Somalia, where medics risk their lives to help
As the conflict in Somalia worsens, medical services are facing growing difficulties. Despite risk to life and limb, ICRC-supported doctors and nurses continue to treat the wounded from all sides. Dr Valery Sasin is the ICRC's surgeon and medical coordinator for Somalia.
We're seeing the fighting there intensify, with hospitals struggling to deal with the growing influx of wounded. For the past 14 months, staff in the two ICRC-supported hospitals in Mogadishu have seen only the occasional lull in the fighting. They're working non-stop, in fact most of them are literally living in the hospital. They're tired, but they go on treating the wounded and the sick, and they do this whatever clan, political camp, religion or armed group the patient belongs to.
So they are neutral and impartial in their work. Is their status respected by the warring parties?
Yes, generally speaking. In Mogadishu, for example, people know which areas are controlled by which groups, and if possible the wounded are taken to a hospital in a zone controlled by the group to which he belongs. But it does happen that a case is so urgent that the victim is taken to a hospital in an enemy-controlled area. So far, this has never been a problem – no patient has been threatened or removed by force from a hospital.
Likewise, ambulances are usually spared by the fighters. They generally come and go in the various neighbourhoods without being shot at. This shouldn't be taken for granted since you can easily guess which group the victim belongs to by the direction in which the ambulance is headed.
Medical personnel aren't targeted. Good. But are there other dangers?
Of course. Medical personnel work right on the front line collecting the wounded, and anyway there is shelling almost daily. Also, a lot of indiscriminate weapons are used. Last December, a bomb went off at a ceremony to award medical degrees. The target was political figures attending, but over 20 people were killed and at least 60 injured. The victims included doctors, teaching staff and students who were graduating that day . And in the past year in Mogadishu, both Martini hospital and Keysaney hospital have been shelled.
An ambulance driver was killed a few months ago. The group that fired on his vehicle hadn't seen the red crescent. They later apologized. Even if this killing wasn't deliberate, it illustrates the danger that faces medical personnel day-in day-out.
What is the ICRC doing to support medical care in Somalia?
We provide medicines and other supplies to 36 clinics run by the Somali Red Crescent Society as well as the two referral hospitals in Mogadishu, one of which is publicly funded and the other administered by the Somali Red Crescent. Most of our aid consists of items needed to care for war-wounded people, and they account for 75% of the patients. We also help train medical staff and support the fight against widespread diseases such as diabetes and malaria.
In 2009, these 36 clinics and two hospitals gave more than 500,000 consultations and administered 70,000 vaccinations. The hospitals treated over 5,000 victims of war wounds, as I said before without regard to clan, religious or political affiliation. In the first half of 2010, they've treated about 3,000 wounded people, a third of them women and children.
Who is in charge of training doctors and nurses in Somalia?
Banadir University is still training doctors, but the problem is that there aren't enough of them. In the Puntland region, for example, there are seven doctors for every 100,000 inhabitants, whereas in Europe there are 250 to 400 for the same number of inhabitants. In all of Somalia there i s only one anaesthetist and one neurosurgeon. And no dermatologist at all.
Non-stop training of medical personnel is essential for high-quality care and the ICRC, as I say, is doing its part. When the security situation permits, ICRC surgeons go to Somalia to discuss the teaching curriculum with their Somali colleagues.
Last March an ICRC medical team went to the medical centre in Gilkayo to meet and talk with Somali doctors. The idea was to share experiences and hone the skills needed to receive wounded people – especially when there are sudden influxes and triage is necessary – and to make sure everyone knew the latest techniques in war surgery. A similar event had taken place the year before in Mogadishu.
Being in the medical profession in Somalia these days means being ready to go anywhere at a moment's notice to administer care. It means risking your life every day. These people are heroes and they deserve our respect.