risk of infection.
Typhoid Fever: Typhoid fever is the most serious of the Salmonella infections. Typhoid vaccine is recommended by the CDC for all unvaccinated people traveling to or working in sub-Saharan Africa, especially if visiting smaller cities, villages, or rural areas and staying with friends or relatives where exposure might occur through food or water. Current vaccines against Salmonella typhi are only 50-80% protective and do not protect against Salmonella paratyphi, the cause of paratyphoid fever. (Paratyphoid fever bears similarities with typhoid fever, but the course is generally more benign.) Travelers should continue to practice strict food, water and personal hygiene precautions, even if vaccinated.
Yellow Fever: Travelers entering the country from areas with risk of yellow fever are required to present a certificate of immunization against yellow fever. Although yellow fever is not currently reported, vaccination is recommended for travelers >9 months of age.