For many families in the remote areas of Somaliland, the simple act of getting a child vaccinated was once an overwhelming challenge. Imagine facing a journey of over 20 miles on foot, leaving your livelihood behind, all to access a facility with the basic equipment to keep vaccines effective. This was the reality for Fatima, a mother from the rural community of Ismael Hussein in Somaliland’s Burao District, and countless others like her. Previously, their local clinic lacked the essential refrigeration needed to store routine vaccines safely. This meant that every immunization required a significant sacrifice: time away from crucial livestock care, exposure to harsh weather, and the inherent risks of travel in a region often affected by instability. Such obstacles made consistent vaccination nearly impossible, leaving children vulnerable to preventable diseases and perpetuating a cycle of health insecurity. ## The Critical Role of Vaccine Cold Chain Vaccines are highly sensitive biological products, and their effectiveness hinges on strict temperature control from the moment they are manufactured until they are administered. This continuous management of temperature is known as the ‘cold chain.’ Most routine vaccines must be kept within a narrow range, typically between 36°F and 46°F (2°C and 8°C). If they become too warm, or in some cases too cold, their potency can diminish, rendering them ineffective in protecting against disease. This is why reliable refrigeration, like specialized vaccine refrigerators, is not a luxury but a fundamental necessity for any functional immunization program. In environments like rural Somaliland, where electricity can be unreliable or non-existent, maintaining this cold chain presents a significant logistical hurdle. Clinics without proper storage are forced to refer patients to distant facilities, creating the very access barriers that Fatima and her community experienced. Addressing this gap is paramount to ensuring that every child receives a potent, life-saving dose. ## Understanding the Vaccination Gap in Somaliland Somaliland, an autonomous region of Somalia, has historically grappled with some of the world's lowest vaccination rates. For decades, routine immunization coverage across Somalia remained below 50 percent, meaning that less than half of the population received protection against a wide array of preventable illnesses. This alarming statistic is a direct consequence of a complex interplay of factors, including prolonged conflict, widespread displacement of populations, severely damaged healthcare infrastructure, and a chronic lack of access to essential medical supplies and vaccines. According to data from 2019, a staggering 1.5 million Somali children under the age of five had never received a single vaccination. This represents an enormous population at risk, not only individually but also for their communities, as unvaccinated populations create fertile ground for infectious diseases to spread rapidly. The implications of such low coverage are profound, leading to avoidable suffering and deaths. ## The Threat of Measles and Other Preventable Diseases One of the most immediate and devastating consequences of low vaccination coverage is the resurgence of vaccine-preventable diseases, with measles being a prime example. Measles is a highly contagious viral infection that can lead to severe complications, including pneumonia, encephalitis (brain swelling), and even death. It spreads easily through airborne droplets when an infected person coughs or sneezes. The disease can be particularly dangerous for young children and those with compromised immune systems. Tragically, these risks became a harsh reality in Somaliland. By mid-June 2026, the Ministry of Health had recorded over 1,600 cases of measles in Somaliland, resulting in at least eight deaths. This outbreak starkly underscored the critical need for timely and widespread access to routine immunization. Each missed vaccine dose represents a missed opportunity to save a life and protect an entire community from the ripple effects of an epidemic. The incident highlighted how easily these diseases can return when vaccination efforts falter. ## A Collaborative Effort Brings Solutions Closer The tide began to turn through a collaborative initiative involving CARE International, Luxembourg Aid & Development, and the Somaliland Ministry of Health. Together, they focused on strengthening local health infrastructure, specifically at the Ismael Hussein Health Facility. This partnership brought in new, robust, solar-powered refrigerators and essential cold-chain equipment directly to the community. These specialized units, capable of holding about 70 liters of vaccines and equipped with separate storage for ice packs, are powered entirely by solar energy – a sustainable and reliable solution in areas without consistent electricity. An external digital display allows health workers to monitor temperatures meticulously, guaranteeing that vaccines remain safely preserved and ready for use. Furthermore, healthcare professionals at the clinic received crucial training to enhance their skills in vaccine management and to bolster their capacity for rapid response during disease outbreaks. This comprehensive approach ensured that both the equipment and the human expertise were in place to make a lasting difference. ## Transformative Impact on Families and Communities For Fatima, the transformation is deeply personal and practical. Where once she faced a long day’s journey, she now needs to walk merely half a mile to vaccinate her child. “Now the vaccine is here, the nurse is ready, and I can return home the same day,” she recounts with a sense of immense relief. This newfound proximity to healthcare eliminates the impossible choice between her livelihood and her children’s well-being, bringing peace of mind to her family and many others. Between May and July 2026, the Ismael Hussein facility administered over 2,600 vaccine doses, including a significant 1,395 measles vaccinations. The availability of other routine immunizations – protecting against diseases like polio, diphtheria, tetanus, whooping cough, hepatitis B, and Haemophilus influenzae type b (Hib) – has reinforced community trust. Health workers diligently record vaccinations, monitoring schedules and reminding parents about follow-up doses. This proactive engagement encourages higher compliance, ensuring children receive full protection and contributing to the overall health and safety of the wider community. ## Strengthening Outbreak Preparedness and Broader Health Initiatives The investment in cold chain infrastructure proved invaluable during the recent measles outbreak in Burao. With vaccines readily available and trained staff on hand, the health facility could react swiftly, protecting children and containing the spread of the disease before it escalated further. This proactive capability is a cornerstone of resilient public health systems, demonstrating what is achievable when local facilities are adequately resourced. Beyond these local improvements, wider initiatives like ‘The Big Catch-Up,’ launched in 2022 by the Federal Ministry of Health and Human Services in collaboration with UNICEF and WHO, are making significant strides. By July 2025, this initiative had contributed to a 28 percent increase in fully vaccinated Somali children, showcasing the powerful impact of coordinated, high-level efforts complementing grassroots improvements. These combined strategies are crucial for addressing the historical vaccination deficits and building long-term immunity across the population. ## A Healthier, More Resilient Future As Ummy Dubow, CARE Somalia Country Director, emphasizes, this project extends far beyond the provision of refrigerators and vaccines. It embodies a commitment to ensuring that children in remote communities in Somaliland have the same fundamental opportunity to grow up healthy as any other child, anywhere in the world. By strengthening local health services and bringing essential care closer to families, these efforts are not just addressing immediate health needs but are actively helping communities construct a healthier and more resilient future. The solar-powered blue box in the Ismael Hussein clinic symbolizes hope and progress. It represents the collective power of partnerships, the dedication of health workers, and the resilience of communities striving for better health outcomes. For Fatima and her neighbors, it signifies a profound change – a future where protecting their children’s health is no longer an insurmountable burden but a readily accessible right, fostering peace of mind and unlocking their potential for a healthier, more secure life. ## Looking Ahead: Sustainable Health Systems The ongoing work in Somaliland is a testament to the importance of sustainable health system strengthening. It highlights that providing equipment is just one part of the solution; training health workers, establishing robust monitoring systems, and fostering community trust are equally vital. These interconnected components create a resilient health infrastructure capable of delivering routine services and responding effectively to emergencies. As global health organizations continue to support local ministries, the focus remains on building self-sufficient systems that can withstand future challenges and ensure equitable access to health services for all, particularly the most vulnerable children in remote areas.