Somalia. Everything is Open to Negotiation

Michaël Neuman (interview with Benoît Leduc)

This chapter is the result of conversations held from June to December 2010 between Michaël Neuman, director of studies at CRASH—MSF and Benoît Leduc, head of mission and then operations manager for Somalia for the French section of Médecins Sans Frontières from December 2006 to September 2010. As a result, the positions of the Belgian, Spanish, Dutch and Swiss sections also operating in Somalia are not covered in any detail.


Médecins Sans Frontières, which had provided assistance to Somali-Ethiopian refugees in Somalia since 1979, quickly came to see the risks and challenges of working in the country. In January 1987, ten members of a team in Tuj Walaje in the north were kidnapped by Somaliland separatists and, in April 1988, the Dutch section of MSF was working in Hargeisa when the town was hit by a heavy bombing raid. The decade that followed began with a conflict that was the outcome of a process initiated years earlier and combined the collapse of the government with an explosion in the number of private armies built around individuals, clans and entrepreneurs.1

Following the fall of President Siad Barre in 1991, MSF embarked on a series of operations in a Mogadishu torn apart by clan rivalry, in rural areas with displaced people and in Kenya among the Somali refugees who had fled the war. One of MSF’s main concerns was to limit the consequences of the famine which, from spring 1992 onwards, was to trigger one of the first international “military-humanitarian” interventions of the post-Cold War period. Relief operations were carried out in one of the most dangerous environments MSF had ever encountered. The intensity of the fighting as well as the direct threats made against MSF’s employees led to a number of personnel evacuations.

From April 1992 to March 1995, the United Nations ran several consecutive missions intended to ensure compliance with a ceasefire by the main warring factions, as well as the safety of humanitarian aid. Successive reinforcements of the international force, however, were to contribute to its becoming directly involved in the conflict. Civilian and military losses increased, while the international forces themselves perpetrated war crimes. The confusion between humanitarian aid and international military intervention reached a climax. Not wanting to be further associated with violence perpetrated in the name of humanitarianism and facing growing security threats and the Somali population’s hostility towards foreigners, the French section of MSF decided to withdraw from the country in May 1993. This decision was also based on the decline in mortality caused by the famine. Over the years that followed the country remained a focus of confrontation between political-military leaders.2 In spite of regular interruptions, MSF continued to work on projects to provide assistance to the Somali population. In 1997 expatriate doctor Ricardo Marques was assassinated in the hospital in Baidoa supported by the French section, which had returned to the country two years earlier. This incident prompted a second withdrawal.

A letup in the fighting in Mogadishu nine years later enabled MSF-France to return to Somalia. During the summer of 2006, the Islamic Courts Union (ICU), established in the mid-1990s in an attempt to restore order in Mogadishu, took control of the capital, which they intended to use as a testing ground for an Islamic Somalia. The population of Mogadishu saw a period of calm it had not known for fifteen years and the international airport, closed since 1995, reopened. A window of opportunity emerged for relief organisations that hoped security conditions were about to improve. The opportunity turned out to be short-lived. In December 2006, the Ethiopian government, fearing the establishment of a radical Islamist regime on its doorstep, launched a large-scale offensive against the ICU and defeated it.

The conflict escalated with renewed vigour, exacerbated by its internationalisation against the backdrop of the “global war on terror”, and opposed transnational Jihadist networks to western powers, the United Nations (UN) and their regional allies. The rebel movement became increasingly radicalised, which resulted in a series of breakaway groups. One of them, Al Shabaab, initially an ICU “youth movement”, became an independent organisation with a small number of highly radicalised individuals. The troops confronted the Transitional Federal Government (TFG), supported by the UN and the AMISOM, an African Union mission created in 2007. Yet the TFG, divided and powerless, was never able to control more than a few districts of Mogadishu.

