Mogadishu's theatre of death

DIGFER Hospital, Mogadishu, was a hospital without beds. Its last allocation was looted during the civil war, along with all the hospital equipment.

The Somali administrator decided to insist that patients bring their own beds. Now the hospital has around 700, though some are simply filthy mattresses on the floor and some are only blood- soaked pieces of cardboard beneath a worn blanket. One of the hospital rules, which like all the others is made to be broken, is that when patients leave they cannot take their beds with them.

Hassan Hassan Mohamed did not have a bed. He was lying on a mattress in the hospital foyer, with a criss-cross of gauze covering his chest, and a host of flies there, too, drawn to the gunshot wound that the dressing failed to cover. Conditions are monstrous at Digfer, but rarely in the way they first appear. Hassan, 23, is lying in the foyer not because there is no room in the wards, but because, according to some, he has no family to bring him food and needs to rely on the pity of visitors. But, according to others, the clan and family groups in the wards will not allow him in their ward, and, while doctors return him to a ward each day, he always appears in the foyer the next morning.

In casualty, a young man on a table is screaming. There is a bullet hole in his right leg. The nurse says that here minor surgery is carried out - tracheostomy, drainage, sometimes amputations. In the surgical intensive care unit most of the patients have abdominal injuries from gunshots. A woman fans her brother who lies under a blanket with a faded rose pattern and a more obvious pattern of bloodstains.

These patients are sick but they are also angry. They are not pleased to be visited by strangers. As we were about to enter one ward, Dalmar Mohalli, the head of personnel, advised us against entering. 'There is a civil war,' he says. 'The patients have guns.'

We made for the operating theatre, the entrance to which was guarded by a man with an AK-47. In the days when the International Committee of the Red Cross (ICRC) worked at Digfer, young men used to appear and order doctors at gunpoint to operate on their relatives first. The doctors left.

Dr Mohalli took us past the armed guard, into a corridor with theatres on either side. On the floor were blood-soaked swabs and bandages. The theatre to the right was for abdominal operations. It was empty as the hospital had run out of the necessary drugs. To the left, an operation was in progress. Dr Ali Hassan had opened up a man's leg, neatly folding the flesh back each side, and was carrying out an internal fixation, hoping to make amputation unnecessary.

The patient had been given a spinal anaesthetic and was fully conscious. He agreed to talk as the doctor worked. His name was Kamilo Mohamed, and he spoke loudly in favour of Somali doctors, one of whom was working on his leg. 'Somali doctors are better than IMC (International Medical Corps),' he said. 'They are very clever doctors. I had two operations before Dr Ali Hassan and they made nothing. Dr Ali Hassan is our great orthopaedic surgeon. He has saved many people from amputation. He is always available, and no one pays him.'

Later, Dr Mohalli complained that the ICRC had stopped supplying the hospital with medicines and equipment. Infections were spread among the patients, from one wound to another, by equipment the hospital could not sterilise.

The ICRC says medicines disappear from the hospital, and suggests this is related to the fact that none of the staff gets paid. They have said they will help if they get figures on the hospital's needs, to which they can relate quantities of medicines supplied. As yet, they have not received any figures.

(Photograph omitted)