Mogadishu and beyond

Last night was a stark contrast to the night before, quiet, barely a sound. It is amazing at how unpredictable this all is. The quiet night last night gave us some hope and we have decided to stay and do as much as we can whilst the security situation permits.

One of the things we are trying to do here is get basic medical assistance to the most vulnerable. It is silly to say, because with mortars falling and bullets flying in all neighbourhoods everyone is vulnerable. We are really trying to understand how we can try and make it as easy as possible to get some basic healthcare to children and pregnant women in the camps for the IDPs; we also need to get the word out to these people that we are here and the healthcare is free. Not as easy as it seems, we need to find out what is stopping them from coming; is it that are too many checkpoints to pass before they get here, is it that they cannot afford the bus or taxi fare or is it just that they don’t know that we exist?

We are conscious that the security situation is unpredictable and we are not able to get the IDP camps but we are able to meet with some IDPs here at the clinic. One of our nursing staff is able to contact some people in one of the camps where we hope to start mobile clinics. I am very thankful that they agreed to come to the clinic, for starters they can see the facility and tell the other women in the camp, that is how things work here; secondly we need to know how to connect better with this particular group of people so we can work out what we can do to deliver medical aid to them more effectively.

I speak with three women first. Two are pregnant and one has a 9-month-old baby. The two women will go to our antenatal care section; they have not seen a doctor during their pregnancies before. I can see two burn marks on the baby’s head. This is a common type of traditional treatment, often used by those who can’t afford to access medical facilities. Nearly all health care here is private and you need to pay, which is not an option with these women unless you are really, really sick. More often than not we have mothers bringing their children when they are near critical as they wait and wait, it is actually a matter of life and death in some instances. Our medical staff spends a lot of time reiterating that MSF treatment is free and they should bring their children as soon as they see they are sick, but this will take time. We ask the mother if the baby was sick and she said he had a cough, which is why he had the traditional burning. We book him in for a consultation.

We explain why we are here and what we would like to talk about, two of the women are very keen and happy to discuss these issues; the other woman is looking rather sceptical. I am not surprised. That is the thing in Somalia: it has seen so many people wanting to do humanitarian work here but unable to do so because of security constraints; there have been so many promises to these people with few results and I can understand why there is an element of scepticism. People often assume everyone is happy to see an international NGO like us. Well in a context like Somalia it is not that simple. Too many broken promises and a life of incredible hardship; the proof is in the pudding, as the English say. It is also good for us to remember that. We are very careful to be totally transparent and frank in what we can and can’t do in these early days of this new project.

Within minutes we are deep in conversation about the realities of life in the camp and the problems for women. I am working with one of our midwives who is exceptional and a joy to work with. She is able to engage with the women, shows a great sense of compassion and with her training she is able to actually provide assistance. We have spoken before and were particularly interested in working out how we can address sexual violence; we hear that sexual violence occurs out there but we are not treating women in the clinic, even though we have the drugs.

I have sat in countless meetings where people have talked about the sexual violence in Somalia, but never in this detail. To understand how prolific the problem is and how powerless the most vulnerable are, they give us example after example. They tell us that a few months ago when the security situation was at its worse that the incidents of sexual violence increased, it is a tragic pattern we have seen all over the world. This conversation cements what we already thought, and we now need to get down to working out ways to get assistance to these women.

This morning we surfaced and the hum of the street behind the big metal gates indicate it is business as usual, or so it sounds like. We had heard last night that something had entered the compound. There is a Somali word for a lot of weapons and we were told a ‘zoo’, a type of anti-aircraft weaponry had clipped the side of the building last night. We take a look and see that the damage is a healthy chunk missing from the outer wall and pockmarks in the surrounding area where fragments had flown in various directions taking chunks from the wall. The building is solid and the damage is relatively minor, but as we sit down to breakfast we just wonder what happens when this happens in the displaced camps or the thousands of homes and shanties that have plastic sheeting or simple tin walls and roofs. The MSF clinic here does not do surgery; we are a paediatric and anti natal care facility. So we won’t see these people at our clinic but no doubt they are plenty of people at one of the private hospitals in town if they can afford it.

