January 31, 2011
Somalia 2010 © MSF
Even a quick glance at Doctors Without Borders/Médecins San Frontières (MSF) updates from Somalia over the past two years shows that the country’s conflict remains as relentless as ever. February 25, 2009: “121 wounded in 24 hours”; June 2, 2009: “218 treated over two weeks”; January 20, 2010: “111 wounded in 3-day period”: February 3, 2010: 89 treated, including 66 women and children, in Mogadishu.
There were 42 people treated for injuries in one day at the beginning of this past July, and 45 in one day at the end of the same month. Weeks later, 127 people were treated for injuries over three days, and another 81 were treated in a 12-hour period in late September. What’s more, three MSF staff members were killed in January 2008 and a fourth in June 2009. Two others were abducted and later released in April 2009. Operations were suspended temporarily in three facilities at various points over the past two years, while some health posts had to be closed entirely due to security concerns. And one site, in Belet Weyne, was hit by two mortar shells this past January.
“When we had 45 war-wounded patients in one day, we thought it was the maximum,” says Thierry Goffeau, MSF’s head of mission for Somalia. “Then another day we had 52. And on September 23, we had 81 in a single day.” Because gunfights and shelling frequently occur in residential areas, civilians bear the brunt. “One third of our war-wounded are children under 14 and women,” Goffeau notes.
Given the pervasive poverty, lawlessness, and lack of infrastructure, the health needs are tremendous. MSF has been able to continue operating largely thanks to 1,300 Somali employees who staff projects in eight regions of south and central Somalia, providing primary health care, surgery, tuberculosis and malnutrition treatment, and water and relief supplies in Galcayo, Mogadishu, Guri El, Belet Weyne, Jamaame, and elsewhere. MSF does not accept any government funding for its projects in Somalia, relying instead on donations from individuals throughout the world. In 2009, staff carried out more than 650,000 consultations, performed nearly 3,000 surgeries, treated more than 34,000 people for malnutrition, and vaccinated more than 224,000 children. MSF also tended to more than 67,000 Somali refugees living in camps just over the Kenyan border.
A team of international staff is stationed in Nairobi, Kenya, making field visits when the security situation allows, which, Goffeau admits, is not ideal. “Working remotely is really difficult,” he says. “There is not enough visibility sometimes to fully comprehend what is going on.” During outbursts of violence in Mogadishu, for instance, the distance seems immense. “Fortunately,” says Goffeau, “the team in Daynile Hospital is experienced in mass casualties and knows how to cope.”
Given the circumstances, it’s crucial for MSF to constantly reaffirm its neutrality and its desire to provide lifesaving medical care for all people who need it, regardless of their clan, political alliance, or religious beliefs. The organization also must prepare for contingencies that might occur, especially for disease outbreaks or clashes that cause, as in September, a flood of wounded people to arrive en masse at MSF facilities. At Daynile, for example, “Four tents have been set up already in the hospital courtyard and we have today a total of 120 beds in this hospital which normally has a capacity of 59,” Goffeau says. And extra supplies of logistical items— mattresses, sheets, gowns, and more— have been stocked as well.
It is, at times, frustrating to have to operate this way, remotely, as one of the few NGOs still working in the country. But, Goffeau says, “We definitely save lives every day.”
© 2013 Doctors Without Borders/Médecins Sans Frontières (MSF)