It is in this context that the French section of MSF did its utmost to find a way to provide assistance in the country. The organisation was forced in a series of never-ending negotiations to compromise in a number of areas: the security of its personnel, the recourse to armed guards, the choice of its action, the standard of its relief operations, its contribution to the war efforts of the warring parties, as well as its ability to speak out.


> For many at MSF in Paris, the situation in Somalia could be summed up in a few words: clans, the memory of the death of Ricardo Marques, and complexity. It was the embodiment of operating in unacceptable security conditions and dependence on armed groups. The French section, which had withdrawn from the country in 1997, examined the possibility of a return in 2006. What was the background to the debate?

In the wake of their victory over the Alliance for the Restoration of Peace and Counter-Terrorism (ARPCT)3 in June 2006, the ICU took control of Mogadishu. The residents of the city who were, in appearance at least, completely unarmed, returned to a level of security they had not enjoyed for fifteen years. The change in circumstances afforded those who supported a return of MSF’s French section to Somalia the opportunity to float the idea once again. An exploratory mission was carried out in the summer of 2006 in Mogadishu and in the port city of Merka in the south of the country, to establish contacts and assess the reality of the situation on the ground. The return to war following the Ethiopian army’s intervention in Somalia at the end of 2006 encouraged this approach. It was then that I was charged with monitoring the situation and looking at potential projects for the country.

There were numerous discussions at MSF on whether we should start up a new project. The director of operations was opposed to the use of armed guards, and brought up the question of the potential security risks for our teams in re-launching activities in Somalia. In addition, four sections of MSF were already working in the country, and that gave some people sufficient grounds to argue that there was no need for the French section to be there.

> Let’s go back to the issue of armed guards. In Afghanistan, in Eritrea and on many occasions in other situations, the organisation has used combatants to ensure the safety of its teams and convoys. Whilst humanitarian aid should not be imposed by force, the use of armed escorts has sometimes been seen in the history of the organisation as a condition for providing assistance. What were the arguments in the debate that prompted MSF to resort to armed guards in carrying out its operations in Somalia?

During the discussions that preceded the decision to resume operations, the reasons put forward to oppose the use of armed guards were based on MSF’s experience in Somalia and in other countries: the risk of getting involved in funding the conflict, putting the teams in greater danger and becoming dependent on the militias sometimes added to the issue of the neutrality of operations. In the early 1990s, the use of militias was a prerequisite for taking action, from which it then became impossible to extricate ourselves. Although they were supposed to defend the organisation, they would themselves create incidents to generate a further reinforcing of the system. From the mid-1990s onwards, the teams began to reduce the number of guards and to limit our contractual relationships with the militias: MSF, if only to a small degree, was potentially able to play a part in creating the conditions for violence. Using guards meant that we ran the risk of a member of MSF staff killing someone. The numerous security incidents we had faced in the past meant this was a legitimate argument.

But in Somalia, armed guards were above all a necessity, not a choice. On our first visits to the country, we also said we didn’t want armed guards. And then we realised that even the smallest of shops had a guard armed with a Kalashnikov. Since the 1990s, security in Somalia had been completely privatised. It was simply something that was accepted by the MSF teams working at the time and that we came to acknowledge. All Somali hospitals are equipped with a kind of cloakroom where owners check in their weapons in exchange for a number. That’s just the way it is. So, after talking it through, that was the reality MSF decided to accept.

> What were the stages involved in re-launching operations?

One of the members of the exploratory mission in summer 2006 had been the head of mission in 1997, and he met his former deputy at the hotel in Mogadishu. Like many other Somalis, the latter had come to see what was happening in the city with a view to starting up activities again. He was based in Kismayo, in the south of Somalia, and helped us with a visit to Jamaame, a town in the region. A rural area that had for the most part been spared from the fighting, it had a landing strip. This was vital as travelling by car quickly became too dangerous.

