The 'Angel of Mogadishu' who raised a hospital from the ruins of war

As fighting was at its fiercest, doctor Aisha Omar Ahmed returned to her homeland to salvage the wreckage on the front line

Reopening the San Martino hospital in the Somali capital Mogadishu has been a largely thankless task for Dr Aisha Omar Ahmed. Instead of earning a tidy living as a consultant obstetrician in Europe, the hospital director has been working mostly unpaid and in appalling conditions.

Since quitting her medical career in Rome to return home to a city and country at war, the 44-year-old has been threatened, beaten and shot at. So far she has chosen to stay.

"I was watching Somalia for 20 years in the headlines. I saw the [wounded] children brought to Italy for treatment. I was always thinking about this country," she says.

The San Martino is barely recognisable as a hospital. A cluster of wind-blown Italianate ruins overlooking the Indian Ocean near the old port, it has long since been overrun by squatters fleeing the destruction elsewhere in the capital. The wards and operating theatres, laundry and clinic have been variously shelled, occupied or looted. The new residents at the facility did not welcome the arrival three years ago of a young doctor with big plans for restoring their adopted home.

In her small office dusted with crumbling plaster she sits behind a spartan desk and makes light of her circumstances: "As you can see I am very poor." There is only one ward with 30 beds. The rest of the complex is a camp for IDPs – internally displaced people – who have resisted eviction.

The hospital's patients, many of whom have gunshot wounds, have only Dr Ahmed and a handful of nurses to care for them. The rusted metal beds are in a ward with a collapsed ceiling where the sea breeze blows through holes in the wall. The floor is scattered with cardboard prayer mats.

Not everyone supports her efforts. Some of the squatters have day jobs as police or soldiers, she explains, which means that rows at the hospital can involve facing down men with guns. In the yellowing corridor outside her office she points to bullet holes punched through the rotten wood of the ceiling as evidence of past tussles.

While admitting she has thought of giving up, Dr Ahmed insists that San Martino must become a hospital again. "I am a Mogadishu person. I was born here. My mother was born in this hospital. This is our place."

Her family wonders whether she has lost her mind. She is the daughter of a wealthy Somali family – Dr Ahmed's father was minister of finance under the socialist dictator Siad Barre, the last time Somalia had a functioning central government before war broke out in 1991. He died during the civil war that followed. Today, most of her relatives live in London and think she is crazy to risk her life in a notoriously dangerous city.

"My brother is telling me that I'm mad," she says. "My mother can't believe I'm here in the hospital where she was born."

When the Somali medical student put her studies on hold to return to her home city for the first time in 2006 the trip was traumatic. The port and airport were closed due to heavy fighting, which meant landing 100km outside the city. At the time Mogadishu was under the control of the Islamic Courts Union (ICU), an Islamist alliance which drove out the warlords who had fought over the Somali capital since the early 1990s. Dr Ahmed chose to live and work at the foreign-funded SOS hospital in the city and was on hand to witness the death of an Italian nun, which prompted the evacuation of all foreign aid workers. The suffering she witnessed stayed with her after her return to Italy and when she finished her PhD in Rome she decided to go back.

Dr Ahmed returned just as the fighting was getting to its worst in 2009. By then, the battle for the city was being waged between African Union peacekeepers protecting the UN-backed transitional government and al-Shabaab, an extremist offshoot from the Islamic Courts. The radical militia had won popular support in Somalia when Ethiopia invaded in 2006 with US support to topple the ICU. The Ethiopian occupation was fiercely resented in Somalia, radicalising what had been a moderate country.

The San Martino was so close to the front line of the fight against al-Shabaab that the hospital director had to be taken to work in an armoured convoy. When asked what equipment the hospital has, the answer is "zero" or next to zero. There are two ultrasound machines, both of which Dr Ahmed brought from Italy. For medicine, food and fuel she gets by on hand-outs from the African Union mission, Amisom. The doctor says her motivation for continuing the struggle to re-establish San Martino has been the plight of her country's women.

The destruction of Somalia's health infrastructure combined with the widespread practice of female genital mutilation has left the country with the highest maternal mortality rate in the world. In rural areas all girls are cut between the ages of three and seven, often leading to complications during childbirth. The doctor estimates that one in five mothers suffer from obstetric fistula – a tearing of the passageway between the bladder and the vagina normally resulting from birth complications.

Her reward comes in the form of a dozen young women sitting in a makeshift classroom near her office. Known as "traditional birth attendants" the ladies often act as midwives and FGM cutters in their home communities. They are now the first graduates of a scheme that the director hopes can help to change conditions for women. They have been schooled in basic hygiene, given a stern lecture on the ills of FGM and dispatched with some sterile gloves and the offer of $10 per referral to the capital – paid for by a local mobile phone operator.

The overawed women sit in silence as she tells them they are expected to "go back to make a difference in their village". The San Martino's director is a tough woman to argue with.