After more than 15 years of traveling to some of the most wretched places on the planet I thought I had seen it all.
I was wrong.
I am writing this letter from the world’s largest refugee camp, Dadaab, which is on the Kenyan – Somalia border just South of Mogadishu.
This must be the world’s hottest refugee camp also. It is close to 100 degrees today and I am sweating as if I am in a steam room.
We are on the equator and the sun is blinding, the earth is parched desert with little to no vegetation and just a few ugly, small scrub trees. Our caravan of range rovers stir up huge clouds of dust as we race from the airstrip to the camp. You can see the ribs on all the camels we pass by. Enormous vulture-like “garbage birds” give us the evil eye from atop of the trees. We all have pits in our stomachs as we drive across the barren landscape, a naked boy stares at us emotionless on the side of the road, as if we descend into a new level of Dante’s infamous inferno, bracing ourselves for what we are about to see.
Dadaab is a “temporary refugee camp” built to house 90,000 Somalians who were displaced when a civil war broke out in1991. Almost 20 years later, 300,000 Somalians are still here, hopelessly condemned to life in Dadaab.
30% are children, 20% of them are less than five years old, many were born here and have never known any other life. It is a fate you would not wish on your worst enemy.
As the two decade old civil war and chaos continues in the world‘s most famous failed state, Somalia, more than 5,000 new victims show up every week begging to be let in to this Hell hole.
Who knew that scorpions, polio, snakes, malaria, cholera, heat, floods and chronic malnutrition would be such a big draw.
I can only imagine how bad conditions must be like where these refugees come from that this is their promised land.
These poor children and their parents are truly stuck between a rock and hard place. They face death and destruction back in Somalia. And they face barbed wire fences and the Kenyan army on the other side, keeping them from venturing further into Kenya where they are not welcome.
20 years after Dadaab was built, things have gotten worse in Somalia and the future looks grim.
Our first stop is a medical clinic = the only medical clinic taking care of 300,000 people, most of whom have never seen a doctor before. It is overrun with children and adults suffering from clefts and all sorts of other problems.
Dr. Dan, our Smile Train partner, and a bonafide, modern-day good Samaritan who has been here trying to save people for 11 years shows us around.
Dr. Dan is a pediatric surgeon that performs cleft surgery for The Smile Train as well as a multitude of other procedures. He is a one-man band, doing his best, but clearly losing the battle. Walking around the clinic we are quickly surrounded by anxious parents and children shoving their medical papers in his face begging for help. You don’t need to speak the langauage to understand what everyone is asking for.
“Look at this”, he says shaking his head, examining the paperwork, “This is my handwriting…. from a year ago, I wrote ‘needs surgery right away.’ It is dated January 5th, 2009. I am doing everything I can to help these kids but my waiting list for surgery is close to 300.”
He explains that he needs another operating room and another surgeon and more supplies. He just can not keep up. Remember, this is the only surgical unit to take care of 300,000 people. It is pathetic. For those with really serious, life or death issues, they need to be taken outside the camp to be saved. Dan is allowed to choose six people for this life-saving treatment every month. Probably 100 people need to go outside every month for life-saving interventions. Six get it, the rest don’t and die.
Dan walks us through the pressing crowd, showing us various children and explaining their issues. There are many, many clefts as cleft surgery is non-existent in Somalia. Many of the children are much older than what we usually see, some 20 even 30 years old. Every child, every cleft can be fixed, but when? Dan’s waiting list is getting longer, 5,000 new refugees come to this camp every week.
He shows us a young boy who is half blind and missing part of his arm. “His family was killed in an explosion in Mogadisu and they were all killed, he has no one. he made his way here on his own. “ says Dan. “I have been trying to get him a prosthetic arm for two years now. I keep ordering it but it never comes. I don’t know what I have to do.”
He shows us a young girl with horribly deformed club feet. As bad as they look, she could be completely fixed with an intervention that costs just about $100. But the reality is she will probably never be helped. She and her parents could never afford that $100. And Dan doesn‘t have the resources.
