Eleven wounded patients were admitted to Mogadishu’s Madina Hospital on 25th September. A week earlier, five others were admitted. The admission numbers displayed on a whiteboard at the triage unit, show that weapon-wounded patients, casualties of explosions, car bombs, shoot-outs, grenade attacks and suicide bombs are a tragic part of life in the Somalia’s capital.

On 25th September, an explosive-laden vehicle detonated at the El-Gab junction in the heart of the city. Seven people died while 11 others were wounded and brought to the hospital. Salah Mohamed, a mechanic in the city, is one of them.

“There was smoke. I was confused and went into the fire but then turned away. I stepped out and the smoke hit my face. I escaped towards the Peace Garden,” the 29-year-old, whose face, arms and legs are covered in burns, recalled.

Amid the chaos after the bomb went off, his first instinct was to call his family.

“My older sister asked how I’m doing. ‘I’m injured,’ I responded. They started screaming and crying.”

Shrapnel from the blast tore through the left leg of Noordin Ali Isaac, 24. He considers himself lucky.

“I’m a father of two. My life and future all went dark. The service I received from Madina hospital was good and I’m recovering. I cannot complain considering the small injury I have,” said Ali.

Civilians like Salah and Noordin continue to bear the brunt of the decades-long conflict in Somalia. According to Armed Conflict Location and Event Data Project (ACLED), 465 civilians died last year as a result of the conflict. As of September, 296 fatalities have been recorded this year.

 “Our message is always the same. Spare civilians from violence and conflict. Protect women and children. And respect the very basic rules of the international humanitarian law,” said ICRC Director of Operations Dominik Stillhart during his visit to the Somali Red Crescent ambulance response unit in Mogadishu.

When the five patients noted on the whiteboard were admitted, it was after a suicide bomber walked into a tea shop. Last month, more than 60 patients were admitted with weapon wounds -- 30% of the hospital’s total admissions.

Madina is Somalia’s de facto war hospital and over the years its admission numbers have become a barometer for the level of insecurity in Somalia’s capital. In a year marked with simmering tensions due to the ongoing polls and Somalia’s fractious government, the hospital’s whiteboard of numbers serves as a bulletin board of emergencies.

“If something happens in Mogadishu, four out of the five injured visit the hospital. There’s a possibility the patients visit other facilities but 90% come to this hospital. So, if you arrived today, and haven’t gone out to the city, what will inform you of the security situation is the patients we receive and where they are coming from,” said Dr. Abdikadir Haji Maalim, a surgeon at the hospital.

Madina Hospital is one of four hospitals that the International Committee of the Red Cross (ICRC) supports in Somalia. Keysaney Hospital, also in the capital, Bay Regional Hospital in Baidoa and Kismayo General Hospital in the southern region of Lower Juba are the other three. Combined, they have treated 231 weapon-wounded patients as of June this year. More than half of these cases were attended to in Madina.

Surgical care is an essential part of the treatment regimen for trauma patients, and Madina hospital boasts the capacity to conduct four simultaneous surgeries, the highest in the country. However, that capacity has been tested in the past. In 2017, nearly 600 people were killed and hundreds were wounded when a truck filled with explosives was detonated at one of the busiest intersections in the city. Madina hospital was stretched way beyond its limits.

“October 14 was a sad day. We can say it was the most difficult day and we couldn’t cope with the number of patients. There were that many patients. About 50 to 80 patients received stomach surgeries. Those that received vascular surgeries. The number of amputations. It was a tough day. It wasn’t only a single day. We had to attend to the very serious patients first and delay the rest to the next day. It took us three to four days to get to all patients,” recalls Dr. Abdikadir.

The ICRC supports the surgery wards in all four hospitals by providing equipment, training and medical expertise. Running costs such as salaries, medical supplies, maintenance work and electricity are also covered by the organization.