The number of war-injured civilians treated in Mogadishu's hospitals has doubled this year. Mary Braid reports

eyond the Medina Hospital compound, the once beautiful coastal Somali capital of Mogadishu is reduced to ruin and rubble. After 16 years of civil war and a recent escalation in violence, a certain hopelessness understandably hovers.

But inside Medina's operating theatres, the surgeons battle on to save wounded civilians caught up in what the UN recently acknowledged as the "worst crisis in Africa".

On a continent that includes Darfur and Congo, Somalia would really have to go some to earn that tag. And, sadly, it probably deserves the distinction. Carved up by the European powers during the late 19th century scramble for Africa, Somalia's suffering has been a constant. Its people languished under brutal Marxist dictatorship during the Cold War only to find themselves at the mercy of competing warlords when the civil war erupted in 1991.

Supported by the International Committee of the Red Cross (ICRC), Medina Hospital, in the south of Mogadishu, and Keysaney Hospital, in the north, have treated hundreds of adults and children in the past month, shot in crossfire and maimed by shells and mines.

Civil war had already claimed a terrible social price but the past year, in which an unpopular transitional Somali government has been propped up by troops from neighbouring Ethiopia, has seen the numbers of war-injured civilians treated in the two hospitals more than double to 4,269, up to the end of October 2007. One third of the injured are women and children. The whole of 2006, by contrast, saw 2,076 cases.

Last month , hundreds died and more than 170,000 fled the fighting in Mogadishu between Ethiopian troops and Islamists, as well as other Somalis resisting both the transitional government and the presence of foreign troops. Another 330,000 people fled the capital earlier this year.

From his hospital bed at Medina, Dahir Negie Ga'al, describes an incident two days before, amid the endless indiscriminate shelling, street fighting and house-to-house raids, in which he was shot and his brother killed.

"I was hit by a bullet as I was leaving my house," he says. "It was fired by Ethiopian troops. My brother was killed."

Ga'al is both heartbroken and worried. His brother's eight children now become his responsibility and he has a family of his own that he is already struggling to support. "I am not working; my brother was the breadwinner. I'm very tired and it's getting worse, deteriorating day after day.

"There is no security in Mogadishu. There is crisis everywhere. People are fleeing and getting wounded. Everyone is just running away. All my family have been displaced one by one since the crisis began."

In fact, hundreds of thousands of refugees are living under trees just 30 km from Mogadishu another huge concern for the ICRC. The complete collapse of the country has led to anguished pleas from outside observers for international action and a political solution to end the suffering of ordinary Somalis.

That suffering is undoubtedly great. At Keysaney Hospital, supported by the Somali Red Crescent as well as the ICRC, mini bus driver Abdi Nagib, 25, describes the frantic effort he made to save the life of his wounded friend Salad Mohammed Hassan.

"We were crossing the road when my friend was shot," says Nagib. "We rushed to the side of the road but the firing meant we could not get back to him. When he finally managed to crawl to us, we had to push him in a wheelbarrow we found lying around."

The wheelbarrow could not be pushed all the way to Keysaney. It was simply too far away. The injured man's life was eventually saved by a passing driver, who Nagib flagged down and persuaded to take him to hospital.

According to Dr Mohamed Yussuf Hassan, surgeon at Medina, time is crucial for the war wounded. The hard reality is that when someone is injured some distance from Medina or Keysaney, fierce and unpredictable street fighting, and the complete breakdown of infrastructure in battered Mogadishu, can make it impossible to reach an operating theatre in time.

"Most of the time, we manage to save them when they get here in time," says Hassan. "But when people get wounded far away and have to wait many hours because of clashes on the streets then the case becomes complicated and the wound very often gets infected."

The wonder is perhaps that Mogadishu's surgeons do not leave their country as many of their countrymen have and look for a safer and easier life elsewhere.

Hassan admits that his staff have struggled to cope with the rise in wounded civilians in recent weeks. "It has been hectic," he says. "The work was overwhelming in a situation where everyone was so tired and we didn't have the possibility of replacing personnel because we have very few staff."

Nonetheless, he is matter-of-fact about the heroic effort he and his medical team are putting in. "This is our job, to save lives," he says simply.

At Keysaney hospital, surgeon Ahmed Mohamed Ahmed says Somalia has lost many doctors in the years of conflict. Some fled the fighting, others were killed. The capacity of his hospital is 65 patients but at times it treats 300.

"In the last 15 years we have saved many lives and we are ready to continue," he says. "I'm really happy to stay here and help my people as well as the staff of the hospital."

What does he wish for? A new operating theatre and repairs to the wards and ventilation. But above all else he wishes for an end to war.

"I wish peace for my country because everyone is very tired of treating all these patients with gunshot wounds," he says. "We would just like peace."