Somalia: Where mercy is in short supply

A "green line" - which is more like a no man's land - is guarded by opposing militia and splits the town into two halves. When MSF reopened the North Galkayo Hospital in collaboration with local doctors in 1997, restarting a service that had collapsed at the start of civil war in 1991, it became the first hospital accessible to all for hundreds of kilometers in every direction. Except for those directly to the south, of course.

"A Somali man shot me in the arm," she says. "I have no idea why." She is not alone. The same hospital has treated more than 300 patients for trauma injuries related to violence in the first six months of 2005. Around 80 percent of these are bullet wounds.

Galkayo, situated in central Somalia, is an important trading town with a population of 80,000. It has all but literally been torn in two. Viewed from the air, Galkayo is a small area of identical metal roofs in the midst of an unforgiving desert. But with no authority other than warlords and no law other than the gun, a dispute between two clans has escalated to the point where people from the southern part of Galkayo cannot venture north and vice versa.

A "green line" - which is more like a no man's land - is guarded by opposing militia and splits the town into two halves. When MSF reopened the North Galkayo Hospital in collaboration with local doctors in 1997, restarting a service that had collapsed at the start of civil war in 1991, it became the first hospital accessible to all for hundreds of kilometers in every direction. Except for those directly to the south, of course.

"We quickly realized that the green line prevented those in the south of Galkayo from traveling the four or five kilometers north to get treatment," explains MSF head of mission Colin McIlreavy. It would be six more years before MSF would finally deem it safe to begin the process of opening a similar hospital on the southern side of the line.

For the majority of the people in Galkayo, to venture across the "green line" - even to come near it - is to risk death at the hands of one militia or another. The latest flare-up of violence took place in April 2005 when a price dispute in the market that straddles the green line escalated into a full-scale battle that left at least 18 dead and 37 wounded, many of the victims caught in the crossfire. The MSF staff cared for the battle's victims.

The division between Galkayo's two factions may seem impassable, but in the hospitals, the suffering is identical. "The needs are huge," explains McIlreavy. "We do over 40,000 consultations per year in the two hospitals but this barely scratches the surface.

"It is not just for residents of Galkayo. People come from up to 700 kilometers away to get medical care, because there is nothing else available to them. Across great swathes of the country there is literally no possibility of access to medical treatment. This is why people come for hundreds of kilometers to reach us in Galkayo. Worst of all, we know that for every person we reach, there are many more who die for the want of sometimes basic care."