The doctor undaunted by Somalia's insurgents

She runs a hospital in one of Somalia's most dangerous areas, but Dr Hawa Abdi refuses to be bowed by clan politics

A doctor tends to children at the Hawa Abdi hospital. The volume of patients means the hospital is sorely overstretched. Photograph: Farah Abdi Warsameh/AP
Aid agencies are still struggling to reach some of the most vulnerable people in areas affected by the famine in Somalia, particularly those controlled by al-Shabaab, the Islamist insurgents.
But getting aid to those hardest hit by the famine is not impossible. Dr Hawa Abdi has been running a camp hospital in one of the most dangerous parts of southern Somalia for almost three decades. Her hospital is located in the lower Shabelle region – one of the five areas identified as famine zones by the UN..
Set up in 1983 in her family's farm, Abdi's hospital was already firmly established when the 1992 famine hit the region. But the current famine is, she says, "much worse [because] aid is not reaching the neediest and most vulnerable".
Speaking from Atlanta, where she is fund-raising for her hospital, Abdi said: "Most of the NGOs that have come back are in central Mogadishu, because it is still too dangerous to come into our area. We are operating here with no support from other NGOs or international bodies; we are in desperate need of help if our work is to continue."
Known to locals as "Mama Hawa", Abdi has become synonymous with hope. When al-Shabaab banned international NGOs from operating in Somalia, her hospital, offering free service and medicine, became the only remaining alternative for the poor.
As one of the first gynaecologists in Somalia, Abdi initially opened a one-bedroom clinic to meet the needs of pregnant women in the immediate area. But with the outbreak of civil war, displaced mothers and children flocked to her hospital seeking medical help and shelter.
The hospital has expanded, but remains woefully overstretched. Only 400 beds are available, but up to 90,000 people have camped outside, many seeking treatment for malnutrition. Victims of war injuries and other diseases are also present.
"This is the most critical moment for us," she said. "We are struggling to cope and to feed all these people. We have seven feeding centres, but more people keep coming every morning and they want to stay. We have no space to accommodate them: we are short on funds as well as staff."
The recent arrival of international NGOs means staff members and volunteers who were working with the hospital have left to seek alternative employment. International aid organisations pay higher salaries.
Abdi's work is supported by her two daughters, also doctors. To fund the hospital they have in the past sold family gold and property. They currently depend on donations to the Hawa Abdi foundation and money sent by Somalis abroad, which is used to buy medicine and equipment.
What Abdi has established within her hospital compound seems like a refuge from the surrounding anarchy. In addition to providing basic health services, Abdi has developed agricultural and fishing projects to encourage Somalis to be less dependent on NGOs. "People should work, we are against handouts," she said. "The long-term solution in preventing another famine in Somalia is to promote self-reliance. Somalia has enough land and a big coast but, because there hasn't been an effective government for over 20 years, we need to educate people on how to use the land sustainably. Our policy is sustainment and development."
Leading by example, the hospital also has a small farm where maize and vegetables are grown. Some of it is sold and the proceeds contribute to the upkeep of the hospital. "The farm's income is only about 5% of the total cost of running the hospital, but it's something," said Deqa Mohamed, one of Abdi's daughters.
Abdi has also banned clan politics and affiliations, which fuel conflict in the country. Patients from different clans coexist in the space provided.
"No clan politics, no man is allowed to beat his wife, that's our policy here," she said. "People value our free service so they abide by the policy."
The ban on clan politics is also a way to ensure the hospital is not accused of favouring one faction over the other, risking an attack by a rival militia group or clan, although this approach has not always worked. In May last year, the hospital was attacked by Hizb Islam, who demanded control over the facility on the grounds that, as a woman, Abdi had to work under their authority. When she refused to comply the hospital was ransacked, two hospital guards were killed and Abdi was arrested. "They held my mother for 10 days," says Deqa Mohammed. "But Somali society and all of our patients stood up for us and demanded her return, so they were forced to release her."
From Guardian