Henok Samuel, MD

Addis Abeba, December 24/2018 – After the last conflict which I posted [in November this year] titled ‘The endless battle of Moyale’, the town was in a tense situation – there had been palpable fear and tension in the air and we were wary of the situation. There have been occasional clashes leaving casualties and some deaths behind.

On Saturday December 10 a woman in her thirties was shot dead by stray bullet while she was inside a Bajaj. She was traveling on the alternative back road since the main asphalt road was closed and is unsafe for a long time. There had been occasional clash since then…

The previous war has already done a great damage – it claimed the lives of many and left an entire village burnt down; its inhabitants had already settled in a different location after constructing their light dome shaped tents. Other inhabitants had also constructed these makeshift tents in the bush preparing in advance for forthcoming conflicts. They have used them this time!

An intense gunfight started on Tuesday [December 11] in the afternoon – some casualties came of whom one was shot on the left upper chest with an exit wound at the back, he has difficulties breathing and has bled a lot… he also has blood and air inside the chest cavity so we rushed to resuscitate him and put a tube inside his chest to remove the blood but he started gasping just before we inserted the tube – we lost him on our hands! We were very anxious as to what was happening while the [federal] defense force is still in town…we thought the defense force will intervene and stop the clash but it didn’t seem so as the clashes kept going strong and they have a bad reputation of withdrawing when clashes get intense.

The clash subsided in late afternoon and we spent the night hoping it ends and we don’t have to wake up to the sound of gunfire. On Wednesday, it seemed like a normal day – I had my breakfast and walked to my HIV Care and Anti Retroviral treatment (ART) clinic where I work. There were also patients at the waiting area of the outpatient department (OPD). I saw some patients and was working on a report with the Data Clerk. We were not able to hear the sound of the clashes and the crowd as the ART clinic is a few blocks behind the ER and quiet. But later on the sound of gunshot and heavy artillery came to my ears and I said ‘please, not again’!

I rushed to the ER to help – there were a lot of injured people. Some of them were in  critical condition – a bullet to the head and chest! It is sad to learn that some of the injured are again civilians who were at home or on the streets in search of their loved ones. The clash was very strong and intense, like we have never seen before – it was very frustrating to work in the ER while listening to the disturbing and scary sound of gunfire and heavy artillery.

We were helping the injured in two places – one in the old small ER with only three beds in it and another makeshift ER, a wide room with a lot of mattress in it. There were a lot of injured men with all kinds of bone fractures, chest and head injuries. In the late afternoon, around 5:00 PM, I was in the other room evaluating a newly injured man who was shot on his right loin with an exit wound on the left side with minimal bleeding; he was not able to move his legs nor feel the sensation of touch. He must have had spinal cord injury. While I continue to evaluate the patient we heard a loud and terrify explosion – the sound was very near. I was terrified and didn’t now what to do but as I continued to evaluate the patient another louder explosion happened just seconds after the first one – this one was for sure inside the compound. I immediately let go of the patient and ran to the gate; I saw the crowd dispersed like wind. I ran to the back of building for shelter. Since then we stopped working, we were petrified… We later learned that it was an RPG aimed attacking the hospital! The remnant of the RPG was later discovered inside the compound! Our fear and panic had escalated to its peak; we can no more do anything than thinking of an exit strategy!

The CEO [of the hospital] was also shocked; he didn’t know what to do! He told us he would find a car to evacuate us and pleaded with us to help until then; so I went back to the ER, it was getting dark and the clash was subsiding, as usual, but the ER was more hectic than ever – there was no one on the door coordinating the movement and helping us as everybody was confused and shocked. Everybody wants to get help as soon as possible; a man with laceration and another man with bullet wound would shout at you for help! What makes it difficult – more than the panic and frustration – is the language barrier to calm patients down and the working environment (jostling with armed men carrying AK47 on their shoulder!)