We get into the car with our armed guards (this is one of the two places in the world that MSF has had to concede to armed guards, but there is no option when you operate in Somalia). Each day starts with a security meeting at the clinic, it is all in Somali, but the information is shared from the various areas the staff live. People go around and nearly everyone has something to say on last nights fighting. As people tell their stories, we wait as the whole meeting will be translated and summarised afterwards. As one of the doctors is speaking Jelle leans over, he tells me that this is usually a man of few concise words, so there really must be something serious. The stories go on and people shake their heads in what looks to me like disbelief. It makes you realise that whilst MSF is treating people in the clinic everyone, including our national teams are confronted and affected by this violence everyday, on their way to work on their way home, it is endless.

As the meeting ends we bump into the doctor, the one of few words. Jelle asked him if everything was all right, and he tells us of a terrible night last night. He spent the night on the floor of his house with his family as the shelling was directed in his neighbourhood.

We keep talking for a while and at the end he tells me “For MSF to come here was a good decision, this is a responsibility and I would even work for free here as this is a time for humanity”… What more is there for me to say really.

The plane journey is as always shockingly early but relatively painless. It is an eight-seated Cessna filled with colleagues from the various MSF project sites, either going into Somalia and peering out with great anticipation, or finishing missions and heading out to Nairobi. We stop in the Galcayo project site and pick up two colleagues and I feel a little bad as we drop them on the runway in neighbouring Johar, which is 80km from Mogadishu. Due to the security situation in Mogadishu we can’t take in transit passengers, so we leave them in the hot sun on the dusty landing strip, with the pilots promise he will back for them soon.

Last time I entered Mogadishu was a year ago and by car and in today’s security climate that would not be an option. Last time I saw the abandoned buildings riddled with bullet holes, and that’s what I had expected from Mogadishu. But flying and landing into Mogadishu is quite striking, from this height the city looks quite impressive, a sprawling metropolis. No sign of the bullets, rocket and mortar damage from the most recent 10 months of fighting. The whole place is capped by ocean, which makes you think that this must have been something else in its day, when there was peace.

My colleague Jelle, the project coordinator, and doctor Fuad are seasoned at this and I follow them as we glide through the regular airport admin. It is a well-oiled machine, with all the people we need to assist us for a safe drive from the airport to the clinic in place. Listening to my colleague and all the arrangements he has done, it reminds me that you don’t take this short 15-minute car ride from the airport to the clinic for granted in a place like Mogadishu.

The clinic and our accommodation are literally a stone throw away from each other, but we drive it, walking just isn’t an option at this point. It is about a 20 to 30 second drive. We drop by the clinic to meet the team who are all waiting. Jelle does a quick introduction of the new face (me); I am always aware that my role does not always make sense to our teams. I am not a doctor or a nurse or a midwife, so we start with a brief chat about my work. We are careful not to keep people too long as it gets both difficult and dangerous the later it gets for them to get home.

In the midst of the conversation a man asks: “Someone who has been affected by the civil war in many ways, who can’t access our clinic, how can you help them?” I am struck by the frankness of his question and wish I had a clear answer, but that is what we are trying to work out and trying to achieve.

We sit over dinner and talk through the realities of how MSF wants to get things done here and what we want to do. We think about access to the clinic for the internally displaced (that’s people who had to flee or move because of the fighting, they are referred to as IDPs) and discuss ways to overcome the difficulties; we are feeling positive and float the idea of possibly seeing if we could quickly visit one of the nearby camps where we are planning mobile clinics. But this discussion comes to a grinding halt as we hear gunshots start, there are often shots in Somalia but these are close and followed by some bigger booms that we suspect are mortars. They start again as I write.

We had an hour of fighting earlier in the evening and moved into what we refer to as the ‘safe room’, a room with solid walls and few windows. We stay there for an hour, and have long conversations to try and work out what is being fired and what the impact must be. Its vague attempt to try and understand what is happening if this lands in the neighbourhood. When a slightly louder bang distracts us, it is clear to us it was close; my colleague Jelle listens to each sound trying to work out what it is and where it landed. Mobile phones beep and ring as information on what is happening comes in. It is not just us though, all of Mogadishu with a mobile is doing the same: trying to work out what’s going on and where your loved ones are I guess, we can’t get through as the network is jammed.

As we sit here, we think out loud about how MSF can operate on a day-to-day basis in this sort of environment.

Tirana Hassan is working with Médecins Sans Frontières (MSF) as a Humanitarian Affairs Officer. She is based in Nairobi and regularly travels to support MSF teams working in different locations in Somalia.