CHOLERA PATIENTS IN A SOMALIAN PRISON.
Wajid, Somalia. March 2017
Photos and text by Giles Clarke for United Nations OCHA.
Through an imposing gated entrance, a crumbling building stands baking in the sun in a dusty courtyard. For months, hundreds of people stricken with cholera have come here to receive emergency treatment. But, this building is no ordinary hospital; it is a former Al-Shabaab prison. Here, patients too sick to move stay in rooms that not so long ago were used to keep prisoners.
Despite progress made on the political front over recent years, the humanitarian situation in Somalia grows more dire by the day. Severe drought, insecurity, and violence have plunged millions of people into desperate circumstances. A staggering 6.2 million people — around half of the country’s population — need humanitarian assistance to survive, and the United Nations regional representatives have warned that famine may occur if urgent action is not taken.
In early March 2017, I was assigned by OCHA (the UN Office for the Coordination of Humanitarian Affairs) to cover the worsening severe drought situation that was steadily unfolding throughout most the East African region. I had arrived in Mogadishu a few days earlier with Stephen O’Brien, the current Emergency Relief Coordinator and head of OCHA. O’Brien had just toured the other affected countries in the region, and told press when he arrived in Somalia that the world was facing the “largest humanitarian crisis since the creation of the United Nations”, with more than 20 million people facing starvation and famine across four countries.
After a couple of days of photographing drought relief sites in and around Mogadishu, I was invited to join UN aid workers on a flight that would take us some 300 kilometers inland, deep into the Somali desert. At the heavily protected UN Humanitarian Air Service terminal located a few kilometers away from the main center Mogadishu, we were given a comprehensive security briefing, and supplied with protective body armor to be worn on the ground. Attacks against aid workers are unfortunately not uncommon in Somalia. In 2013, a devastating attack on a UN compound in Mogadishu killed 13 people, including one UN staff member, three contractors and four security guards. Just this past February, an attack on a market left 40 people dead.
As we took off in an 18-seater Turboprop plane, the long-troubled city quickly disappeared behind us as we sharply veered away toward the vast expanse of the scorched Somali desert.
On the plane were a host of humanitarian personnel from the World Food Programme, OCHA and UNICEF. This was one of the many emergency assessment trips humanitarian partners have made to the worst-hit regions in the Somali interior, an area riddled with violence and armed groups, most notably Al Shabaab. The town of Wajid, itself a former Al Shabaab held town, was liberated by Somali Armed Forces and Ethiopian AMISOM (African Union Mission in Somalia) forces in March 2014. It is still deemed too dangerous for aid truck convoys to travel here by land, so critical supplies have to be flown in by air, which is considerably more expensive.
As we flew deeper into the interior, the marks of the country’s drought — which has entered its third consecutive year — became increasingly obvious in the landscape. The short rain season at the end of last year brought below-average rainfall, with central and southern Somalia receiving a mere third of normal levels. Experts fear that the next rain season, starting this month, will not be much better.
In a country where 60 per cent of the population relies on agriculture, livestock and fisheries, this lack of rainfall has dealt a massive blow to the country’s economy, and is threatening people’s very survival. Millions need food aid to survive, including over 360,000 children under the age of 5 who are acutely malnourished, meaning that they will die soon if they do not receive urgent treatment.
According Laurent Bukera, the Head of the World Food Program in Somalia, the current situation and humanitarian effort has evolved considerably since the last famine in 2011, which killed over 260,000, yet remains a formidable task. “The towns in this area are often cut off from the rest of the country so in many ways, the most vulnerable and challenging. Many of the local agricultural livelihoods have gone, much of the livestock is dead and local food supplies and regular trade is depleted. Couple the difficult access due to security along with the mass-movement of people, we need to constantly assess the situation. Remote towns like Wajid, are struggling with people are pouring in every day from villages all over the region in search of food.
Just over an hour later, we dropped down onto a rough, bumpy airstrip on the outskirts of Wajid. In the blistering desert heat, we were met by a local security convoy, who took us to a local government administration building in the center of town. After meeting with local officials to talk about security, aid and access issues, the humanitarian team was escorted to various locations around town to assess the work of local organizations and UN agencies.