Then, of course, there were clearly identified medical needs, as is the case in all Somali rural areas and, above all, the fact that there was no one to provide care. We carried out a few exploratory missions in the surrounding villages. There were heavy floods between November 2006 and January 2007. According to what we were told, children died of diarrhoea because of a shortage of drinking water—the people drank water from the river. Aware of the impact of the floods on the harvest, we feared that the nutritional situation would deteriorate too.

There were many discussions over whether it was appropriate to intervene in Jamaame. Many people felt that the process would slow down our objective of starting up in Mogadishu, which was seen as a priority insofar as the capital was heavily populated and the focus of the conflict. In fact, the project in Jamaame started up very quickly. Some people in the region were already familiar with MSF through our work in Kismayo in the 1990s. The village representatives quickly appointed a single point of contact to manage the vehicles, recruit unskilled staff and rent buildings. We explained and emphasised the principles that underpin MSF operations, namely neutrality in relation to the conflict, our independence from the political authorities and the imperative of being able to provide care for everyone. We had a team in place as of March 2007. In April, we turned our attention back to starting the project in Mogadishu.

I think the work we did in Jamaame was invaluable. It’s important to remember that we had started working in Somalia on the basis of a few previous experiences. It was as if we were paralysed, we understood nothing—or maybe we only understood the risks. In Jamaame we were able to learn again how to operate in Somalia in the right conditions: how to travel around, how to carry out swift nutritional assessments, and how to talk to our contacts to gain an understanding of the health situation.
There was only one clan, which had a reputation for keeping out of the conflict, and the people were asking for help. This enabled us to understand the role of the elders in the village and that of the chiefs who represent each of the clan’s seven sub-clans, and to tackle the question of sorting out cars, houses and armed guards, all issues we would face in Mogadishu. Hiring a car in Somalia results in a series of compromises. You have to forget what you learned as a logistician; that a car should drive straight, brake and have safety belts. There, it’s first and foremost about finding out who owns it, what the power relationships are between clans and individuals and evaluating the risks of reprisals against the teams. We would never have been able to figure all that out in Mogadishu, what with the war, population displacements, the multitude of clans, and so on.
Besides, there was an advantage in having a rural base and a project with seemingly more long-term viability in terms of security. So, until 2008, there were almost no team evacuations. Some of the reasons behind starting up the project in Jamaame were institutional. We didn’t know how long it would take to set up a project in Mogadishu, so it was also a way of getting off the ground and a justification for setting up a team in Nairobi to support Mogadishu.
As far as armed guards were concerned, we discussed different options in order to rid ourselves of some of the constraints they engender. MSF’s guards are not under contract and we do not manage them directly; we give the people’s representatives a sum of money and they decide and run the organisational aspects. But the questions remain. What instructions should we give the guards? How do we manage their relationship with us?

> The team that carried out the first exploratory mission in Mogadishu during the summer of 2006 had proposed working on maternity and obstetric care, but this was rejected. There weren’t sufficient indicators and the risks the teams would be taking seemed too high. The fall of the Islamic courts and the return to fighting in early 2007 prompted a fresh round of discussions. In the end, it was agreed to make surgery the focus of the project. Why not reconcile both priorities? How did the launch of the project in Mogadishu go?

We were faced with the difficulty of obtaining reliable indicators right from our very first visits to Somalia. There is no official data and the numbers can be rigged because they can’t be verified. MSF, with its culture of working with numbers and used to dealing with epidemiological tools, finds it difficult to go ahead with a project based merely on the teams’ gut feelings or intuition. How to grasp the concept of need, when the whole situation feels like an emergency: population displacements, recurring nutritional crises, mediocre immunisation rates, general insecurity, etc.? It was difficult to carry out the actual assessments as the lack of public health facilities was, to some extent, compensated for by pharmacies and private surgeries. We really had no understanding of Somali healthcare practices.

