The main hospital in Somaliland is short on supplies due to the escalation of fighting

Somali troops have repeatedly fired mortars targeting and destroying buildings at Las Anod General Hospital

Las Anod, Somalia — Eight months after conflict between the armed forces in the breakaway state of Somaliland and the local Dhulbahante militia in Las Anod, Somalia, hospitals in the conflict-torn city are working furiously to provide lifesaving supplies.

Although the conflict had been reduced to a stalemate, as neither the Somaliland troops nor the Dhulbahante militia were able to decisively change the balance of the battle, the Somalilanders continued to indiscriminately attack the civilian area of ​​Las Anod with mortars and artillery.

On July 8, after the Las Anod General Hospital was subjected to fifth sporadic shelling in a six-month period by Somaliland troops, the international aid organization Doctors Without Borders (Medecins Sans Frontieres, or MSF) announced that it was ending support for the hospital because it was too dangerous to work there.

The latest attack injured seven hospital staff and three nurses but did not cause any casualties, hospital staff said. It also caused “very, very significant” damage to the facility, leading to MSF’s “very difficult” decision to withdraw its staff and support, said Dana Krause, the organization’s representative for Somalia.

“Ultimately, when situations become unpredictable and hospitals are no longer a safe place and patients are no longer safe, it becomes a problem. [to keep working],” he told Al Jazeera.

The fighting started earlier this year, after protests against Somaliland’s control of Las Anod developed into an independence movement by the local Dhulbahante clan. Somaliland claims the city as part of a country that declared independence, based on British Somaliland’s pre-1960s colonial boundaries, while the Dhulbahante clan sees the city as the capital of what they will create SSC-Khaatumo, within the Federal territory. Somali government.

Early in the conflict, mortar and artillery rounds disabled the hospital’s solar panels, paralyzing the blood bank and operating theaters. In response, doctors and nurses went to the adjoining medical university to continue emergency treatment for the victims brought in from the battlefield.

Local volunteers said they were trying to find stronger, concrete buildings to operate in but were unable to place hospital beds and medical equipment in potential locations. With MSF’s withdrawal, they will continue to operate within the Somaliland strike range.

Las Anod General is the only public hospital in the city and a center for casualty collection and public health care. There are four small private hospitals in Las Anod treating the injured, including a women’s and maternal health clinic which has been converted into a trauma ward. In addition, classrooms at Nugaal University have been used as recovery rooms for wounded soldiers.

Somali troops have repeatedly fired mortars that have destroyed buildings at Las Anod General Hospital [Paul Stremple/Al Jazeera]

‘great war’

Krause mentions the dangers both for patients who feel unsafe going to the hospital for treatment and for the staff working on site. The withdrawals mean the loss of 13 staff, he said, although not all of them work at the hospital. Some of them remotely support MSF’s mission at Las Anod.

At the hospital itself, the organization pays the salaries of doctors and surgeons working for the Ministry of Health and funds medical supplies such as equipment to treat battlefield trauma. MSF plans to make a final “massive” donation of supplies to the hospital before departure, including standard war trauma kits.

Dr Ahmed Abdi, director general of the hospital, said he hoped local staff would remain at the hospital, working as volunteers. Abdi was among those injured in the July 8 mortar attack although he assumed his injuries were only minor – from a small shrapnel in the leg. His main concern is what happens if hospital supplies run out.

“Currently the big challenge we face is the provision of medicines and even food for patients,” he said. “Not enough supplies. We are in a major war, and in the next few days, if there is a serious battle, 200, 300 wounded will deplete our entire supply.”

Fighting has been sporadic in recent weeks without major clashes, but the city remains under siege and the economy has almost stalled. Food and supplies were trucked in from neighboring Puntland on the arduous journey to escape the fighting by snaking along dirt roads in the Somali interior for hours in heavily laden trucks stuck in the mud or crunching through carved ravines.

Despite the challenges, the trip was essential for the delivery of supplies. All the private hospitals in Las Anod have raised funds to keep their shelves stocked with everything from medicines to bed sheets, which must be shipped from Garowe, the capital of Puntland.

Call for support

Donations came from businesses and community members across Somalia, but most of the funds were collected from abroad. Diaspora Somalis have organized via social media to purchase supplies and ship them to Las Anod.

Aliya Fardus, a nurse working in London, traveled to the conflict zone soon after the outbreak of fighting. Her family is from Las Anod, and although she spent most of her life abroad, she now manages the logistics of a private hospital.

And she has donor fatigue.

“What we are worried about is supplies and food, only basic needs,” said Fardus. “After eight months of war, when we raise money from civilians who may not have much money, the amount of donations has decreased.”

He estimated that meeting the needs of Las Anod General, the largest hospital in the region, would require a 50 percent increase in materials and, consequently, donations. This means not only medicine but food and care also for those injured and recovering in hospital.

Normally, families are prepared to cook for their relatives in the hospital, but with the majority of the population displaced by the fighting, Fardus has had to employ nearly 30 staff to meet basic needs such as food and laundry – all of which require medical assistance. funding.

After leaving Las Anod General Hospital, MSF will shift its support to Kalabaydh, a nearby town where thousands of Las Anod residents have fled and are struggling to access food, water and medical care in makeshift camps.

Local clinics are overwhelmed with the influx of new residents, and now MSF will work to provide emergency health services and maternal support to the refugees, most of whom are women and children.

The conflict has been condemned by the UN Security Council, and Amnesty International has called for an investigation into Somaliland shelling of hospitals and civilian areas – a potential crime against humanity – but even after eight months of fighting, the Somali government has not done so. nor international actors did not intervene.

With no sign of ending, the biggest victims of this conflict are still civilians. Drought continues to hit the Horn of Africa, and even if vulnerable groups of women and children do get food, the lack of adequate medical care will have dire consequences.

In Las Anod, volunteers like Fardus do the best they can, but they can’t work here forever. The state that will become the new state, SSC-Khaatumo, recently transitioned from a transitional governing council to an elected leadership of 45 people.

“They are trying their best,” said Fardus, “but this is not something civilians can cover up.”

The state was unable to tax the beleaguered capital with few inhabitants and few businesses, and with the city’s water and electricity cut off, the chances of financing a hospital were slim. Fardus had planned a trip overseas to raise funds directly from donors but didn’t have time to leave the hospital that was in dire need of help.

“I’m doing this work myself with the support of the diaspora, but I have to leave it to them and show them how important this is,” he said. “I will not be able to continue without support.”

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