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Somalia: the struggle to handle mass influx of wounded in conflict zones

31-03-2010 Feature

Coping with a massive influx of weapon-wounded patients is a challenge for a hospital anywhere in the world – staff must make difficult decisions as to who has first call on precious surgical time and resources. In Somalia, conditions are even more challenging as the health system has collapsed under the weight of a decade of civil war and there are only a few qualified doctors and functioning health facilities left in the country.


Galkayo, Puntland, Somalia. Group photo of 25 doctors and nurses from conflict zones in Central and Southern Somalia who particpated in the war surgery seminar. 
    " In an unstable and unsafe environment such as Somalia, medical staff in the few remaining hospitals is under a lot of pressure, " explains Valery Sasin, coordinating ICRC's medical activities in Somalia. When fighting breaks out, they have to deal with a massive influx of patients with very limited resources. You need to be thoroughly trained to be able to do your job as a surgeon in such harsh working conditions, adding to the stress and danger associated with a conflict zone . "

On 21 and 22 March, an ICRC medical team invited 25 Somali doctors to share experiences and improve their skills in wound management and situations of massive influx of weapon-wounded patients, including triage, in the Galkayo Medical Centre. The participating surgeons all came from war-torn areas of Southern and Central Somalia, as well as from Puntland. The ICRC in Somalia organizes such war surgery seminars in order to ensure that doctors operating in such harsh circumstances can improve their response to trauma casualties. The seminar has prepared the participants for practical war surgery training that will be organized by the ICRC in the coming months.

" The seminar was very useful to refresh my knowledge of war wounded management, " says Dr Taajir, head of surgery at Keysaney hospital in Mogadishu run by the Somali Red Crescent Society. " But it will also allow me to go back and train my staff at the hospital, multiplying the impact especially for young Somali doctors and nurses. "

 Recent fighting in Mogadishu brought nearly 1,000 wounded to area hospitals  

Somalia has been plagued by fighting for almost two decades now. Insecurity and violence continue to drive millions of people from their homes. During the recent upsurge in armed confrontations in Mogadishu, countless civilians have again paid the price. Since the beginning of 2010, the hospitals of Mogadishu alone treated almost 1,000 casualties of the conflict, mainly wounded by bullets, bomb blasts or shrapnel. Almost a third are either women or children under 15.

Galkayo, Puntland. War surgery seminar on the management of massive influxes of weapon-wounded patients in war-torn Somalia. 

" In war surgery it's very important to exchange experiences with colleagues: that's something we don't often have the opportunity to do whilst working in Mogadishu, " adds Dr Taajir.

" The philosophy behind the ICRC approach is based on the concept of appropriateness; what is appropriate in one context does not necessarily apply to another, and the key to success is to define the correct – appropriate – response to a given situation, " according to Valery Sasin. " Thus, success also depends on the exchange of surgical experience, as well as human resources and available technology. "

As part of its comprehensive health programme in Somalia, the ICRC supports 36 clinics run by the Somali Red Crescent Society (SRCS) and two hospitals in Mogadishu, one run by the SRCS and one community based. It provides these facilities with surgical equipment, medicines and training for doctors and nurses. The medical facilities and hospitals accept all patients, regardless of their clan and their religious or political background.

The ICRC has been providing hu manitarian aid to the people of Somalia since 1978, working in close cooperation with the Somali Red Crescent Society.