MOGADISHU, Somalia — Across this port city patches of wasteland and bombed-out buildings are being transformed into squalid refugee camps, new homes for the more than 100,000 Somalis who have fled famine.
They come in search of food, shelter and medical care but this damaged city has been at the epicenter of a 20-year conflict and has little to offer.
The makeshift settlements in and around Mogadishu were themselves declared famine zones by the United Nations earlier this month, after mortality and malnutrition rates exceeded the famine threshold.
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Mogadishu has for years been considered the most dangerous city on earth because of its vicious battles between rebel militias and the transitional government. Now the capital city is in the grip of the famine that is affecting an estimated 12 million people across the Horn of Africa.
Just over a week ago the Islamist militants of Al Shabaab withdrew from the capital but their retreat does not translate into respite for the city’s residents, old or new.
“We cannot reach all the Internally Displaced People … only a very small fraction,” said Abdi Awad Ibrahim, an adviser to Somalia’s health ministry.
“There is no water, sanitation and hygiene is very poor, there’s no supplementary feeding for the children, malnutrition rates are very high, infection, epidemic of measles, these are some of the things we face,” he said.
The luckiest of the worst cases find their way to Banadir, one of Somalia’s few functioning hospitals, where an entire wing is dedicated to treating diarrhea, a killer here.
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Inside, past the gunmen swaddled in bullet belts who guard the entrance, patients lie wherever they find space: on tables, makeshift camp beds or the floor of corridors and hallways. The wards are already overflowing yet dozens of new patients arrive every day.
Like every other building in Mogadishu, the hospital is a crumbling monument to 20 years of state collapse. It is a dismal place: overcrowded, buzzing with flies and filled with the clamor of moaning and crying patients.
Medical students who make up the majority of the doctors say that these days patients suffering malnutrition far exceed those with gunshot and shrapnel wounds.
Gesturing towards the triage hall packed with small, sick children, most suffering from diarrhea and measles, 21-year old medical student Zacharia Ali Hursi said, “We do whatever we are able to do.”
What they can do is not much more than offer oral rehydration salts and the IV drips that pierce the arms or temples of every child lying on the tables and benches in the open-sided hall.
“Children are dying from measles and malnutrition cases are increasing day by day,” said Abdullah Mohamed Yassin, another young doctor. “We do what we can [but] we don’t have enough medicines.”
Holding the hand of his listless seven-year old daughter, Mohamed Abdi Yussuf explained that he and his family had only decided to come to Mogadishu after their last camel died. He has not left his daughter, Isha, for the four days that they have been at Banadir. Isha lies on a table shared with another sick child, as doctors tried to treat her acute diarrhea.
Since the famine crisis began the big fear among aid workers has been that disease will spread, fast and deadly, through the weak and malnourished populations.
Now it seems that fear is becoming a reality in the crowded, unsanitary camps of Mogadishu. The World Health Organization (WHO) is warning of a cholera epidemic.
It says Banadir has recorded over 4,000 cases of acute, watery diarrhea this year, resulting in 181 deaths. “The number of cases is two or even three times more than what was there last year. So we can say that we have an epidemic of cholera going on,” WHO’s Michael Yao told reporters in Geneva.
Outbreaks are predicted to multiply as thousands of people make the long trek out of the southern famine zones to camps in Mogadishu and across the borders in Ethiopia and Kenya.
Al Adalla camp, squeezed between crumbling, bullet-riddled buildings close to the airport, is just a month old and is already home to more than 2,300 families living in tightly packed domes made of bent sticks covered with a patchwork of stitched together pieces of fabric.
“Nobody manages the camps. People see where there is bare land and they come and settle,” said Mohamed Haji Adan, an aid worker with the United Nations refugee agency (UNHCR).
The U.N. has begun to airlift emergency food and supplies to the people crowding into Mogadishu, but it is only scratching the surface of the crisis. Last week UNHCR landed three cargo planes of blankets, sleeping mats, plastic sheeting, jerry cans, high-energy biscuits and cooking sets to be distributed to some of the 20 new camps in Mogadishu.
“It’s not enough,” conceded Bruno Geddo, UNHCR’s Somalia representative, “but, little by little, we are moving in.”
Recently relief packages were distributed to some of the residents of Al Adalla camp. Watching as women lined up to receive sacks of blankets and cooking utensils Adan Ali Abdirahman, an elder from the Al Shabaab stronghold of Baidoa in southern Somalia, said: “We came here for survival, we get a lot of charity from the residents of Mogadishu, and that is how we live, but this is the first we get from the international community.”
Despite Al Shabaab’s withdrawal from Mogadishu earlier this month, security fears remain a major hindrance to the international aid effort and the militants have vowed to return with suicide attacks and bombs.
“The things that I saw will stay with me for the rest of my life,” said Valerie Amos, the UN’s top humanitarian official, who visited Mogadishu over the weekend. She described “heartbreaking” scenes at Banadir. “Children who are so malnourished they can barely lift their heads, suffering from skin diseases, mothers in despair," said Amos.
“We can save the lives of these children if we can treat them early enough, but we also need to get aid to areas outside Mogadishu where most of the people in desperate need are,” she said. “That is why I am here. I want to make sure everyone understands the depth of this crisis.”
Amos, the highest level U.N. visitor to Mogadishu in many years, emphasized the need for improved security if aid efforts are to increase. It was telling that while Amos was able to travel to the hospital and the presidential villa in a bullet-proof jacket and armored truck, U.N. security restrictions prevented her from visiting any of the camps for Internally Displaced People in the city.
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“I am confident that with an improvement in the security situation we will be able to do more to help those people who desperately need it,” she said after meeting Somalia's Prime Minister Abdiweli Mohamed Ali.
Ali subsequently announced the formation of a 300-member Special Forces unit to protect aid convoys and food distribution in Mogadishu where aid is often targeted for theft by clan-based militias. At least 10 people were killed this month when attempts to distribute food led to deadly shoot-outs and the looting of supplies.