The first location we visited was a former hospital. The enclosed compound provides a little more safety for the hundreds of women who have gathered to register for assistance. Many of them have walked for hours with young children to reach this site, where they are given water, biscuits and some shade before being fingerprinted for assistance cards, and medical aid for their children.
Looking around at the hundreds of people gathered in the walled enclosure, some sitting in the shade underneath acacia trees, others squatted in groups in the open, I was struck by the noticeable lack of men. Around 440,000 people have abandoned their homes so far this year in search of food, water and other assistance. The majority of those displaced are women and children, since men tend to stay behind to protect the family’s dwindling herds. On the road and separated from male family members, women and children face serious risks to their safety, including rape and forced recruitment into armed groups.
After leaving the registration center, we walked through the town toward a drab stone building. A doctor, dressed in a bloodstained and soiled white coat, wearily greeted us as we walked into the silent courtyard. Many of the aid colleagues split off into various directions. Speaking to the doctor, I soon learned that we were in an abandoned prison with cells as makeshift cholera wards.
I walked into a crumbling cell nearby and, as my eyes adapted to the dim light inside, I noticed four eyes peering up at me from the corner of the room. Two very young children sat motionless in the dirt, both stricken with cholera. Their tiny bodies were filthy, their crude bandages blackened with dust, blood, and dirt. Opposite on a low wooden slatted bed lay their mother, also completely still, but quietly keeping her exhausted eyes on her children.
In another cell nearby, I met an elderly lady sitting in a plastic chair. Next to her, a relative was covered in a blanket, having died from cholera earlier that morning.
As I looked around the room, the history of this place was hard to ignore. The building was used by Al Shabaab forces as a prison until 2014, and evidence of torture and blood lined the walls and floor of the cells.
Leaving the room, the doctor told me that the number of patients have increased over recent months, and are quickly overwhelming the hospital’s limited capacities. Basic supplies like IVs are dwindling, and hygiene is virtually non-existent.
The drought in Somalia has contributed to a renewed outbreak of cholera. As water sources dry up and disappear, people are faced with a hard choice. Either they buy water at prices that are largely out of reach in a country ranked the fifth poorest in the world, or they resort to unsafe water sources and risk of contracting cholera or some other waterborne disease. Since the beginning of the year, the UN has registered more than 18,000 cases of acute watery diarrhea (AWD) and cholera, and there is concern that this number will increase substantially with the start of the next rainy season.
After what seemed like a few short minutes, I was reminded by one of our security advisors of our time pressures. “Al Shabaab will be informed of our presence already,” he says. “If we stay in one place longer than 25 minutes, they can mobilize to our position.”
As I walked quickly through the remaining makeshift wards, I photographed as many of the victims as possible. I did not have time to process what I was seeing, but looking back on the images today, I am haunted by their desperation, etched deeply in their sunken faces, now seemingly resigned to this debilitating disease.
As we made our way out of the prison, I began to feel a sense of panic and hopelessness. I wanted to stay and speak longer with the doctor who, so clearly devoted but utterly under-equipped, was keen to share this terrible situation with the outside world. In a town such as this one, where foreign journalists are a rare sight, I felt his complete despondency as I looked at him while leaving. Given the opportunity, I would have stayed with him all day, but in these high-risk security locations, it is likely that our presence would not only endangered him, but also those under his care.
We somberly boarded our small plane, and began the two-hour journey back to Mogadishu. While I have photographed a lot of different crises, this visit to Wajid has firmly lodged itself in my mind. With limited humanitarian access and continued insecurity, there is little end in sight for the people sheltered in this town. And as we flew over other regions, I am reminded that Wajid is but one place in a country that is widely affected by crisis.
With over half of the Somali population of 12 million now facing the risk of famine, and the growing threat of a cholera epidemic looming on the horizon, there has been no more urgent time for action.
Text and Images by Giles Clarke/Getty Images Reportage from Wajid, Somalia. March 2017. (Support provided by @UNOCHA @UNICEF and @WFP)
