Letters from the field

What Hiloweyn Meant to Me

Ethiopia / 25.05.2012
Michele Trainiti

I have spent almost 8 months in and around Hiloweyn working for Médecins Sans Frontières. At the onset of the crisis, I was responsible for the Health Centre and later the overall responsible for the projects in Liben. When I think of the Hiloweyn refugee camp, I think of Ambia. One of our first patients, 9 yrs old, 10 kg of weight, sick with TB and no family member except her uncle, all the rest had died of hunger or war. Ambia has been one of the symbols of our Health Centre.

At that time, late Summer - Autumn 2011, the Médecins Sans Frontières health centre was packed up with patients, we had constantly between 40 and 50 hospitalized severely malnourished children, of whom at least 8 would be in the Intensive Curative Unit, and the medics were on exhausting rounds to cover all the patients every day.

Outside of the health centre, an endless crowd was looking to be admitted in our nutritional programme, hundreds of women with malnourished children. Inside the centre, the doctors and the nurses were running from one tent to the other, from one patient to the other for the whole day, with just few minutes break for lunch and dinner. At that moment the camp was hosting around 25,000 refugees from southern Somalia, who had arrived a few weeks before, and every morning we were distributing burial clothes for those who had died in the camp over night.  We would lose three/four children every week, but in the worst moment we lost almost one per day. The situation was very difficult, the population in the camp would not recognise malnutrition as a disease, probably used to years and years of hunger and drought, and therefore they would bring us the children only when they would get sick with something else (diarrhoea, respiratory infections, etc.). Often the children arrived at the health centre in already critical conditions.

And between them there was Ambia. Eyes wide open on a new world, wrists of a child of 4 yrs, very defensive, very stubborn, very weak. Always sick. It did not matter how much the medics were busy, they would always find few extra minutes for her. She would smile but not get better. She would gain weight for few days and then rapidly lose it again. Her weight diagram was a hopeless, descending line.

Thinking of that period I feel somehow she represented the whole situation: a very difficult place where despite the immense efforts the situation was not giving signs of improvement, where every morning you would count the beds emptied overnight, where the mothers would want to take home their dying baby since they had lost all hope, where the medical staff was slowly but progressively wearing themselves out in the exhausting effort of confronting an overwhelming malnutrition crisis.

Then one day Ambia improved. We had just changed her diet, since she was not responding anymore to the therapeutic food, and the TB treatment was starting producing the first positive effects. I will always remember her uncle quietly crying, thanking the doctor for saving his niece’s life.

In October 2011 the situation started to improve. Fewer patients would need admission, fewer patients would die, and the mortality in the camp came under control. The health/nutrition situation in the camp was slowly stabilising, the food distribution was reaching more and more people and the medical efforts were finally giving result.

Last week I saw Ambia again, after 7 months. And I could not recognise her. In her traditional Somali clothes, with her hair covered and the veil around her face, her cheeks puffy and a sparkling face, I had to look for the blink of stubbornness in her eyes to find my old friend again. She was sharing a packet of biscuits with a friend in the health centre. The nurse in the ward told me that she had just successfully completed the TB treatment but that she would still come every day, out of habit as well as for the biscuits. Ambia looked at me and I could notice a deepening of her smile. I like to think that she recognised me.

Now the ward where Ambia had been hospitalised is almost empty, just very few beds are occupied with sick children. The endless crowd queuing outside the centre has disappeared and it is very quiet in comparison with a few months ago. The health situation in Hiloweyn has significantly improved nowadays; the nutritional crisis in the camp is overcome.


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