For every bomb and gun attack that rocks the Somali capital, Mogadishu, there’s one small bright spot – the largely volunteer ambulance drivers and medics that rush to the scene to rescue survivors, risking their own lives in the process.
Aamin Ambulances, the largest free ambulance service in a city of three million people, is often among the first to arrive. Funded almost entirely by Somali businesspeople and well-wishers, it has been running for the past 17 years, its longevity testimony to the need it fills.
Its founder, Abdulkadir Abdirahman Adan, is a former dentist who returned to Mogadishu in 2006 after qualifying abroad. It was a period of intense urban combat between US-backed Ethiopian forces and the Islamic Courts Union, whose youth section would eventually become today’s jihadist insurgent group al-Shabab.
Determined to save what lives he could, Adan spent all his savings on a second-hand minivan that became Aamin’s first ambulance. The service has since grown into a fleet of 16 working vehicles, with a team of roughly 20 drivers and paramedics. The only other free ambulance service is provided by the Somali Red Crescent Society.
“We have come a long way,” laughed Adan, showing a picture of himself posing in front of the first vehicle. Aamin, which means “trust” in Somali, now has a 999 hotline that operates 24/7. In August, the emergency crews were called out to attend to 175 cases.
The day shift
It’s 8am and the day shift has begun in a dusty compound off a small backstreet. The first task for the drivers is to inspect the vehicles to make sure they are in running order. They are all second-hand, but some are in better shape than others.
From this central station, most of the ambulances will leave to wait in front of the city’s health centres, ready to respond to cases needing immediate hospital care. Some Mogadishu hospitals have their own ambulances, but they charge for a call out – except in the case of a terrorist attack.
Most of the emergencies Aamin attends to are linked to child malnutrition or pregnancy complications – extremely common in Mogadishu, where poverty levels are high, especially among the 400,000 people who have been driven from their rural homes by war and drought and have squeezed into the city’s informal settlements.
This morning, Sabir Rashid, 26, is taking a nine-month-old baby to Banadir hospital. It’s one of four public hospitals in Mogadishu, but the only one with a paediatric unit.
The child, weak and listless, weighs barely five kilos – he should be at least two kilos heavier. His mother, Saadiya Sidow Ahmed, had taken him to a nearby clinic for treatment, but the nurse on duty told her he was dangerously malnourished and needed to be in hospital.
“Did you bring clothes for him?” Rashid asked as they got into the ambulance. A stressed Ahmed snapped back: “Do your job, I’ll do mine… And don’t put him on this stretcher. I’ll hold him.”
It’s a short three-kilometre drive to Banadir, and the ambulance is waved through a series of checkpoints made of heavy blast-proof concrete blocks, manned by armed soldiers.
Although al-Shabab was ousted from Mogadishu in 2011, it still has an underground presence in parts of the city and has launched numerous high-profile bombings and assassinations. Last year was one of the deadliest years on record.
After nearly three decades of war, and repeated climate disasters, Somalia remains mired in humanitarian crisis. Eight million people – half the population – are dependent on the relief that aid agencies supply. Yet Somalia still has one of the world’s highest maternal mortality rates, and half of all children under five are acutely malnourished.
At the hospital, Doctor Ibrahim Sraj looked over the infant and quickly arranged for his transfer to the malnutrition ward. The priority, he said, was to get his weight up. Then, “if there are no complications, we will provide Plumpy’Nut [a peanut-based nutritionally rich paste] for him, and he will be followed on an outpatient basis,” he told the New Humanitarian.
There’s nothing more Rashid can do. “I hope he will be fine,” he said, walking back to his ambulance.
Rashid has been a driver with Aamin for more than five years. It’s his first job and, like most of the crew, he sees it as something of a calling. “I’m proud of what I do. I serve my people,” he told The New Humanitarian.
Aamin operates on the slimmest of budgets. There is no government help or direct financial support from donor countries, although that would be welcomed, said Adan. When he first launched the service, he asked university students to donate $1 “to save a life”. This Somali-based philanthropy has become central to its identity.
Aamin can only afford to have a handful of salaried staff on its books, with most drivers getting paid a small stipend, but only when enough money has been raised to cover fuel and medical supplies. It’s such a shoestring operation that drivers – although trained on first aid – often go out on their own, without paramedics.
It’s the al-Shabab shootings and bombings – designed to create maximum carnage – that are the biggest challenge for the emergency services. Mogadishu, the seat of the federal government and base of international aid operations, is the target of the majority of urban insurgent attacks.
One of the deadliest was in October last year, when two car bombs exploded minutes apart at a busy intersection outside the ministry of education. The second blast went off as medical teams began arriving. All told, 121 people were killed, and hundreds injured.
Rashid’s ambulance – one of four dispatched by Aamin to the scene that day – was hit by the second bomb. “There was a blast, and I was thrown out of the vehicle,” he recalled. “I found myself on the ground, unconscious. I woke up in the hospital.”
He had been carrying eight survivors from the first explosion. “Some were seriously injured, but they were all alive,” he said. “Then, they were all dead.”
Since the launch of the Aamin service, two drivers and a paramedic have been killed in the line of duty. Yet staff typically shrug off the risks with patriotic bravado. “What we see often breaks our hearts,” said ambulance driver Abdulkadir Abdulahi. “But however bad the situation is, I’m here to help my fellow citizens.”
The personal cost
Rashid was seriously wounded in the October blast, with shrapnel splattering his leg and genitals. Adan covered his medical bills, but he still walks with a limp, and suffers from flashbacks.
A father of five, he lives with his family in a rented two-room house made of corrugated iron in one of Mogadishu’s poorer suburbs. Rashid hopes that one day he might get a salaried position in the Aamin team – the privilege of only the most senior drivers.
In the meantime, when he does get paid, he earns around $180 a month. His rent alone is $100, and there are some tight months when he receives no money at all. “Then we have to buy food on credit, or we ask our parents to help us out,” he explained.
Rashid’s mother, Halima Hagi, is proud of the work he does, but worries for the future.
“He’s a good father, but he hasn’t been able to pay his rent for the last four months and he has also been wounded,” she told The New Humanitarian. “I’m terrified every time I hear an explosion.”
The job inevitably takes a toll on Aamin crews. “We transport the sick and those injured in attacks, but sometimes there is little joy here,” Rashid admitted.
Yet he tries to stay upbeat. “I do my bit to help my county,” he explained. “I pray that my children will be able to have a good future – maybe our lives will be better one day.”