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Inside Port Harcourt's 'ER' clinic

By Andrew Walker
BBC News, Port Harcourt

Surgeons operate on a man injured in a traffic accident
Port Harcourt is oil rich but state hospitals are resource poor

Calm has returned to the Teme Hospital in Nigeria's oil capital Port Harcourt after a weekend of violence saw 15 men with gunshot wounds brought to their trauma clinic.

A turf war between gangs, known as "cultists", flared in the city's waterfront slums when armed men zoomed into the docks on boats late on Friday.

"I'd call it stressful," says Thierry Goffeau, field co-ordinator at the clinic after the weekend's shootings.

Only one man died of his wounds at the hospital, the surgeons there are experienced at dealing with gunshots - they see three or four every day.

But in Nigeria's oil capital, the home of the nation's multi-billion dollar oil industry, this accident and emergency ward is run by a charity more known for aiding in war zones and natural disasters.

Attention is not given early enough to patients because they have to pay, and you might find that before a patient can get these things together it may be one or two weeks
Dr Charles Nwagbara
Nigeria is theoretically rich with oil money, and Rivers State has received billions of dollars from the federal government, but when people are injured in Port Harcourt they turn to Medecins Sans Frontieres - Doctors Without Borders - for help.

The international aid agency, founded by Bernard Kouchner - now French foreign minister- after his experiences as a Red Cross doctor during the Nigerian civil war, has been running a clinic here since 2005.

It provides free healthcare to anyone who comes, and its wards are often occupied by wounded police officers and gang members at the same time.

The clinic maintains a strict neutrality, and the respect of both gang members and police, by treating both without asking too many questions.

It receives between 25 and 30 patients a day.

Most of those are road traffic accidents, but a quarter are victims of violent crime, gunshot wounds, stabbings and beatings, doctors say.

Fees

When the BBC visited in July the clinic was calm.

Dr Ike Oruaari is the first person an injured person meets when they arrive at the clinic.

Dr Charles Nwagbara
Doctors say Port Harcourt feels like a war zone at times

"Sometimes they're in such a terrible state we have to drop everything or they die."

Other hospitals do not work like that, he says.

Doctors in hospitals that are funded directly by the state will not touch a patient until they have paid their fees.

Dr Oruaari got his medical degree from Port Harcourt University three years ago.

"I don't think I'll be going back to the state government run hospitals," he says.

He is not the only one.

Orthopaedic Surgeon Dr Charles Nwagbara used to work at Imo State Teaching Hospital.

"Attention is not given early enough to patients because they have to pay, and you might find that before a patient can get these things together it may be one or two weeks," he says.

Bad ones come inside the place and just started shooting
Prince Akpelou, gunshot victim

"Port Harcourt is a very violent place, its right that MSF should be here," he adds.

Rivers State government acknowledges the situation is not good.

"In the past the administration did not have its priorities right," said state spokesman Ogbonna Nwuke.

He says more clinics are being built and improvements made to the state hospital.

This year, government spending on hospitals and clinics has been increased almost sevenfold on paper, to 13bn naira ($110m, 55m).

But campaigners say they are waiting to see if the government can deliver and if they will pay the salaries necessary to attract medical professionals of the right quality.

Violence

Prince Akpelou, 20, was in a beer parlour when he was shot in the arm and back.

"Bad ones come inside the place and just started shooting. Everyone ran away. I was the first one they shot."

Prince Akpelou
The clinic receives three or four gunshot victims every day
His brother was shot dead.

Unemployed, he is from a rough neighbourhood and says the men were not robbers, they were just shooting people at random.

In Port Harcourt gang violence is extreme.

Jobless youths are armed by gang leaders who sell their services to crude oil stealing cartels.

Law and order has almost completely broken down, civil society campaigners say.

Last year scores were killed and injured in a week of violence that saw a curfew imposed on the city.

The military tried to regain control with helicopter gunships.

'Mass casualty'

At times, doctors say, it feels like a war zone.

The only other clinic MSF operates like this is in Haiti, where poverty, lawlessness, and gang warfare perpetually pitch the country at the brink of chaos.

French doctor Cecile Barbou, a veteran of MSF missions in southern Sudan and Colombia says that the numbers of people who are victims of violence justify MSF's presence in Port Harcourt.

They believe it is possible the violence could get worse.

"It's true, it's quite a wealthy country and they have some structures in place to deal with health, but we wanted to be in place in case something very important occurs."

"We hope it doesn't occur, but we want to be ready if there is any mass casualty occurring," she says.


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