In some ways it was a little simpler in Mogadishu after the Ethiopian intervention; there was a war, and people were wounded. Given the security conditions we were facing at the time, we felt it was important to act where there was risk to life. Surgery was the obvious choice. We carried out an assessment in January 2007 and another in April 2007. At the time, the Somali capital was in turmoil. Ethiopian and government troops were engaged in major offensives against the Islamist combatants in the northern districts of the city. According to the UNHCR, the fighting left over 1,000 civilian casualties and 350,000 people were displaced, primarily in the Afgooye corridor, located some thirty kilo-metres to the west of the capital. The Ethiopians systematically looted and destroyed the medical centres that could have provided assistance to the Islamist rebels.

Evaluation missions were carried out in various facilities in and around the city. We wanted to be based in an existing facility, to make the procedures required for launching the project and the negotiations regarding security easier. We looked at what was available. Of the 800 hospital beds available in January 2007, there were only 250 left by June. The only surgery facilities were those supported by the ICRC. But they were not fully accessible to the opposition forces, partly because of their location.

The hospital in the suburban district of Daynile in the northwest of the city was thought to be a potentially good location. It had received an influx of patients and was struggling, but it was in good condition. Located right in the middle of a displaced persons’ camp, it was some way from the centre. This was crucial, because a facility in the centre of the city would have put us right in the firing line and people would have found it hard to reach.
But warlord and local entrepreneur Mohamed Qanyare, a key figure in Mogadishu, already controlled the hospital. Our relationship with Qanyare was the subject of some profound disagreements with other sections of MSF, which saw it as a risk for the security of our projects. First close to the TFG, he had moved away and then joined again. He had been bankrolled by the United States, notably within the framework of the 2006 Alliance for the Restoration of Peace and Counter-Terrorism (ARPCT).

We explained to Mohamed Qanyare the importance of providing access for everyone. He seemed to accept this and withdrew from the management of the hospital. He said: “I’ll deal with security in the area. As far as the rest goes, talk to so-and-so, and so-and-so, and so-and-so”.

Qanyare is a Murusade chief, a sub-clan of the Hawiye clan. There were Murusades more or less everywhere, both among Al Shabaab and within President Yusuf’s government and the National Security Agency, which is responsible for intelligence and counter-terrorism. These multiple allegiances, of course, result in a highly complex situation, but we can also put them to our advantage to create opportunities for discussions with the various players involved.

We were able fairly quickly to secure guarantees that combatants from all factions would be able to receive care at the hospital. Everyone agreed to play the game, albeit reluctantly. To some extent, Qanyare took a gamble on his reputation in the operation. He had stood in the 2004 presidential elections and was still counting on carving out a political career for himself, and wanted to show that he was open to all the clans. I think he both played this role and acted as a gatekeeper, opening the door to foreigners and thereby making an agreement with the clan possible.

From the rebels’ point of view, it was in their interest to support assistance for their wounded and displaced populations and to encourage the aid organisations to attest to the crimes committed by the Ethiopian army with the support of the government militias. They knew that we were going to work with someone who they had been at war with, while Mohammed Qanyare knew that he was giving us access to a hospital that would be used to provide care for enemy combatants.

> Taking into account the interests of the parties to the conflict raises questions over how operational decisions are made, demonstrating that they are not purely the result of MSF’s assessment of the needs of the population.

The decisions were based on a combination of different criteria. There were discussions on whether we should gear our operations towards paediatrics or surgery. Paediatrics would have met some real needs and would have been easier to put in place as the technical requirements would have been less complex. But we started with sur-gery—for which there was also an overwhelming need—because it was what the key players and leading figures we were able to meet asked us to do. If we had opened a nutrition or paediatric centre, the rebels, the radical Islamist militias, the Murusades and all the other groups would have been less tolerant in their attitude towards the project. It is likely the hospital would have been looted at some point or another.

