They are dying because societies have yet to make the decision that their lives are worth saving. Outside, family members of the women within crouch beside the wall, avoiding the slanted columns of harsh Somali sunlight that line the floor. They are waiting, and sometimes praying, for healthy sons, daughters, grandchildren, nieces and nephews or, at least, for the lives of their wives, daughters or sisters.
Inside the delivery ward it is dark, and mostly still but for an occasional flurry of activity as nurses armed with cooler boxes full of vaccines sprint from one room to another and orderlies push women on stretchers down to the surgical theatre. According to Somali custom, women giving birth should remain quiet, but every now and again a shout shatters the silence and reverberates through the halls.
At the centre of all of this is Dr Marian Omar Salad. Around her there are midwives and nurses, the clutter of surgical steel, the flutter of white coats and the muted groans of women in labour behind baby-blue curtains.
Salad surveys it all intently with warm brown eyes that go soft at the edges. Today, a patient from the town of Afgooye, more than km away, is the particular focus of her attention. Howa Oofay Moalim arrived just two hours earlier, and the doctor considers it a miracle that she is still alive. According to Salad, Howa has been in labour for nearly five days, with life threatening complications that arose almost immediately. Her baby was positioned crookedly in her uterus and his arm punctured her bladder.
She has a fever and a serious infection. The life she is trying to bring into the world now threatens to kill her. Despite the warning signs, traditional birth attendants tried to deliver the baby. But Salad says they only made things worse. The tugs have broken his arm in multiple places.
