In 1991 when people returned to Hargeisa and other parts of Somaliland such as Burao, Gebiley, or Arabseyo, they found little left standing. This was particularly the case in Hargeisa where so many houses and building had been destroyed. The mass destruction of homesteads meant that many people found themselves homeless. Amidst the destruction, Hargeisa Hospital remained intact. Consequently the hospital became a place for homeless people to set up home. Whilst the hospital wards were left for sick patients, other areas such as the doctors’ room and the nurses’ room, the storage area for medicines, the kitchen, the administrative offices, were occupied by homeless people. The squatters were ex-hospital staff members, disabled people, SNM veterans, and returnees from Ethiopia whose homes had been destroyed. Some people even set up the traditional Somali homestead known as the aqal inside the hospital, while others constructed their homes within the hospital using corrugated-iron sheeting.
In 1992 my friend Amina and I had started working to try to improve the health situation in the town. We had developed a dispensary for the SNM Veteran’s Widows. One of the medical staff who helped at the dispensary regularly referred people to the hospital, thinking that it was at least standing. So Amina and I decided to go and visit the hospital to see for ourselves. Human beings were living everywhere and there were even qaad-chewing sessions going on – one room was just a qaad-chewing venue! People, young men and young women, would say: ‘Oh, we’re meeting at the hospital (for a qaad chew).’ Secondly, people were using the medications to sell or to use for themselves – there were some drugs, tranquillisers, that could be sold and other drugs that would make you spaced out. But worst of all we found that the maternal mortality level at the hospital was incredibly high. At one point, in one night there were 10 maternal deaths. This was horrendous. A child and a mother would die. A child and a mother! There was no professional screening of staff. People
were operating and working without necessarily being qualified to do so. It was a terrible situation.
A doctor at the hospital who was disgusted by what was happening came and asked us if we could do something to help sort the place out. We realised that it was too big a thing for us alone so we set about getting others involved. In the end we managed to get a team of 18 together – four members of the Committee for Concerned Somalis, three doctors and 11 businessmen.
Our first task was to clean the place. Cleaning the place meant removing the squatters. We counted 53 families living in the hospital. After some negotiation a few agreed to leave but 47 families simply refused. So we talked to them, we brought SNM people to talk with the SNM veterans, we tried our best to persuade them to leave. We kept visiting them, spending time with them. They didn’t like it. The group was willing to help the squatters to entice them to leave the hospital. Each squatter family was offered a truck to take them and their property wherever they wanted and every five family members were provided with a tent. If there were ten family members then they would be given two tents. Eventually the squatters agreed to go – all except six individuals who adamantly refused to leave. They saw me and Amina as the biggest threat because I had a car giving us the freedom to come and go to the hospital.
Some of the squatters were suffering from mental problems or trauma, which made evicting them difficult and dangerous. One day one of the remaining squatters pulled an automatic gun on me. In the belief that the further away one is from a gun the more dangerous it is, I rushed towards him and said ‘Shoot!’ He was shocked and said:‘I want to kill you!’‘Yes! Kill me!’ I replied and stayed close to him, staring him in the eyes. He looked at me and seemed amazed.‘Now I know you must be crazy. You are a crazy Christian’, he said.‘Yes, I am a crazy Christian who, like you, comes from Burao’,24 I told him. At this reference to the place we had in common, he gave up his gun to me. By then everyone was coming to see what was happening. I took the gun and gave it to someone to remove the bullets. The squatter who had pointed the gun at me was a disabled man and was using a wheel chair: I told him that if he ever threatened me again I would take the two arms of his wheelchair and throw him backwards. He asked if I was going to kill him? I said:‘Yes. You wanted to kill me so now I am going to kill you!’ He saw the funny side of this and we settled our dispute as friends though he still refused to leave the hospital.
Another squatter who had had a leg amputated was similarly aggressive towards me. When he started threatening me I told him that there were men from my own tribe who were amputees like him but they didn’t squat in the hospital preventing it being used for the care of the sick. The next day when we were alone together; he brought out a hand grenade.
I had never seen one before but I guessed what it was. He told me he was going to pull the pin out if I did not give in to his demands. Without thinking, I rushed at him, taking his left hand in my right hand and taking his right hand with my left hand and I said:‘OK. Let’s pull it together; Come on, after three. One, two, three.’ He was really shocked and told me that it would kill us.‘Yes. We will die together’, I said.‘Your body and my body will never be separated. We will be buried in one batch but then you will go to hell. On top of everything else you will go to hell.’ He argued that it would be me who went to hell if I killed him. No, I told him:‘You pulled the grenade, I’m just helping you.’ He was really afraid and said that he couldn’t pull the pin. He asked if I really wanted to and I told him no. I asked him what he was going to do and he said he wouldn’t do anything.
