If there is a hell on earth, it would have to include the Dikfeer Hospital. Nothing from Dickens or even Dante prepares one to enter Mogadishu's only operating medical facility. It is nothing short of an abomination, an offense against humanity.
Yet it is what Somalis have. Its staff tries to ignore the stench, filth and lack of what other hospitals would consider necessities. Some people even emerge alive.
The first assault on the senses is the smell, an indescribable stench of rotting flesh, putrefaction, soured blood, urine and death.
The first thing a recent visitor saw upon entering the massive, war-battered building was a cloth-covered lump on a table, set against a wall, splattered with what appeared to be dried blood.
A woman sat next to the table. She reached her arm toward a stranger. She said nothing but her eyes spoke of fear, grief and pleading. Her daughter lay beneath the gritty cloth, dead of malnutrition. Both mother and her dead child were ignored.
The first sound here is wailing grief, not from the patients but from relatives who seem to anticipate the death of their children, their parents, their spouses.
There are no lights in the Dikfeer Hospital. No air conditioning in the 100-degree heat. No running water. There is no electricity. There is no kitchen so there is no food for the patients unless relatives bring it. People starve in this hospital because no one can or will bring in food.
There are heroes here. They are the doctors and medical personnel who work through the worst of conditions, and sometimes their own ignorance, to try to repair the result of Somalia's insane civil war and its man-made famine.
One of these valiant individuals is an American, a 42-year-old surgical assistant from Los Angeles named Raymond Delille. He came here 15 weeks ago, after joining the International Medical Corps, a worldwide organization that sends doctors and other medical aides to treat the world's poor.
Delille, a burly black man with graying hair, said he views his work here as a mission and "I decided to make my mission in Africa. I didn't know what to expect when I got here," he said in a deep, deliberate tone. "It was filthy. People, refugees, were literally living in the halls. It is pretty clean now."
The first thing he learned was that he would have to go well beyond his specialty--pediatric cardiology. Just how far he has ventured is illustrated by the underlined book he carries in his hip pocket. It is a paperback version of "The Dictionary of Surgery."
"I (deal with) everything here; gunshots, starvation, you name it," he said.
Delille and the staff doctors are proud of their work, a pride that seems to have cast a shadow over the reality of this nether world.
"The surgery department is, for the most part, sterile," Delille said as he walked a reporter through garbage-strewn halls into an operating room, where a doctor and nurses were treating a young boy suffering from gunshot wounds in the right shoulder and stomach. The floor was sticky. The odor was rank. No one wore masks; the window glass was blown out; there were flies all about.
The boy was awake, undergoing treatment with only a local anesthetic because that was all that was available. "He'll be all right," said Delille. "He'll be in post-op for a few hours, then we'll move him into the recovery room."
His words were those used in a normal hospital. But as he opened the doors into those rooms, there was nothing to see except the numbing inadequacies. One grungy room looked like all the rest--no equipment, just dirt and disorder.
Dr. Mohamed Hussein, the hospital's deputy director, said it is difficult for the International Medical Corps to provide enough supplies. Sitting in his office, the only room in the hospital served by a generator and air conditioner, he said the hospital had been the site of vicious fighting during the civil war. "We lost everything but we have never closed," he said.
"Sometimes it is frustrating and it's always exhausting" to work here, Delille said, "but it is so rewarding that it overcomes frustration and exhaustion."
He is to stay another two months but noted, "Sometimes I wonder if I'm going back. . . . We really practice medicine here. We have no diagnostic equipment, none of the tests we rely on at home. It is primitive, on the one hand. But that means you have to fall back on your own skills, your own knowledge. You can't blame failure on a machine."
Delille's supervisor for the day was Dr. Abbas Hassen, head of emergency services. During a tour of his section, Hassen told of the success he has had in saving gunshot victims. "We are as fast and good as anyone," he asserted. "Maybe it's because of all the practice we get." He estimated that as many as 50 people a day are brought in with bullet wounds. "Sometimes it goes into the hundreds."
The tour ended with a visit to Kaiffio, a 12-year-old country girl to whom Delille was clearly devoted. Kaiffio is one of the reasons why the American Marines are in Somalia. She is typical of every skeletal child shown on American television, her skin pulled taut and dulled by hunger. To her misery, add a bullet in the stomach, the result of standing in the way of a gunman.
"She came to us 45 days ago," Delille said, "and she's gone through everything but cardiac arrest. Renal failure. A collapsed lung. Infections. And bed sores."
She lay on her back, making no sound and dully watching the visitors. Her mother sat at her side, trying to keep away the buzzing black flies with a whisk. "It is a cultural thing," Delille said. "They don't want to move her because they think she should be still. So she gets bed sores and it slows her recuperation.
"And she doesn't want to eat, even though she's starving. It may be that she's afraid to ask. It wasn't until yesterday that she even asked for water. I think she'll make it," Delille said as he ran his hand gently across her forehead. "She drank some milk this morning."
Perhaps so, but that isn't always a blessing. "I think she should be allowed to die," said one of Kaiffio's older sisters. "We have no money and no more food. We can't afford to stay here. She should die."