Fieldset
Fistulas and Fighting

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.

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 four 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 three 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.