Fieldset
The sound of silence

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.

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.