A recurrent theme of my life in Somaliland is people from back home asking me about the plethora of dangers that exist here. There is a permanent US travel warning in effect for Somaliland and Somalia, and for good reason. Kenya’s recent military offensive against al-Shabaab in Somalia has destabilized much of the region and raised the security threat level throughout the Horn of Africa to code red. Al-Shabaab has responded to the invasion with a series of bombings and kidnappings throughout Kenya, Somalia, Puntland, and Ethiopia.
In addition to the current turmoil in southern Somalia, years of civil war and a fragile, unrecognized democracy have contributed to an “AK-47 culture” – many people here own automatic weapons and we are accompanied by armed guards wherever we go. With a conservatively Islamic population that has learned to be suspicious of the West, anti-American sentiment is prevalent. No substantive US-Somaliland diplomatic relations exist, so there is no American embassy to bail us out or provide useful security intelligence. A crippling famine struck much of the Horn this year and the Gulf of Aden, one of the world’s busiest shipping lanes, now holds the clear title as the most dangerous, pirate-infested body of water on planet earth. I also recently found out that the valley surrounding our school was scattered with landmines during the war, and a major de-mining NGO has been active in removing mines in our local village through this year.
Put simply, the list of hazards is long and diverse.
Despite such a troubling array of potential threats, the most likely way to die here is from a car accident.
Like most developing countries, Somaliland is cursed with a perfect storm of atrocious roads, vehicles that look like they have been salvaged from auto junkyards, and old, shared taxis crammed with two or three times the healthy occupancy. Although the Chinese have been busy building and improving infrastructure throughout the African continent, they don’t seem to have made it to Somaliland yet. The decaying roads are pockmarked with potholes and it is not uncommon for a camel, tortoise, cow, or hyena to suddenly decide to cross a major road. Most of the infrastructure was laid by the British in the 1950’s when Somaliland was a protectorate, and then later by the Soviet Union during the US/USSR Cold War standoff in Africa.
The standard of automobiles here is beyond bad. Used vehicles in Somaliland are usually being bought for the third time – they were sold new in East Asia, then used in UAE or the Gulf, and finally dumped here to live out their short remaining lives being driven haphazardly through Somaliland. Cars in Somaliland drive on the right side, but the driver and the steering wheel is also located on the right side. Anyone who drives could tell you that that is not safe. The only tires for sale here are bald, discarded ones that would be sitting in a garbage dump in any other country. Discovering that your vehicle has a seatbelt is like finding a four-leaf clover, and I still don’t think I have ever seen a Somali wear a seatbelt, even if the car has one.
To maximize profit per trip, most trucks, cars, and taxis will cram as many passengers aboard as possible. It is not uncommon to see a full bus with an assortment of luggage, oil cans, fruit, and people all loaded on top of the roof. A five-seat sedan might hold ten people; our school’s fifteen-person bus usually takes almost thirty kids into Hargeisa on tutoring days.
The serious risk of auto accidents became crystal-clear this past week. An unexpected problem with the school gave the students a few extra days off for the weekend and with quite short notice, we resumed classes on Monday. Most of our kids had gone home to Hargeisa for the weekend and were making the 40-minute drive back to school on Sunday night, after dark. The road from Hargeisa to Abaarso is pot-holed and has no street lights, and many trucks bringing in khat from Ethiopia drive at maddening speeds to deliver their shipments on time.
As I was sitting in on a fellow teacher’s class in Hargeisa, we got a call informing us that seven of our students had been involved in a car crash while coming back to Abaarso and that three of the kids had been rushed to the hospital with serious injuries.
The students, all boys, had been sharing a taxi from Hargeisa to Abaarso. In addition to the seven boys, there was also the driver, a woman whom the students didn’t know, and the woman’s young child riding with them. The rusty station wagon was carrying ten people when it probably could have safely carried five. The taxi had attempted to pass another car when the driver saw an oncoming vehicle and swerved back into his lane to avoid being hit head-on. Apparently, the driver yanked the steering wheel too hard and caused the vehicle to flip without actually colliding with any other cars. The station wagon flipped a couple of times and the passengers, none of whom were wearing seatbelts, sustained a variety of injuries, many of which were serious and life-threatening.
Mike and I, upon hearing about the crash, immediately left the university and rushed to the hospital, which was luckily located right across the street in Hargeisa. There was a huge crowd of people outside of the hospital and a large mob of angry, crying, and screaming Somalis all pushing at the entrance gate to the clinic. The hospital had a few armed guards who were responsible for keeping people out, and they used a combination of yelling in Somali, cocking their AK’s, and forcefully pushing back the crowd with sticks and canes to prevent the visitors (who were presumably family members of victims in the hospital) from entering.
