NEWS UPDATE

Roda Musa lies on a bed, cradling her arm. Her flowing, colorful clothes are a stark contrast to the white plaster that covers her from hand to shoulder. She looks to be in her early twenties, but her face lines with anger when she explains why she has found herself surrounded by other Somali women in the trauma ward of the Doctors Without Border/Médecins Sans Frontières (MSF)-run Galkayo hospital in the north of the town.

"A Somali man shot me in the arm," she says, "I have no idea why."

She is one case among many. The same hospital has treated more than 300 people for trauma injuries related to violence in the first six months of 2005. Around 80 percent of these are bullet wounds. While Somalia is no longer at war, the violence of anarchy is no less brutal. There has been no national government in the country since President Siad Barre was ousted by an armed insurgency in 1991. Ruled by clan-based militia, it has stuttered to an uneasy and extremely violent status quo.

The pharmacy at Galkayo hospital. Photo © Mika Tanimoto

Galkayo, situated in central Somalia, is a relatively important trading town with a population of around 80,000. It has all but literally been torn in two. Viewed from the air, Galkayo is a small area of identical metal roofs in the midst of an unforgiving desert. But with no authority other than the militia and no law other than the gun, a dispute between two clans has escalated to the point where people from the southern part of Galkayo cannot venture north and vice versa. A 'green line'–in reality more like a small no-man's land–is guarded by opposing militia and splits the town into two halves.

When MSF re-opened the 'North Galkayo' hospital with collaboration of local doctors in 1997, re-starting a service collapsed since the start of civil war in 1991, it became the first hospital accessible to all for hundreds of miles in every direction. Except for those immediately to the south of course.

"We quickly realized that the green line prevented those from the south of Galkayo from traveling the two to three miles north to get treatment," says MSF Head of Mission Colin Mcllreavy. It would be six more years before MSF would finally deem it safe to begin the process of opening a similar hospital on the southern side of the line.

For the majority of the people of Galkayo, to venture across the green line is to risk death at the hands of one militia or another. Even to come close to the line can put your life in your own hands.

For the outsider, the line is virtually impossible to determine. But after 15 years of conflict and killing, the local people have no doubt as to where it is situated. When we approach the line, in this case a small shop selling the colorful wraps favored by Somali men and women, our guide stops us abruptly. "This is it," he says.

The latest flare-up of violence took place in April this year when a price dispute in the market that straddles the green line escalated into a full-scale battle, which left at least 18 people dead and 37 wounded. Many of the wounded had been caught in the crossfire. As is often the case, the MSF hospital dealt with the casualties.

In the male trauma ward of North Galkayo hospital, a man in his early 20s lies emaciated on his side, paralyzed by a gunshot. He has been in the hospital for over two months and nobody knows when he will be able to leave or what will become of him. In the next bed is a man with his arm in plaster. "I was shot in the hand for no reason," he says. Each person in the trauma wards, north or south of the green line, has a comparable story to tell.

The violence also has consequences for MSF. To ensure access to health care for people in both the north and the south, MSF has been forced to set up hospitals on both sides. Neutrality allows the teams to travel from one side to the other. The trip takes no more than 15 minutes over deeply rutted roads, but requires a switching of the armed guards for the teams before crossing the no-mans land. The MSF car bumps across the no-mans land to be met by another set of guards from the other side.

The division between Galkayo's two factions may seem impassable, but in the hospitals, the suffering caused by conflict is identical. Like the line itself, any difference between the features, culture and language of the Somalis from north and south Galkayo is imperceptible to outsiders. But beneath the similarities lies a depth of often-fatal animosity entwined in a complex web of clan allegiances.

Although most people in Somalia own a gun, relatively few choose to be fighters. They have just been caught up in a society where strength is justice. The lack of government has left the population of Somalia to fend for itself. The result is a brutal survival of the fittest.

"If you have money, you survive," says Mcllreavy. "If you are poor, which is the case for the great majority, you have no safety net and are left at the mercy of the rich."

Gunshot wounds are the most visible result of the violence, but hunger is also a consequence. MSF runs therapeutic feeding centers for malnourished children under five years old in both the north and the south of Galkayo. These centers are never empty. By early June, there have been nearly 350 admissions to the facility since the beginning of the year.

Other services in the hospital include maternal care, tuberculosis treatment, and pediatric care. With the number of trauma cases, surgery is also a necessary component in Galkayo. All services are constantly full and due to limited capacity, MSF is only able to see a maximum of 40 patients per day in each outpatient department.

Mother and child in the pediatric department of Galkayo hospital. Photo © Mika Tanimoto

"The needs are huge," says Mcllreavy. "We do over 40,000 consultations per year in the two hospitals but this barely scratches the surface. It is not just for residents of Galkayo. People come from up to 500 miles away to get medical care, because there is nothing else available to them. Across great swathes of the country there is literally no possibility of access to medical treatment. This is why people come for hundreds of miles around to reach us in Galkayo. Worst of all, we know that for every person we reach, there are many more that die for the want of sometimes basic care."

But the violence in Somalia, compounded by the complex clan structures, means that few organizations risk trying to deliver humanitarian aid. With no state and therefore no state medical services, Somalia is a country in desperate need of much more of this type of assistance.

Hope among the Somalis for a new government is not strong. In the meantime, while the warlords cum politicians continue to wrangle over the future of the country, Galkayo will continue to be divided by a deadly green line, and the Somali people will continue to suffer.

© 2005 Doctors Without Borders/Médecins Sans Frontières (MSF)