Eyewitness: On Somalia's surgical frontline

Keysaney hospital in north Mogadishu was once a prison

By Mark Snelling International Committee of the Red Cross, Mogadishu

If you think you have a demanding job, spare a thought for doctors Ahmed Mohamed Taajir and Abdi Mohamed Hangul.

Since the outbreak of civil war in the early 1990s, the two surgeons have worked at the sharp end of the conflict, braving constant threats of attack and kidnap to treat thousands of victims that have passed through their operating theatres.

There are daily victims of violence

"I have friends abroad who have asked me many times to leave this dangerous place," says Dr Taajir, chief surgeon at Keysaney Hospital, perched on the dramatic coastline of the Indian Ocean, some seven kilometres outside of Mogadishu North.

"But I am happy to stay here and save my patients," says the softly-spoken 42-year-old.

Somalia collapsed into vicious conflict following the removal of President Muhammad Siad Barre in 1991 after 22 years of dictatorial rule.

The subsequent power vacuum unleashed a bewildering array of competing and overlapping clan rivalries, placing the country at the mercy of warlords and their heavily armed militias.

No fewer than 20 peace initiatives since 1991 have failed to restore any kind of order to Somalia, and on the streets of Mogadishu, the fighting continues to take its bloody human toll.

Gunshot wounds

Keysaney was inaugurated in February 1992 by the International Committee of the Red Cross (ICRC) together with the Somali Red Crescent Society on the site of what had been a prison.

Many injuries are from banditry

The building was available because rampaging clan militias had released all the prisoners.

More than 46,000 patients later, Dr Taajir and his colleagues are still receiving the victims of the city's daily cycle of violence, more than half of whom are admitted with gunshot wounds.

The 127 beds are almost always full. Fighting between the five major clans has disintegrated further into a host of smaller conflicts between sub-clans.

Dozens were killed a few weeks ago following a simple football match.

But these days a greater number of the injuries are the result of banditry or disagreements over business deals.

The scale of the individual tragedies, however, never diminishes.

Hussain wants to be president

During morning rounds, we meet six-year-old Mohamad, sitting quietly on a corner bed with his mother, Shamsa.

Two days before, bandits had come to their house to steal the family car, but not content with simply taking the vehicle, they shot the boy through the head. The bullet exited through his left eye.

In the next ward, a 25-year-old militia fighter called Hussain is recovering from a gunshot wound in the leg.

"When they get injured, the warlords don't care anymore," says resident surgeon Dr Mohamed Sabrie.

Hussain himself remains defiant. I ask him what he wants to do with his life. "I want to be president," he beams.

Surgical challenges

Due to security concerns, the running of Keysaney was taken over by the Somali Red Crescent in the mid-1990s with medical and logistical support supplied from the Kenyan capital, Nairobi.

Medina Hospital provides a vital service for Mogadishu South

But surgical care for the community was also urgently needed in Mogadishu South, so in 2000, the ICRC supported the reopening of Medina Hospital, a former police facility that had been forced to close in 1991 in the face of overwhelming unrest.

The 65-bed hospital is sandwiched between areas held by warlords Osman Atto to the north-east and Omar Finish to the west.

The Transitional National Government (TNG), a nominal administration formed after peace talks in Djibouti in 2000, controls territory east of Medina, less than half of Mogadishu.

In its first year after reopening, almost 3,500 people were treated.

The freshness of many of the injuries has forced the surgeons to master complex surgery simply not required in other theatres.

At Medina, chief surgeon Hangul now routinely uses a technique for operating on abdominal gunshot wounds devised in Lebanon, but never widely used.

Pioneering techniques have impressed regional colleagues

He and Dr Taajir - who has pioneered a technique for draining blood from a wound to be used again as a transfusion in the absence of blood donors - presented their experiences to an international conference of African war surgeons in Addis Ababa last year.

"They were amazed by what we were saying," says Dr Hangul. "It was a new approach in Africa."

It was the first trip outside Somalia for both men, but their initial nervousness quickly gave way to renewed confidence.

Like his counterpart at Keysaney, Dr Hangul, 39, understands the risks in staying in Mogadishu, but he too remains committed.

"Until I become a target, I will stay. I'm not ready to be a refugee," he says.

Mohamed: Where there is life there is hope

Aside from treating those wounded by weapons, both Keysaney and Medina also provide vital medical care to their local communities. Medina's youngest patient is five-day-old Mohamad, who was born unable to defecate, but was saved by a simple operation.

"He would have died maybe within a week," says senior surgeon Mohamad Yusuf.

"Now he has a very good life expectancy."

Amid the chaos and brutality, there is always hope.