During our visit in April 2007, at the same time as the discussions on starting up our project in Mogadishu, we were put in contact with a group of doctors who were close to the rebel movement. They were operating in secret and described the violent actions of the Ethiopian army against medical facilities. They stressed the importance of a neutral facility able to treat the wounded, regardless of who they are. We talked to them about our project in Daynile and working with Qanyare. Although they were reluctant, they understood that rebel combatants would have access to the hospital. To support them in their medical intervention, we donated medical equipment, a radiology device and operating tables worth over 120,000 euros. Opposition doctors no longer had the resources to care for the population and wanted treatment facilities to re-open. The donations gave us the opportunity to meet their needs and build relationships with the doctors; it was also a way for us to pay the price of our relationship with Qanyare while negotiating the setting up of a project in Daynile. We had no direct control over what use they would make of the equipment. But we decided to go ahead in spite of the fears of other MSF sections, who maintained that this so-called support for the Islamist opposition could jeopardise all our projects in the country.

We also implemented water supply projects in the displaced persons’ camps established around the hospital after the wave of displacements during spring 2007 and distributed jerry cans of water and blankets. Supporting the local people was a way of protecting the hospital.

> While setting up the project, MSF was keen to formalise the sharing of resources with its various key players. What were the strategies adopted?

Our ability to set up and maintain the project relied primarily on establishing a body to govern the hospital, namely a sort of Board of Directors independent of MSF. We continue to provide “indirect” management, avoiding as far as possible any involvement in personal, political and local clan disputes. We do not select the dozen or so members of the Board, who are co-opted. Usually leading figures in the district, they are frequently relatives and friends of Qanyare and the Murusades.

If there’s a problem, we say to them: “You’re the Board, it’s your hospital, you manage it and we’ll support it”. When we wanted to pull out of supplying water by lorry to drill instead, we discussed it with the Board. It was the Board that negotiated access to the land and then sorted out terminating the lorry rentals. We find these negotiations unfathomable, and do not get involved. All we do is convey messages: “If MSF is threatened, we might have to cut short the projects”.

As far as recruitment is concerned, we decided to take a gamble: if we focused on skills, we would find the diversity of clans vital to reach our patients. We recruit using written tests and questionnaires supervised by international staff. We have promoted the transparency of the system in conjunction with the Board. If everyone is entitled to take part and staff are recruited for their skills rather than their clan, people are ready to go along with it. In April 2008, we organised a test to recruit twenty nurses which was taken by 535 people.

As in Jamaame, security is arranged at arm’s length. The budget allocated to armed guards is included in a package we give to the hospital designed to fund its running costs, including non-surgical medical activities in which we have no direct involvement.

> Since the project began, over 12,000 patients have been treated in the hospital, with over 50% of injuries caused by the war. That said, the situation has changed hugely. The region is now controlled by Al Shabaab and Qanyare’s influence has decreased. Given this context, can civilian populations and combatants from different factions still access the hospital?

During the first months of the project, patients came primarily from areas in the immediate vicinity of the hospital. There was a significant proportion of women and children among the injured who had been victims of the bombing raids: over 56% between October and December 2007, and over 53% in 2008. Gradually, patients started to come from a wider area and we were reassured that the whole of the population, whatever their clan, had access to the hospital. We are now effectively in a neighbourhood controlled by the Islamist opposition, with the war-wounded coming from this area. This is less the case for patients not wounded in the war and who come from a much more diverse range of geographical areas.

It’s highly likely that some armed factions refuse to go to the hospital, but that is certainly not the case for women and children. It’s difficult to be sure. They have fallen as a proportion of all those treated for war-related injuries since 2008, but the figures vary as the conflict evolves along with the nature and location of the fighting. As soon as there are bombing raids in residential areas, the proportion increases again. Conversely, during periods of intense and direct clashes such as we have seen since the beginning of the year, more of our admissions are combatants. But we must continue to closely monitor this issue of access without distinction to the hospital.

In these conditions, we are sometimes seen by some political players, the African Union mission officers, for example, as the opposition’s war surgeons. This is when we need to remind people of the fundamentals of providing access to medical facilities in times of war, namely that injured and unarmed combatants are classed as non-combatants. What’s more, they only represent a proportion of our patients. We can also remind people of our support for the medical department of the hospital, where 70% of in-patients are women and children.