I persuaded him to hand over the grenade to me. The thing was, I didn’t know what to do with it and I didn’t know if it was still safe or not. So I called for someone to come and help. They came and they told me that as long as I didn’t pull the pin it would be safe. I eventually found a policeman and gave it to him. The amputee and I became friends after that. He would say:‘Ah, the crazy Mariano, the crazy Christian.’
In both situations I was lucky It was the danger that made me quick. In such a situation your life depends on you being fast; otherwise you are gone. There’s so much that could make you afraid but as my mother told me,‘You die every day if you are afraid.’
After these incidents the remaining squatters realised that my group and I were serious. With the hospital cleaned and cleared of most of the squatters the Hargeisa Hospital Group, as we were then called, arranged a selection process for doctors, nurses, paramedics and auxiliaries. It was easy to check the credentials of the nurses because they had been registered in Mogadishu and we had copies of the registers in Hargeisa. But we had to find ways of verifying the rest – the doctors, lab technicians and so on. We got verifications from the (newly established Somaliland) Ministry of Health in the end but we were afraid that tribalism would lead to dishonest claims.25
We set up an emergency rota system consisting of three shifts. The group would take it in turns to visit the hospital, the wards, and patients and monitor what was happening. We would check with patients:‘Did you get your medicine last night? Did you get you injection?’We would do spot checks, turning up in the middle of the night sometimes. We met with the Matron every morning at 10am and with the doctors. Many doctors were unhappy about what we were doing. They were threatened because until then they had done what they liked. The Hargeisa Hospital Group actually ran the hospital for four months and even paid salaries. The money for the salaries was collected as donations from Somali businesses and the international organisation Caritas.
We were active in trying to bring down the high levels of maternal mortality We made a great deal of noise about it. We went to the doctors, the Ministry of Health, and then we started to campaign for attention, saying that maternal deaths were not like measles or cholera that are seasonal. Why have the high numbers of deaths been occurring? We really blasted the doctors. It was because we made such a noise that President Egal let us be responsible for the hospital temporarily
We discovered that three or four of the doctors (one of them hadn’t even completed his second year at college) were using veterinary drugs, meant to be used for livestock, on women to speed up their labourThe use of this drug was the main cause of the maternal death rate – scandalous! When we found out we told the doctors that we’d take them to court. In the face of questions the doctors kept quiet. They denied it. Then we made lists with photographs. We didn’t print them in the newspapers but we had photographic evidence. We went to the court and said that we wanted to file a case. We were told that we couldn’t because the medical code of ethics hadn’t been drawn up.26 (And who is going to draw them up? The very doctors who are carrying out criminal practices? If a man shoots a woman he is taken to court and very likely shot or put in prison. Why then is nothing done when he kills a child and mother through medical malpractice?) We succeeded in having the veterinary drugs taken out of the store and removed from the pharmacy. We announced in the newspapers that we would publicise the names of anyone found holding the drug because it was a criminal act. All the pharmacies subsequently destroyed their stocks.
The Hargeisa Hospital Group handed over management in April 1994 but by August the civil war had broken out [between the Somaliland government and Isaq sub-clans].The tribal nature of the war meant some of the hospital staff had to flee for their lives. All the people we had sacked came back to the hospital27 – this time with guns. During one of my support visits to the hospital some of these people reminded me that they were the ones Id sent away and they threatened to shoot me. I went to the Minister to complain and to ask what he was doing allowing the hospital to be invaded.
While I was at the ministry some of my tribal cousins got to hear about what had happened to me. About ten of them went to the hospital carrying guns and demanded to know who had been threatening Noreen
Mariano? I was summoned to the hospital to prevent my tribesmen from causing trouble and I found the ones who’d threatened me had run away We called it a truce but after that I kept away from the hospital more as I didn’t want to be the cause of any trouble between the tribes.
I’m not brave. It’s just that you have to live in this country. I am determined to live here and improve it. This is the most important thing. In 1992 [when an earlier conflict had broken out in Hargeisa] I decided I would not leave. I was displaced from Mogadishu, Berbera and Burao and if I get displaced from Hargeisa I will literally leave Somaliland and never come back – that’s my promise. So I have to make Hargeisa liveable.