Mogadishu and beyond

There are more people arriving from Mogadishu. The first woman we met is 70 years old, the same age as my father, it is hard to believe how different their two worlds are. Whilst her face tells a story of life full of challenges and struggle, she still has an energy that just resonates and despite the displacement and the tragedy of her experience, she tells her story and even laughs and jokes.

She invites us into a small one room house, where she is staying with her three grandchildren. She took them here after her son was killed during the fighting in Mogadishu. She rolls out a small plastic mat, which she explains is the only thing she left Mogadishu with, besides the clothes that they were wearing.

As I am sitting on this mat, I realise how numb one can become to the language of 170,000 people are ‘fleeing’ Mogadishu …You read and listen to the reports and think of it in a non emotional way when you see…the people are ‘displaced’, ‘fleeing’, ‘leaving’…But, as Mariam is talking it hits me, what this REALLY means. For Mariam, it was running, it was looking around and grabbing her three grandchildren children 8, 5 and 3 years old and running, and as she was running out the door, she saw her son being killed. There was no time to stop, to think, to plan, not even to grab a few thing, she just ran and has never been back. That is what displacement is like. As we end she asks me if I have her name spelt correctly, she is not sad, she does not want pity, she just tells us, she only has this mat, what more does she have to lose, she wants us to tell her story to people outside, to someone who cares, to someone who will do something.

In MSF we are always constantly aware of the impossible choices that the people in places like Somalia face on a daily basis. For instance, we were wondering why children are dying from diarrhoea or malnutrition only 3km from our hospital which is free. Free drugs, free therapeutic feeding, free medical care. The reality is that these children are sick during the day when they are at home being cared for by their 9,10, 11 year old sibling. Their parents are working, the mother is in the market or in someones house washing clothes to try and make enough money to take care of the family, it is day by day survival. Of course there is no sick leave, if she misses a day at work to bring the sick child to the clinic where will the money come from to feed the other 5 children? If she does come and the medical staff need to admit the child into the therapeutic feeding centre (that is the place you have probably seen on television, rooms with malnourished children being fed with big orange cups by their mothers), she sometimes can’t stay in the hospital and care for the child as she has to get back and feed the other children who are alone in the camp where they live. Nor can she stay for several days in the hospital or the families she washes clothes for will find someone else, and then she will go from little income to no income. These are real dilemmas these people face every day.

We went to a camp on the other side of town today. I was not expecting to find such large numbers of Mogadishu displaced in the camps. The chairperson said they had received between 600-700 people displaced from Mogadishu. We speak with numerous people today. They are some of the most recent arrivals from Mogadishu, they are young mothers many of them, with children and they have absolutely nothing, they have come to Galcayo to flee the fighting in Mogadishu. There are consistent stories of people witnessing horrific things as they were fleeing. Many have left and are lucky to have their lives. 3 separate people tell us the house next to them as destroyed when artilleries fell on them, they could all tell us how many people were in each of the houses when it was destroyed, all of which died.

People tell of running and not looking back, being separated from children, husbands and family members on the way, and still not knowing where they are. Even when they have made away from the fighting, the journey out of Mogadishu is perilous. The roads are scattered with thieves and bandits who set up road blocks, where they demand money to pass. If you run out of money then they begin to take your personal belongings. By the time most of them arrive here, they have absolutely nothing, just the clothes on their backs. We have been told there are approximately 150 checkpoint between Mogadishu and here, that is only 750 km, it should only take a couple of days but with the roadblocks and the searches the journey takes anywhere between 7 to 12 days now, depending on if you have problems at some of the checkpoints.

Sometimes it is hard to put into words what you see and hear. If I tell you the stories verbatim, you may feel a sense of hopelessness and these are incredibly tragic stories in incredibly brutal circumstances. But when you talk to these people you are mostly struck by the resilience. These people are focused on survival, there is no time to sit around and be sad they are focused on finding work and building a life for their families.

I ask one woman where she is living in the camp, I assumed she had family. She tells me she knows no one here and her daughter was 6 months pregnant when they arrived and miscarried on arrival. She told me that someone in the camp moved out of their small shelter and stayed with another family to let her and her children have somewhere to stay. I am not sure if I could say the same thing would in my community. Amongst all of this chaos there are incredible acts of compassion which are quite humbling.