In Jamaame too we have had to deal with a change in authority and the fact that Al Shabaab has taken power. At the beginning of our intervention, the elders were in power and in charge of the judicial system, the police, the prison and the market—even if a representative of the TFG was present. When Al Shabaab regained control of the town in May 2008, the elders were removed from power and in some cases accused of corruption. They have now been partially reintegrated into the community, because Al Shabaab has probably understood the advantages of having their support in administering the region.

> In January 2008, an attack on a team from the Dutch section of MSF in Kismayo caused the death of three employees, a Somali, a Kenyan and a Frenchman. These murders and an ongoing deterioration in the country’s security situation instigated a major review of MSF’s operating methods. All projects switched to what is known as “remote management”, which means that day-to-day project management is carried out by national staff working remotely with international staff. It is, to some extent, comparable to the armed guards’ issue; it shatters the idealised vision of the giving of aid. Is humanitarian aid not fundamentally about our relationship with other people: the doctor from here who goes to care for people there? The arguments opposed to this method of management raise questions about the neutrality and independence of national staff, as well as the issue of control of resources. How do we resolve these dilemmas?

The attack in Kismayo in January 2008 led to the withdrawal of international staff from all MSF projects but, after a few weeks of internal discussions, we sent teams back to Jamaame and Daynile. The assassination of Al Shabaab leader Aden Hashi Ayro4 by the United States in May 2008 created a power vacuum that a number of Jihadist factions were able to take advantage of and which drove some of them to become more radical, more quickly. This fragmentation of the Islamist rebellion had a very high cost in terms of humanitarian workers’ security. At the same time, we saw an escalation in the rejection of humanitarian aid—seen purely and simply as providing support to the Islamists—by many supporters of the TFG. Until Sheikh Sharif Sheikh Ahmed was elected head of the government in January 2009, attacks on humanitarian workers by TFG fighters were no less dangerous than those carried out by Al Shabaab.5

In the period that preceded Ayro’s death, we had been able to maintain contact with the opposition via the Murusade and medical networks, and established a constructive working relationship with Al Shabaab. The organisation even wrote to us in January 2008 to offer us their encouragement. But as soon as non-Murusade Islamist rebels arrived in Daynile, it became more difficult for us to negotiate visits, particularly as the journey between the airport and the hospital became even more dangerous, due to the fighting and the risk of kidnap.

We were forced to restrict ourselves to organising occasional visits to Jamaame, where we had an expatriate team. In Daynile, we had started the project without any international staff present on an ongoing basis, not only because of the risks of foreigners being targeted but also the potential for collateral damage—getting caught in crossfire, attacks, etc. Our decision not to get involved in non-surgical medical activities was also due to insufficient expatriate staff. We moved from this kind of intermittent mode to making infrequent and last-minute lightning visits. The expatriate team is still based in Nairobi, so project management now relies much more heavily on Somali personnel than it did in the past. Of course some people have been able to adjust to a situation where they are paid a salary and have access to resources and drugs with less supervision. Organising visits to Daynile is an additional source of stress for staff because they have to organise and pay close attention to our security.

The future of the programme will depend on the relation between the security issue and the obligation to monitor; from their side, a member of the Board in Daynile explains that, “We know that if something goes wrong, it’ll be the end of the hospital”; and from our point of view, as our head of mission explained, “If nothing happens, meaning that if we don’t go there, that’ll be the end of the hospital too”. And that’s where we are today.

Our biggest constraint is our limited ability to expand our activities and our capacity to respond to emergencies. In August 2010, the number of displaced people living in the camps in the Daynile area was probably around 110,000. There was a very high level of need and the aid provided was inadequate. A few organisations, such as the Red Crescent, do a small amount of work in the camps. In normal times, we would probably decide on a major intervention, supplying water, purification and distribution systems, providing medical care, etc. But the camps are Al Shabaab’s constituency and are under its tight control. Our staff are not always comfortable with the idea of working in them. Generally speaking, the threats faced by the local employees are immense and the risk to their safety huge and incessant.