An angry man (may be a militia) showed me a chest x-ray, which was sent by another colleague; it showed multiple fragments in the chest cavity but no blood collection in the cavity and I told him so but he got angry: ‘how come you say its fragments – I saw the man who shoot me he boasted that he killed the shooter and brought another rifle with him!!)’. He had three small wounds in the left lower lateral chest area but his vitals were normal and he was stable. I reassured him that we will repeat the x-ray later and moved to another patient – a very familiar face: a 7 years old [boy] known HIV patient on antiretroviral therapy got hit by explosive fragments on the right upper back. I opened an intravenous line and put the kid on fluid, cleaned the entry wound and dressed it and took him to x-ray. While I was doing this that other man was shouting at me despite the reprimand from a colleague who knows the language well! Then I decided that it was dangerous to stay there and left the ER and went to home. We packed our luggage for an early morning departure. I spent the night with friends and colleagues who came to the hospital seeking for shelter. By this time only a few of us were in the hospital but others had already left! We heard that the fighters on the other side was pressing hard and they have already crossed the asphalt road. In the morning we went out in search of any bus available to leave – the hospital denied us a vehicle for a sole reason that the situation will improve. We found an old bus in front of the hospital; we (about ten of us) hurriedly got into the bus hustling with the crowd of people – we didn’t get a seat, so we all stood among a multitude of people – there was no space to move around – we started the journey using the bypass sandy road through the bush until we came back to the asphalt road.

Make-believe war! How Moyale boys play! How can one not be wary of this situation!!

When we reached Mega town, some 100kms north of Moyale, the people, especially the youth, were on the street demonstrating against the killings in Moyale. Inside the bus station a woman recognized our faces and said the hospital must be empty as “you all are here.” Later on we learned that the road was closed and we couldn’t go out. After about half an hour we managed to convince them and found a minibus, but it was like a trap and we found ourselves in a big argument that we shouldn’t leave! We were stopped by a group of youths called ‘Qerros’ and a cabinet member. We were forced to get off and were taken back to Moyale against our will in an ambulance! Inside the ambulance there was a militia in the front seat and the cabinet member and ten of us in the back-seat side by side. What is more annoying was that the cabinet member bleed our ears with his [sic] propaganda and weak arguments despite our silence. He even mocked us by saying ‘we will give you AK47 and you will fight alongside’. He added that the stray bullets which came to the hospital compound were weak with minimal energy, you won’t die unless it’s your time….

Finally, we arrived back at Moyale Hospital and the fight had already continued – the fighters from this side have gotten additional back up force and were defending much better. The Yabello hospital had sent a team of health professionals to help us. The clash has continued on Friday [December 14] leaving additional deaths and injured men. On Saturday there was not much fighting, it was a relatively quiet day. But in the morning a young man came to the ER after he ingested an unknown chemical which we guessed was a pesticide after the effects we have seen. He died just after he was delivered to the ER – we were not able to know as to why he committed suicide.

These are the light dome shaped huts made of acacia roots and covered with plastics and mats! Some of the local people hide away in these make shift tents, many others dwell here permanently!

The clashes have continued on Sunday for the sixth day in a row. It’s now getting boring and we got desensitized. late in the afternoon some of us gathered to watch the English premiere league Manchester united vs Liverpool in the medical director’s house. While we were watching the last minutes our medical director was tipped with information that the force on our side were withdrawing for an unknown reason and the fighters on the other side have reached the asphalt road – we thought this was rumor but what can we do? We were already ready to leave anytime. We were told that we will be leaving the next morning. All patients have been sent to Yabello hospital.

On Monday morning the clashes  began again – the sound was close to our ears and terrifying! It was indeed true they were near! My friends and I found some food from a woman who used to cook in front of the hospital. (In all this time we were not able to get enough food – we often eat plumpy nuts and a few times a rice with goat meat prepared for patients and the staffs.)

When we came back to the car which was ready to take some of us – the back seat was already full with only one seat reserved in the front row for someone – I immediately took it! Guess what? my lean body helped and we shared the front seat for three, four with the driver!! The car left through the bush. We arrived at a health center some 25 km away to be able to help the injured from there. But there were nothing in that health center: no sterile gauze , no lidocaine (local anesthetic), no drugs or fluids…

The ambulance went back to fetch some equipment, drugs and other staff members. Sadly, just before they left the compound the hospital got bombarded by three RPGs – fortunately the RPGs hit the ground and didn’t do much damage! Two ambulances arrived and collected the remaining staff members from their hideouts and brought them to the health center. It feels like the health center is in the middle of no where! The ambulances started to bring casualties…we had seen a helicopter flying to Moyale at midday. The injured men who were brought in the afternoon claimed that it was the defense forces who shot them!

After the day was done we made our way to Yabello and to Addis Abeba, then after……..!

We will see what happens Next – Uncertain future!

Please share so that everybody knows about this hostile situation, which the government ignored!

Editor’s Note: the original blog was published here. Please visit the site for more pictures by the author.

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