Somalia: treating the war-wounded
For years Somalis have been struggling daily to survive amid armed conflict, destitution and a lack of basic services. Mohamed Yusuf defies security risks to run the ICRC-supported Medina Hospital, which provides badly needed surgical and medical services in his hometown, Mogadishu. He discussed his experiences with Bettina Rühl, a journalist.
I think this is the main hospital in the country today. The planned capacity is 80, but most of the time we have patients in much greater numbers than that. Sometimes we even have 200 patients or more. We receive people wounded in landmine explosions, shelling, mortar attacks and shooting. We also get a lot of people injured in road traffic accidents or after a fall. They all come to this hospital. We have medical patients as well.
Is the support you receive from the ICRC sufficient?
As far as drugs and medical and surgical supplies are concerned, yes. If we are concerned about shortages of any kind, we simply call the ICRC and get what we need. But we don’t receive money for the cleaning of the hospital, cleaning materials or for fuel for the generator – which has to run 24 hours a day – and the like.
To have some sort of income, we ask patients to pay a bit of money for treatment. But we help the people by making a lot of exceptions for those who are unable to pay. So we never ever say: this guy cannot pay, he cannot be treated, or, he cannot have health services.
What do you get from ICRC?
On a monthly basis the ICRC provides the hospital with surgical and medical supplies, pays staff salaries, and assists in carrying out maintenance on hospital equipment and infrastructure. The ICRC also helps us train medical and technical staff.
Given the malnutrition and other diseases in Somalia, the number of people requiring treatment must be much higher than the 200 or more patients that you receive?
Unfortunately we do not have enough means to create a feeding centre. It would be great if we could.
Could you describe the health status of the population?
It is very bad. The population is living with constraints that we have never seen before. Somalia has experienced something like 19 years of war, but the last two years were the worst of all. This has caused major problems. Humanitarian aid workers cannot come into the country. They cannot reach the people and provide them with food. And if someone is malnourished, his immunity system is depressed. So people are anaemic, chronically anaemic. They are already very weak by the time they get injured. We see a rising number of patients whom we can’t help b ecause they were already too weak before they were injured.
The hospital also has to contend with another burden: feeding the patients. Most of the time, they cannot get food from their homes because they no longer have a home here. So the hospital has to provide them with food.
If you have only 80 beds, how do you cope with the additional demand?
We have tents, and we have opened another facility that was, until a few months ago, occupied by military personnel. We asked the military people to move to another place and leave us the hospital. So we got some rooms there, which increased our capacity considerably.
If you have more patients, that means a lot of additional hours for the staff? How do you cope?
If there is an emergency situation, most of the staff will not go home at the end of their shift. The entire hospital, including maintenance people, sometimes, comes to chip in: by taking out patients, or changing beds. So the whole hospital is a hive of activity. They will stay until the emergency situation passes. When it is over, everyone goes home. And life goes back to normal at the hospital.
But the problem is that there are not many qualified people left in Somalia today. Because of the situation and the lack of security, most, up to 70%, have left to look for greener pasture.
Why are you still in the country?I myself was in the diaspora then I decided to come back and work here. And I am getting a lot of satisfaction in this. I don’t think that one who kills has respect for life. If we, who have r espect for life, stay here or, even, come back from the diaspora, we can make up the majority of the people. But if we leave and therefore create space for those who kill, they will take over – and they are taking over today –then the country is lost.
When you say you were in the diaspora, which places are you talking about?
I spent something like 22 years in Rome, Italy, and ten years working around Africa. I was in South Africa, Swaziland and Maputo, in Mozambique, before returning to Mogadishu in 2002. Since then, I have done a lot of different things; a lot of operations and teaching. I teach at Benadir University and Medina, which is a teaching hospital today.
What are the main problems you face today?
The biggest problem in this hospital is lack of fuel to keep generators running. And you know how crucial electricity is for us. The cold storage facilities in which we keep drugs and blood have to function 24 hours a day.
Unfortunately we do not have such facilities in our mortuary. Sometimes the remains of a patient who has died are not identified and claimed immediately by the next of kin. But because we cannot keep them, we just take photos, which we then show the relatives. “Is this the person you are looking for?” We ask them. “We already buried him or her”. And that is not right. One has to have a chance to see their dead before they are buried.