The country's political and economic landscape has experienced incremental changes in recent years but its basic features as a country without state remain largely unchanged. Much of the south, exemplified by Mogadishu, continues to be characterised by the chronic symptoms of complex emergencies with no authoritative government, high levels of criminality, sporadic armed conflict, lack of economic recovery, endemic humanitarian needs in nutrition and food security, basic health and education and population displacement. With immunisation levels of only about 30 percent, measles continue to result in many deaths during outbreaks. Somalia remains among countries with the highest incidence of tuberculosis in the world and cholera is endemic in most areas.
Malnutrition is a chronic problem in all areas.
Poor availability and accessibility to food, mainly due to successive droughts and conflict, poor diet and harmful feeding practices contribute to the poor nutritional status of children, in particular in the Central and Southern zones. Maternal mortality rate is among the highest in the world. Only about 20 percent of the population have access to and are using safe water and 30 percent are using sanitation facilities. 65 percent of the permanent water sources are not functioning. Three quarters of mothers report not using soap for hand washing.