In this extract from his book, The World’s Emergency Room, Dr Michael Vanrooyen recalls the menace and mayhem of his first humanitarian mission

The moment the back hatch of the C-130 cargo opened at the militarised airport in Mogadishu [in 1992], a wave of intense heat hit me. The hot wind blew fine red dust that covered me before I even reached the tarmac. I knew this place would be unlike any other I had been to before. Unosom, the United Nations Operation in Somalia, controlled the airport, and the property was surrounded by military vehicles, sandbagged posts and razor wire. It was a hive of NGO and UN activity, with shipments of relief goods and aid workers arriving hourly. I hitched a ride with the Save the Children convoy and stayed in their walled compound until I could find my way to our headquarters. The rest of the team, including [my partner] Julie, arrived the next day, and I joined them at the Samaritan’s Purse compound.

During our first night there, we heard yelling and running and machine gunfire just ouside of our room. After the first crackles of gunfire, I realised that all the windows to the bedroom were open. I yelled to Julie to roll off the bed and lie flat on the floor. Keeping the lights off, we crawled on our hands and knees out of the room and up the building’s two flights of stairs to avoid being shot through the open windows along the stairway. The gunshots now sounded like they were all around the house.

We scrambled our way on to the flat roof, where we found the other members of our team. A moment later, one of the surgeons appeared carrying an AK-47, and we all reflexively ducked as he swung up the stairs. I wondered which was more dangerous – the shooting down below or the gun-wielding surgeon on the roof. He laid the gun down, and we called the UN compound to report the event. By then, the gunfire seemed to have stopped, but we all waited for what seemed like hours before returning to bed.

I struggle to write about Somalia in ways that are not cliche. As my first humanitarian mission, it was so incredibly different and larger than life. The ruined city of Mogadishu had a hellish feeling, starting with its temperatures, which reached 110 degrees fahrenheit. The buildings were pockmarked with holes from bullets and rocket-propelled grenades (RPGs). Somali militiamen wearing sunglasses and toting the universal AK-47s patrolled the streets in “technicals” – Toyota pick-up trucks that had been modified by welding large-calibre machine guns on to their beds. Even the peaceful-looking waters of the Indian Ocean teemed with sharks.

One day, Abdulahi, the Somali manager of all the compound’s staff, told me that we needed to have more weapons, even though we had hired security guards to protect the compound.

“Go to Bakara and buy some more weapons,” he said, “and then show your own guards that you have them.” So we went with our security guards to the Bakara market in central Mogadishu, the largest of the central markets. Bakara was a congested bazaar filled with fruit, trinkets, blankets, hanging meat that was collecting flies, and khat, a locally grown stimulant that looks like cilantro but acts like an amphetamine.

The arms market was surreal. We wove through its crowded, sweltering alleys and were directed to a dark plywood stall that looked like an arsenal. Automatic weapons hung on the walls like groceries. The Kalashnikov rifles, hand grenades and rocket-propelled grenades were all leftovers from the Soviet era, when weapons had flooded into the country. At one time, it was estimated that there were 300,000 automatic weapons in Mogadishu, about one for every three people in the city.

We bought one AK-47 and ammunition for about $250 [£196]. Over the following weeks, in addition to our medical work, we all took lessons in cleaning, storing and shooting AK-47s with the US marines stationed in Somalia. I must admit, however, that it was no comfort to me or any of the staff to have weapons in our home, but they were everywhere in Somalia – a strange reality. About a month later, the weapons shops at the Bakara market were shut down by Unosom forces in an attempt to disarm the citizens of Mogadishu. This ultimately proved to be futile.

As part of the medical team, I helped organise mobile clinics – trucks loaded with medical equipment, supplies and personnel – that would take us around the capital and to inland towns like Baidon and Baardheere and their surrounding villages. I also helped select appropriate sites for our clinics and negotiated safe passage with the local elders and warlords. On one memorable day in March 1993, we set up a clinic inside an abandoned movie theatre. It was an odd sight. The hot, cavernous old building had its own war wounds – its ceiling was crumbling, the old screen was in tatters, and RPGs had left car-sized holes in its walls – but it was the best available space for our work. My colleagues and I had unpacked and were beginning to set up a station to triage the ill and injured Somalis who had gathered when the leader of one of the warring clans barged in with family members in tow, demanding that we take care of them immediately. We told him, through a translator, that we had to treat the sickest people first, and that his relatives – who seemed comparatively healthy – would have to wait.

Infuriated, the clan leader left. He soon returned with a half-dozen raggedly dressed militiamen carrying AK-47s and chewing khat. Shouting in Somali, the jumpy young men circled around us, rummaged through our supplies and terrified our patients. When we heard the crack of gunfire outside, I fully expected them to start shooting in the theatre. We stopped our triage, and I asked the clan leader to speak privately. After some conversation, we finally agreed that I would treat his wife first. Guards stood by while I quickly examined and treated her with Tylenol for her chronic back pain. I reassured the clan leader that his wife was in good health, and we were allowed to proceed with our clinic. It was the first of many compromises I would have to make in the field for the sake of keeping our relief programmes running.

• The World’s Emergency Room: the Growing Threat to Doctors, Nurses and Humanitarian Workers, by Michael VanRooyen, is published by St Martin’s Press ($25.99)

 Source:the Guardian