Somalia, where access to basic health services is a luxury for most

© Alexander Glyadyelov

Whenever the East African Air 'Grand Caravan' airplane chartered by Médecins Sans Frontières (MSF) lands in Dinsor, it is hard to not hear it. The aircraft circles above the quiet looking town for a few minutes while the pilot carefully checks that the air sock standing next to the airstrip has been pulled up. A discrete signal that the place is secure and that the plane can land safely.

Lost in the middle of Bay province in south west Somalia, the small city with its 20,000 strong population is a significant crossroads and marketplace in the region. Regularly, large herds of camels are gathered here before leaving for the capital, Mogadishu, where they will be sold at higher price.

Further north, the regional capital Baidhoa continues to be in the news with recent clashes between fighting clan militias and with probably more to come. This is the reality of Somalia as it stands, a country riddled with violence, always vulnerable to local and regional fighting while the fragile peace process continues to suffer regular blows. A stateless land with no central government where the power remains in the hands of local administrators who follow clan rules and laws to support their authority in their attempt to maintain law, order and relative tranquility.

© Alexander Glyadyelov Click for large view

In this context of isolation, MSF volunteers assist people who have been greatly weakened by 14 years of war and chaos, and during which time a sanitary desert has emerged and remained throughout the country. Government health structures and administration have collapsed due to a lack of financial resources as well as trained human resources and can not provide any kind of medical assistance to people in need. In a land where the infant and mother mortality rate is one of the highest in the world, and where tuberculosis is rampant, it leaves a bleak picture.

Left with nothing other than their often meager family resources, Somalis are resorting to buying medicines of mediocre quality from some unscrupulous local pharmacists. The frequent absence of qualified medical personnel also pushes them to consult traditional healers who are almost entirely incapable of addressing most illnesses, fractures, open wounds and the numerous obstetrics complications that occur.

The end result of that disastrous situation is a regular influx of patients in serious medical conditions who land at the door step of our facilities, a situation that does not leave Fatuma Aden Gedi unmoved. A Somali Kenyan expatriate nurse and midwife working with MSF in Dinsor for the last eight months, Fatuma is struggling to hide her exasperation when she sees all the young pregnant mothers in troubling condition who come to her, desperate for help.

© Alexander Glyadyelov Click for large view

"It is unfortunately not uncommon to see young pregnant women who arrive at the hospital too late," she says. "They often travel long distances to get here and most of them have seen a traditional healer and a local pharmacist. The result of treatments received from these 'practitioners' is sometimes catastrophic for the health of these patients. More often, it has not had any impact other than wasting precious time."

Somali women start giving birth at an early age. Many of those who come to hospital have already been pregnant seven or eight times by the time they are 25 years old. They remain more fertile than other women because they breastfeed for only short periods after birth. They also take better care of the child they carry than the one they have just delivered, resulting in malnutrition cases among infants.

Convincing patients about the necessity for treatment and respecting instructions is one of the most challenging task of the medical staff. In this respect, tuberculosis, one of the infectious diseases that continuously ravage Somalia, is one illness that is of great concern to the staff. Fatuma explains that in order to prescribe a treatment, it is imperative to know if the patient has already followed one before.

"It is common to find patients who have already been taking a treatment for two or three months - medicines they bought from the local chemist," said Fatuma. "They usually stop when they start feeling better or when they run out of money. But they are far from cured. We must then prescribe a TB treatment for those patients over a longer period of time, sometimes even up to nine months. It can be very long for some and we try to do that only when we are sure that the patient will be disciplined enough to follow the treatment until the end."

© Pep Bonet Click for large view

A new building will soon be under construction for the TB patients who require hospitalization. In the meantime, they stay under semi-temporary structures in the hospital compound. A small group of patients who do not have relatives in Dinsor and who are, for the most part, disabled, stay in shelters on the outskirts of town. Every day, a team of medical staff goes to visit them to provide their medicines and a pack of biscuits.

The majority of TB patients though, come everyday to receive their treatment from the hospital nurses. Hussein is one of them. A school teacher by profession, he was able to go back to teach his pupils a few months ago.

"They do not know that I am a TB patient at the hospital, there is a stigma attached to the disease," he said. "But what matters most is that I am back at work."

He is healthy again and that makes him very happy.

"When I started the treatment, it was really tough," Hussein said. "I could hardly walk but today I feel much better, I can work and I have tested my discipline with the constraining treatment."

For some in Somalia, there is a good reason to hope that the future will look better. Inch Allah. However, for most of the country, it will probably have to wait a little longer.