Our purpose in going to the hospital was to check that our students were alright and that their families were aware that they had been involved in a serious car accident. Nevertheless, I found it incredibly unsettling that even with a desperate stampede of people being pushed back from entering, we were quickly whisked inside the hospital because our white skin made the guards think that we were important and took priority. I couldn’t help but notice the looks of the other Somalis clamoring to be let inside as the guards pushed them out of the way to let us in.
Once inside the gates, the hospital was just as crazy and chaotic as it had been outside. We were essentially standing in the ER, which was just a cramped set of six operating rooms with plastic curtains cordoning off the patients. Doctors were furiously running around tending to the patients, all of whom had very serious injuries. It reminded me of images I’ve seen of hospitals in Rwanda, Somalia, and the D.R.C. that try to treat lots of critically-injured people with not enough staff or equipment.
We found our three students who were being treated and made sure that their families were either present or had been notified. Two of the boys had serious head injuries and had large sections of their heads shaved as they were being stitched up. They were both conscious and able to hold conversations with us, even with dried blood caking their faces and patients screaming from behind the other closed curtains.
The third student who was injured was hurt pretty badly. We identified him as a 9th grader who I teach and is one of my favorite kids – always enthusiastic and with a positive attitude. His left arm was severely dislocated and his entire arm had been shredded. It was the worst open wound I had ever seen and there was a bucket under the metal gurney collecting the large amount of blood that he was losing. A doctor was attempting to stop the bleeding and clean the wound, and then began to try and stitch up part of his arm. He had no visible IV’s and it was pretty clear that he was being operated on without anesthetic – his painful screaming filled the room, along with that of the other patients.
Eventually, his arm was bandaged up and his screaming turned into more of a quiet sobbing. We learned that the other four boys had all incredulously emerged from the wreck relatively uninjured, except for a few sprained wrists and bad bruises. Once we determined that all of the three students were in stable condition and that their families were with them, we thought it would be best if we cleared out and notified all of our kids back at school that the injured boys would be ok.
The experience at the hospital was really horrific. When I contracted malaria in Ghana, I remember thinking the same thing. The hospitals in both Somaliland and Ghana had long lines of desperate patients and were disturbingly understaffed, underequipped, and unhygienic. At the hospital in Hargeisa, privacy of the patient was non-existent and the perpetual screams of other patients and the shouting of angry guards made it an unimaginably terrible place to be.
Despite the event, I soon realized how fortunate we were to have our students sustain non-life-threatening injuries. We later learned that that the driver of the taxi was in a coma and that the woman who had been traveling in the front seat had died. All of our students had been riding in the backseat – had they not been sitting there, they almost certainly would not be here today.
Our students are all now in stable condition and recovering from their injuries, but this event was a serious wake-up call to me about the threat of auto accidents here and also the miserable state and clear limitations of healthcare facilities in the developing world.
The boy who sustained the worst injury received a blood transfusion because he lost so much blood and wasn’t even given painkillers by the hospital until we realized this and insisted that he be given them. To treat the multiple fractures in his arm, the doctors immediately set his arm in a hard cast.
Yesterday, we learned that he would undergo his first surgery, which was to remove potentially life-threatening tissue that had become infected because the doctors had not properly cleaned his wound before incorrectly putting it in a hard cast. That surgery cost $150, which I find pretty disturbing seeing as it was only necessary because the doctors who treated him screwed up in the first place.
On top of the improper treatment, there is the financial issue of the boy’s medical expenses. I don’t think medical insurance even exists here, and most students’ families simply don’t have the money to pay hospital bills. The injured student’s family was reluctant to move him to the much better medical facility because it cost an extra $10 a night. The head of the school has assured his family that we will work to make sure that all the costs are covered and emphasized that their priority should be on getting the best care for their son, not worrying about the price they will have to pay. Many of the parents from the school are chipping in to help cover the cost, and lots of the teachers and staff are also helping out.
As another teacher pointed out, it is really inspirational to see how this tragic event has brought the students, parents, and teachers together to help these injured students who are such an important part of the Abaarso Tech community. The students involved in the accident are all resting at home now and should be back at school relatively soon.
For me, this disaster reemphasized the importance of wearing your seatbelt and driving cautiously on third-world roads, as well as exposing the harsh reality of medical care in Somaliland and the financial worries that accompany it for many people.
We are incredibly fortunate that we did not lose any of our students and this event showed how precious life really is.