We meet another girl who has suffered horrible burns on her back. Burns are a huge problem everywhere we go. Young children fall into open fires in all developing countries. The ones who live suffer from contractions which happen when their skin melts together and sticks their chin to their chest, or all their fingers together, or their forearm to their biceps. They too could all be helped with a simple surgery called a “release” that costs only slightly more than cleft surgery.
Chances are they will not be helped either. It is frustrating to see so many children with easily solvable problems who will never be helped and will suffer their entire lives because they were born poor and in the wrong country and at the wrong time.
Being born in Dadaab has to be the first handicap. Being born with a birth defect here is just beyond the pale.
We visit two patient homes and get even more depressed. One woman had traveled by truck, for six days, with 4 children to get to Dadaab from Ehtiopia. Why? To get cleft surgery for her children. We were speechless. She had traveled many hundreds of kilometers and actually moved to Dadaab because it was the only way to get her children surgery.
One of her sons has a palate and cannot feed properly. Dan lifts the little boy’s shirt and shows us his ribs explaining this boy will die if he doesn’t get surgery soon. He is on the list Dan tells us shaking his head.
The next woman, another widow, came from Mogadishu with her five children, three of whom have clefts. “Everyone despises us, “she told us. “Everyone believes we are cursed.” The stigma of having a cleft is a horrible curse when one of your children has one. I cannot imagine having three children with clefts in a refugee camp where everyone is going to think you are the Devil family.
She explained how the all the local boys beat her son with a stick when they get him alone. Her son shakes his head as he hears her tell us this, embarrassed and ashamed, as if it is his fault. When will they get surgery? Again Dan tells us, they are on the list.
We stop by a “nutrition feeding ward” on the way back. This is the last stop for babies who are basically starving to death. Here they force-feed the babies and use I.V.s to try and save their lives.
We meet a little girl who weighs 7 pounds at the age of 7 months. I remember my daughter was 8 pounds when she was born. An average American baby girl weighs 18 pounds at 7 months old.
“Most of these babies will die within the next week, ” Dan explains as we all look around helplessly. The mothers stare at us with blank looks on their faces, holding their dying babies on their laps. None of us can talk as we follow him like sad sheep out of the building, back into the 100 degree heat and blinding sun.
“Some genius bureaucrat came up with this idea that if we reduced the amount of food we give everyone in Dadaab, if we cut the calories per day from 2,100 to 1,600, this place would be less desirable, “ explained Dan.
“Desirable?” we all asked together not having any idea what he was talking about.
“The basic concept is that if more people starve to death here, less people will want to come here. You know, make it less popular.” Dr. Dan says angrily. “It is an unwritten policy of course, no one would admit it publicly.”
Not only is there acute malnutrition, there is an acute water shortage also. Water is given out only every two days. Some NGOs have offered to drill wells but the Kenyan government has refused. Again, they don’t want life in Dadaab to be too “desirable.” Now it all makes sense. Well actually, that’s not true at all .Nothing about Dadaab makes sense at all.
Today, at the end of a very long, sweaty. and depressing day, we left Somalia by a small, six seater Cessna headed back to Nairobi. Exhausted, depressed and confused, all of us were scratching our heads with many more questions than answers.
How can the world let this happen? How many of those babies we saw today will die tonight? How long you can someone live on 1,600 calories a day? How can we as a small cleft charity possibly make a difference in such a large, desperate and hopeless place?
Well, none of us had any good answers. But we did come up with a plan.
We are going to do everything we can. We can’t solve 99% of the problems there but we can fix every single cleft. And we have friends and know of other partner organizations that can help the kids with burns and club foot as well as some of the other surgical problems.
Dr. Dan is a living Saint and we will help him as much as we can.
We are going to help him build another operating room right away. And we are also going to try and find some more surgeons and even mission groups that can help eliminate that 300 person surgical waiting list.
There is an awful lot of suffering in the world and our program is a very cost-efficient, strategic, and well-managed way to do something about it.
One child at a time, one smile at a time, we are making a difference in even the most wretched and God forsaken places in the world.
