Rebuilding nursing and midwifery in Somaliland Somaliland’s maternal, infant and child mortality rates are among the highest in the world. A rudimentary health system collapsed in the final years of the civil war which ended in 1991. Fighting forced the country’s health professionals to leave the country or flee to refugee camps. But since 2000, a small number of well-qualified, experienced nurses and midwives have returned to Somaliland determined to rebuild their professions. “What do you do when conflict has destroyed all your institutions and professional associations? That was the question which confronted us,” recalls Fouzia Ismail, director of the Somaliland Nursing and Midwifery Association (SLNMA), in a new publication from Africa Research Institute, Patience and Care: Rebuilding nursing and midwifery, in Somaliland. “It was difficult to know where to start”. The SLNMA’s inaugural meeting in 2004 was attended by just seven people. The association’s first task was to ascertain how many nurses and midwives there were in Somaliland. Since this inauspicious beginning, the SLNMA has played a leading role in developing five new nursing and midwifery curricula, revitalising regional nursing and midwifery schools, training a new generation of nurse tutors, and advocating for better regulation of health services in Somaliland. Fouzia is candid about the factors which have hampered the development of health services in Somaliland. Many are common to other post-conflict states in Africa, and elsewhere. She explains – clearly and concisely – the way in which obstacles have been overcome. Consensual decision-making, community and diaspora participation, and the selection of appropriate long-term international partners are among the features of the distinctive strategy being pursued in Somaliland. For Fouzia, the achievement of Somaliland’s social and economic goals is dependent on improving the health of the nation. “A minuscule health budget and some of the poorest health indicators in the world called for ingenuity, and a good deal of courage, on the part of those who have sought to drive improvements in health care in Somaliland,” said Edward Paice, director of Africa Research Institute, at the official launch of Patience and Care in London on December 6th 2011. Andy Leather, director of King’s College Hospital Centre for Global Health, concurs: “Global health has come alive, and a lot of it is to do with Somaliland and what has come out of it”. As part of an enduring partnership between King’s College Hospital in London, the Tropical Health and Education Trust (THET) and Somaliland, more than 100 British health professionals have undertaken teaching trips to the country since 2000. Leather is adamant that UK professionals gain more from this interaction than they give – and that healthier populations in the Horn of Africa and elsewhere are “in all our interests”.