MOGADISHU, 11 October 2003 — A doctor slices a scalpel into Abdi Fatah’s bleeding groin to repair a botched circumcision. The boy screams. But the urologist’s expert care puts a big smile on the face of his relieved father Mohammad Ahmad, who rushed the eight-year-old to hospital only minutes earlier.
“You did a good job,” he tells the doctor, who treated his son as an emergency, and for free. “I regret having done the circumcision outside. Next time I’ll come to the hospital!”
Relief of traumas big and small is a daily event at Arafat hospital in Mogadishu, a two-year-old facility which every day sees 300 new patients and 200 others returning for checkups. But the hospital itself is anything but ordinary. It was started by Somali doctors who gave up cushy lives in the Gulf to return and build one of very few facilities providing specialist care in the capital, among the world’s most violent cities.
Pediatrician Abdullahi Farah Asseyr now takes home about a quarter of the $4,000 a month he once earned tax-free in Dubai but he says it is worth it because his new job has more meaning. Like many colleagues he did basic training at taxpayers’ expense in Somalia before the civil war, going overseas to complete his medical qualifications and work. He now wants to repay his debt to a society ravaged by 12 years of bloodshed.
“I went to Arab countries, worked in nice places and lived in very good circumstances. But I feel I have a great responsibility to change my country and society,” he said.
“So that is why we ‘forgot’ our lives and I brought my wife and children here to establish Arafat and help my people because they invested in me. I have to make a big effort.”
There is no doubting the need.
Arafat specialists estimate that a good half of the city’s more than one million population receives no care at all from a medical system brought to near-extinction by militia mayhem. “Of those 50 percent who are treated, maybe 30 percent do not continue treatment because once the immediate crisis is over their families shift priorities to getting food,” said Asseyr.
Adults and children missing limbs hobble down every street. Sufferers of an array of ailments weaken and die untreated in the plastic and thatch huts of internally displaced people that seem to dot every spare patch of Mogadishu’s waste ground.
Somalia has been torn by war since the overthrow of military ruler Mohammed Siad Barre in 1991. Conflict and famine have killed hundred of thousands of people.
Most Somali doctors fled: 26 doctors and 28 nurses who stayed behind were killed in the chaos of the 1990s. For much of that decade clinics depended on relief agencies for drugs and focused on emergencies such as bullet wounds or endemic diseases of poverty such as cholera and tuberculosis.
Arafat has returned the skills of specialized medicine to Mogadishu, treating ailments such as diabetes, renal failure and respiratory stress and has high-tech diagnostic gear to support work in gynecology, urology, obstetrics and internal medicine.
A consultation costs between $1.30 and $1.50, but the price includes 10 days of follow up care, even if a patient comes back with another disease. Emergency cases are admitted unconditionally with payments charged, or not, on a case by case basis.
Satellite television news is beamed into a clean waiting room. Trainee nurses peer into humming diagnostic computers.
Fees pay running costs but are too meager to fund expansion. A constant flow of money from Somalia’s large diaspora and businessman benefactors, who along with the doctors were the hospital’s original investors, is required for new equipment.
Zakaria Moammed, a coach for the national soccer squad, is one of a growing army of grateful customers. His five-year-old daughter Moamina was admitted with her eyes turned up in their sockets due to dehydration from severe gastroenteritis.
“Without this hospital she would be dead,” he says. “There is no government. We are kidnapped by warlords who see only their interest and not the people’s interest.”
Admiration for professionals like Arafat’s doctors is an increasingly common sentiment in Mogadishu, where warlords are despised for doing little or nothing to help their communities. The hospital’s inauguration was part of a wider revival of professional associations working to rebuild the city, motivated by a realization that the substantial foreign aid projects may not revive anytime soon, such is the capital’s militia chaos.
Internal medicine specialist Mohamud Zahed Mohamud, 50, worked for years in Saudi Arabia before deciding to come home and more than halve his $2,700 tax-free Saudi monthly salary.
He and Asseyr argue that the success of Arafat is tangible proof that Somalis are helping each other, providing a check on the influence of militias and paving the way for what they hope will be a full-scale return of foreign relief agencies.
They want to encourage UN institutions to return to Mogadishu after a decade in which most projects have been at a low ebb and the world body’s international staff largely absent. “We are in need of their help,” said Mohamud. “Whatever resources we have is nothing compared to what the UN can do. If you want to prevent communicable diseases you must have water, sanitation and electricity. Without these things we cannot cope.”
Some US analysts see Mogadishu’s middle-aged returnee doctors and teachers as Muslim radicals seeking to turn Somalia into a strict theocracy. Shaking his head and smiling, Mohamud says he has no hang-ups about soliciting Western support. “We feel a commitment from Arab countries and Arab civil society,” he said. “We would like the same commitment from the West. After all we are human beings, and we deserve their help.”