The Times of London
When Idris was thrown from his donkey cart on Sunday, blood from a nasty gash clotted in his hair and stained his threadbare shirt. The best he could have hoped for until that day was a dirty needle to stitch the cut and painkillers, as likely as not counterfeit. But his accident coincided with the opening of a health clinic in the Somali town of Hudur, two months after it was liberated from militants linked to al-Qaeda.
He was treated by Dr Mohamed Warsame, 25, a surgeon trained in Mogadishu and sent by the World Health Organisation to extend basic healthcare beyond the capital. Idris, 7, was checked for fractures and injected with local anaesthetic so that his wounds could be cleaned and stitched. Then he rested on a bed overnight.
For nearly four years al-Shabaab counted Hudur, the capital of the western region of Bakool, with a population of 40,000, as a stronghold. International aid agencies were kicked out and trade dried up. When drought struck, Bakool was among the first areas to be declared a famine zone by the United Nations, in July last year.
But two months ago the al-Shabaab militants withdrew from the town as more than 2,000 state troops and Ethiopian soldiers advanced. Now the militants’ first roadblocks are 12 miles away, the town is under tight control and medical treatment is again possible. The first Western journalist visited this week.
Fatuma Hussein Abdullahi is one of five midwives who continued to deliver babies after the clinic was shut down by al-Shabaab. “We worked throughout, though we lacked supplies and sterile items,” she said. “In hospital you have medicines, other nurses, but at home if there are complications or bleeding it’s very hard on your own.”
Somalia has one of the world’s worst records for maternal mortality. Last year, Maryan Qasim, who was then the Women’s Minister, said: “The most dangerous thing a woman in Somalia can do is to become pregnant.”
Aid agencies have been focusing their efforts on Mogadishu, as other parts of the country are considered too dangerous, difficult or expensive to work in. As a result the capital, already bloated with refugees and the homeless, is a magnet for desperate civilians seeking food, medical treatment or work. They must travel long distances through countless al-Shabaab roadblocks or cross front lines between the militants and their Ethiopian, Kenyan or African Union opponents.
Al-Shabaab has been pushed out of several urban centres in the past year but much of southern and central Somalia remains under its control, leaving towns such as Hudur marooned islands of government influence.
“We have to start treating people where they are,” said Dr Omar Saleh, the WHO emergency co-ordinator for Somalia. The British-trained Egyptian surgeon brought two tonnes of medical equipment and drugs worth £45,000 to Hudur to reopen the clinic, which offers free treatment.
“We are sending a message that you are not in Mogadishu, but you are not forgotten, and we are showing other agencies that it is possible to work outside Mogadishu,” he said.
Within the clinic’s first two days, more than 250 patients were seen, with 14 having operations. Consultations were short, the diagnoses speedy. Patients were sent to the operating theatre or to the pharmacy for drugs. But not all ailments can be treated in a field hospital focusing on maternal health and basic surgery.
Among the first patients was a man aged 20 with a cancerous tumour in his knee. He leant on a walking stick, his father by his side. The right treatment, Dr Saleh said, would be amputation above the knee followed by chemotherapy, but it was too late: the case was already terminal.
Dr Saleh said that up to 40 per cent of the patients seen over two days were suffering inoperable or terminal illnesses. Had they been seen earlier they might have been helped, but for years the area had been inaccessible. “If you ask me that’s the true impact of al-Shabaab,” he said.