As for checking that the resources provided by MSF are properly used, we look at as much medical, logistical and financial information as we can and, up to a certain point, all the elements of a normal project are there. We have to examine supervision, the quality of medical care and monitoring. We analyse the quantities of drugs used, activity reports and the number of registered patients. We then examine the consumption of certain sensitive and expensive drugs, as well as the reasons for and data on admissions and discharge in nutritional activities. There’s some information we’re not able to get hold of, such as the number of children in the nutrition programme, for example, and we do have some fictitious patients. But we encounter the same challenges in projects where expatriates are involved. Our visits to Daynile—and we haven’t been back since April 2009—are, in fact, relatively ineffective. We spend our time dealing with the unplanned events that crop up on a day-to-day basis while the medical side, such as carrying out an inventory of the pharmacy, monitoring a patient, checking the quality of care and prescriptions, is reduced to a bare minimum.

This is an ongoing situation and the quality of care provided by MSF gives cause for concern. Our standards of care in Daynile are not those of our programmes in Haiti, for example. It is even hard sometimes to check our doctors’ qualifications. Because of this and despite our discussions with the staff and the training we have put in place, fracture repairs and infection control are not carried out in conditions as satisfactory as we would like.

As long as the security situation continues to remain this problematic, we are unlikely to see a return to a regular expatriate presence in the near future. What’s more, new constraints may well be on the horizon, notably Al Shabaab’s demands regarding the nationalities of the expatriates it will authorise to visit the projects.

> In January 2008, Al Shabaab proclaimed its unequivocal allegiance to the leaders of Al Qaeda. At the same time, the international intervention was operating in a context increasingly influenced by the “war on terror”. What has been the impact of this polarisation on our activities?

We are seeing a new period where the parties to the conflict are attempting to co-opt aid, in a country that has seen many such attempts. In January 2010, the WFP, against a background of accusations of misappropriation and corruption, announced it was suspending its aid programme in the centre and south of the country because of the growing number of attacks on its staff. Then, in February, Al Shabaab itself prohibited food aid from the WFP on the pretext that its operations were “politically motivated” and that they were undermining the local market. In November 2009, it issued a list of eleven conditions for the continuation of international aid, including payment of a 20,000 dollar tax every six months and the dismissal of all female staff, except for those working in treatment facilities. In August 2010, Al Shabaab announced it had banned NGOs such as World Vision, ADRA and Diakonia, accusing them of proselytising. The group is now demanding that Somali employees working on MSF projects in the area under its control pay a tax equivalent to 5% of their salary, in addition to “registration costs” of 10,000 dollars per project. It also tries to impose taxes for using the airports. Daynile is not affected, or at least the Board has been able to block the demands, which proves how important the project is to Al Shabaab.

Each Al Shabaab demand leads to more discussions on the restrictions we are prepared to accept or that it is reasonable to accept in such a complex situation: a combination of the considerable medical needs, questions regarding our ability to manage such complicated programmes and the impasse in which international intervention and the country, now embarking on yet another peace plan, find themselves.

But, international sanctions and anti-terrorist legislation do tend to limit the ability of aid organisations to work in rebel-controlled areas. It is civilians’ access to aid that is undermined. As the United Nations sends out on a daily basis ever more alarming messages on the “humanitarian situation”, in 2009 American donors suspended some of their funding, fearing that they could be prosecuted for providing assistance to Al Shabaab, classified since March 2008 as a terrorist organisation by the US State Department. In March 2010, the United Nations itself adopted a resolution6 that potentially sets up the conditions for imposing sanctions on aid organisations working in areas controlled by opposition groups. In an article published in June 2009, the United Nations’ special representative in Somalia, Ahmedou Ould-Abdallah, wrote that “those who claim neutrality may also be the accomplices” of the opposition. Even if it has no immediate consequences, this process makes the need to differentiate international initiatives in the eyes of both the people and the parties to the conflict all the more vital.