Galcayo is dusty and hot, when you look around this is the type of picture that someone who has never been here probably has of Somalia. But amongst this harsh backdrop today is a great day at the hospital, they are doing measles vaccinations and ambulatory therapeutic feeding, it is crowded with mothers and children, more than 150 children, the place is a buzz. The children really are very sweet, you just want to pick them up and play with them although as soon as they see our funny coloured fair skin (which most of them have never seen before) they usually burst into tears, so I let go of that idea.

Sometimes you hear the funniest things in the field. Today as I was stepping out to meet some women who had arrived from Mogadishu I was stopped in my tracks by the midwife Sarah, with her hands in the air, crying ‘thank god we found a fistula’!! Not quite as strange as it may sound. It’s actually more of a statement that they found someone eligible for the surgery, someone they can actually help.

You see this is not purely a medical issue the social consequences of fistula are incomprehensible. First of all you dribble urine down your leg, all day every day. Of course you wash and wash and wash but you can not get rid of the smell and often your husband rejects you, maybe you are lucky enough to have your family take you in, but the stench sometimes means that even they drive you out, out of the house, to sleep under a tree or sometimes out of the family. Some of these women are with out any support, living in isolation and humiliation; it is incredibly tragic, especially when you think it is preventable. The team here have been trying to identify women for weeks that may be eligible for the surgery. There is a sense of nervous excitement amongst the midwife and the surgeons who will be involved. If they are successful it could change these women’s lives.

Today I am en route to Galcayo, that is a town on the cusp of a region of Somalia they call Puntland. MSF runs quite a big hospital here. It does surgery, in patient and out patient care, an emergency ward, a TB programme as well as paediatrics and therapeutic feeding. It is busy and the team is energetic and fun to work with. They are all very switched on to MSF’s witnessing and advocacy work so it is bound to be a busy time.

I am travelling in with a Danish surgeon, Peter who is going to be conducting 4 weeks of very technical surgeries to correct fistulas. It is a little tricky to explain to those of us who are non medical, but the easiest way to describe it is as a physical hole that is created either between the vaginal wall and the bladder, or sometimes between the vaginal wall and the rectum which means she has urine constantly running down her leg. It is caused by prolonged labour, when the babies head is thrust against the pelvic wall for a long period of time. In Somalia some of the women who have come to have their fistulas repaired were in labour for 3 days. During the prolonged labour the babies head damages the tissue around the vagina, which eventually causes a hole to form. One of the main reasons this happens here is because girls are marrying and having babies in their early and mid teens and their bodies are still too small to deliver naturally. It has massive social consequences for a woman, not to mention that most of the babies die during child birth.

Whilst I came originally to document this fistula problem, Mogadishu also remains plagued with troubles. The situation has degenerated. The area that MSF had the children’s clinic is now deserted. The fighting was so intense in the area that pretty much everyone fled in the 1-hour window of calm at 5am on Thursday morning. The team described it as ‘empty’, ‘deserted’; they were virtually the last people to leave as they struggled to find a window of opportunity to move out of the area. Now they have moved to another area and the Mogadishu staff, besides all of their own personal worry and the fact that majority of them are displaced themselves or housing members of their families who have been displaced have said they will work and they want to work so they are sending out mobile clinics to the camps.

We see the press releases and news reports and calls by various bodies who are focusing on the displacement from Mogadishu. It is dire, no doubt about it but what we are worried about is the people who are stuck in Mogadishu still. The market closed 3 days ago and that means no income for many of these people so how do they buy food? It is too unsafe to pop your head out your front gate let alone ‘take a quick trip to the market’. Getting enough for bus fare to leave is totally out of the question for the IDP’s who relied on the now closed Bakara market for their daily income. A woman in Mogadishu described it to me once as “if there is no market there is no work, if there is no work there is no money and if there is no money there is no food.” Now with the road blocks in the city even walking out is also becoming less of an option. Between poverty and insecurity they are trapped.

Read MSF’s latest Press Release :

“No safe place in Mogadishu” – 05 November 2007