However, insofar as Al Shabaab controls the majority of the country and Mogadishu in particular, all we can do is accept reality. It is crucial that we ensure that patients are not selected on the basis of their allegiance to or membership of certain groups, and that we don’t choose whom we talk to—including those claiming to be from Al Qaeda.

> Violence against civilians is frequent, attacks on hospitals are not irregular and our activities are restricted by security issues. In the public arena, however, we hear much more from the United Nations than from MSF, which doesn’t appear to be saying much at all. What do we want to say? What are we not allowing ourselves to say?

Initially, our communications policy was coherent with that of our operations. Keeping a low profile was the order of the day. We didn’t want to say anything at all. We were afraid of everyone. Responsibility for the attack in Kismayo against MSF-Holland has never been clearly established. We were afraid of Al Shabaab, the Ethiopians, the clans, the warlords, the government and the lack of government.

In the beginning, everyone in Daynile—the local people, the staff, the rebels and then Al Shabaab—told us, “Don’t talk politics, don’t get involved in politics”. This was the message we were given very clearly on several occasions. Maybe the strategy has paid off, given that Al Shabaab in Jamaame has expelled all other NGOs, but not MSF.

The risk we run when we speak out in such a complex situation is huge. As a result, our current public communications are purely factual and very closely linked to our activities, such as our treatment of malnourished children and the wounded in Daynile. Fear of Al Shabaab is even greater and MSF’s communications must be pragmatic, as it is now more important to distance ourselves from international efforts focused on defeating Al Shabaab and offering absolute support to a transitional government running out of steam. While we were able to publish a press release appealing to the African Union not to bomb residential neighbourhoods, we have never asked Al Shabaab not to use civilians as a human shield when its members take cover in the market in Bakaraha.

Given the immensity of the medical needs and the complexity and difficulty of meeting them, we are afraid of losing what we have managed to put in place. It seems to us essential that we set ourselves apart from other international players, by not calling for the reinforcement of AMISOM, for example. But speaking out about who is responsible for the conflict is certainly more difficult to define and accept.

Translated from French by Karen Stokes

  • 1. See in particular Roland Marchal, “Mogadiscio dans la guerre civile”, Les Etudes du CERI, no. 69, Oct. 2000.
  • 2. We have used this term in preference to “warlord”. Roland Marchal covers the latter in detail, as the term primarily used by institutions and the international media to describe the Somali leaders in charge of the warring militias. For a critical analysis of the term and the consequences of its use on the shortcomings in the analysis of the situation in Somalia, see Roland Marchal, “Warlordism and terrorism: how to obscure an already confusing crisis? The case of Somalia”, International Affairs (83), 2007.
  • 3. The Alliance for the Restoration of Peace and Counter-Terrorism was a coalition of political-military leaders, supported by the United States. Although it has not been established whether or not it was formed at their instigation, the alliance was supported by the US in order to counter Al Qaeda’s influence in Somalia. It quickly turned into a group with a focus on combating the Islamic courts. According to International Crisis Group, the CIA is believed to have provided the ARPCT with between 100,000 and 150,000 dollars a month. (
  • 4. One of the leaders of Al Shabaab, Ayro was considered to be a representative of Al Qaeda in Somalia.
  • 5. In 2008, forty-five humanitarian workers were killed in Somalia, compared with thirty-three in Afghanistan, nineteen in Sudan and thirteen were kidnapped, Stoddard A, Harmer A, DiDomenico V. “Providing aid in insecure environments: trends in violence against aid workers and the operational response” (2009 update), Apr. 2009, London: Overseas Development Institute”, 2008 was deadliest year for aid workers—study”, Reuters, 6 Apr. 2009.
  • 6. Resolution 1916 (2010), adopted on 19 Mar. 2010.