The doors of the Suuqa Xoolaha Center for Mothers and Children, a vital hospital in southern Somalia, were locked shut in early July.
This closure wasn’t voluntary; critical funding from the United States, which covered staff salaries and medical supplies, had been abruptly halted by the Trump administration. Consequently, the aid organization overseeing the hospital was forced to lay off all its dedicated doctors, midwives, and support staff.
Tragically, news of the shutdown hadn’t reached everyone. Just days later, Khadija Ali, a 25-year-old woman from a nearby displaced persons’ camp, arrived in advanced labor, desperately seeking care with her aunt by her side.
Panicked, she pounded on the locked gates, her cries echoing the fear that she might die if she couldn’t give birth inside. This was a stark reminder of Somalia’s harrowing maternal mortality rates, among the highest globally.
Her aunt, Habiba Ali, explained their dire situation: Khadija’s labor was too advanced to seek another facility, and without funds, Suuqa Xoolaha was their only hope for free maternal care. With no other option, Khadija began giving birth right outside the hospital’s entrance. The commotion drew neighbors, who quickly brought her into their home, where she successfully delivered a healthy baby girl.
Khadija’s harrowing story of a midnight birth outside the hospital quickly reached the ears of the recently dismissed healthcare workers.
Khadija Noor Adan, a former nurse-midwife at the center, was appalled. She declared that she wouldn’t stand by while women were forced to give birth in such desperate conditions, regardless of her employment status.
Her determination resonated with many of her former colleagues, and together, they made a courageous decision: they would reopen the hospital.
“We decided it was time to serve our community,” Ms. Adan explained. “Even without salaries, we felt a profound responsibility to return.”
Fueled by their unwavering commitment, the former employees quickly spread the word, and within days, the hospital sprang back to life. Doctors, mental health counselors, cleaners, and the pharmacist all returned to their posts, working tirelessly without a single paycheck.
“Regardless of whether we receive payment, we must do everything in our power for our community,” stated Abdikadir Hassan, the hospital’s pharmacist.
This crucial medical center is located beside a bustling livestock market on the periphery of Baidoa, a city of 750,000. Its population has swelled with an additional 770,000 people displaced by relentless drought and ongoing conflict, now residing in makeshift camps across the area.
While technically managed by the state government, which could authorize its reopening and welcome staff back, this hospital, like most healthcare facilities in Somalia, relied entirely on foreign aid for staffing and equipment.
Until January, the United States stood as Somalia’s largest benefactor, annually contributing hundreds of millions of dollars to essential projects in health, nutrition, shelter, and sanitation. The majority of these funds were distributed via the United Nations and various nongovernmental organizations.
However, since the Trump administration assumed office, a significant portion of US aid to Somalia, primarily disbursed through the United States Agency for International Development (U.S.A.I.D.), has been withdrawn. This was done either by terminating existing grants or by not renewing annual awards.
For eight consecutive years, the International Medical Corps had secured a U.S.A.I.D. grant of approximately $10 million, specifically to fund and equip this medical center and three similar facilities across Somalia. When this crucial grant expired in July, it was not extended.
In response, the State Department affirmed that both military and humanitarian aid to Somalia were ongoing. They stated that the administration was focused on “significantly enhancing the efficiency and strategic impact of foreign assistance programs and ensuring that foreign assistance reaches those in need.”
The Trump administration justified these cuts by asserting that a substantial amount of past U.S.A.I.D. funding had been mismanaged, and that the United States was shouldering an disproportionate share of global foreign aid. Prior to these changes, the U.S. was indeed Somalia’s primary donor.
The uncertainty surrounding the vanished US funds has left patients deeply concerned that the hospital might permanently close. ‘It’s a real dilemma for the community,’ explained Dr. Hassan Adan, the hospital’s acting director (no relation to Ms. Adan). ‘People are asking, “When will you be paid? Is the facility going to shut down again?”‘
This volunteer-led operation has necessitated some adjustments. Nurse teams no longer conduct mobile outreach, instead focusing entirely on covering the 10-bed maternity ward around the clock. To manage, everyone now takes an additional day or two off weekly.
Ms. Adan admits that some of her time off is spent searching for new employment. The harsh truth is that she, like others, needs a paying job. ‘If I find one, I will have to leave,’ she stated plainly.
On her modest $536 monthly salary, Ms. Adan supported ten individuals. Dr. Adan, meanwhile, was providing for twenty people, including covering school fees for four siblings. Without his income, these children have been forced to drop out of school.
“My family constantly asks me if I’m going to get paid,” remarked Mr. Hassan, the pharmacist, highlighting the everyday pressure they face.
Already, the hospital’s original director and a nurse have been recruited by Baidoa’s regional hospital. This facility is now grappling with a surge of new patients who previously relied on primary health centers in displaced persons’ camps—half of which have ceased operations since the U.S.A.I.D. cuts took effect.
The grim question remains: What will become of their medical center if most, or all, of its remaining staff are forced to leave?
“That is a difficult question,” Dr. Adan responded, looking around the patient-filled corridor. “It will close. But our hope is to keep working, serving those who need us.”
Additional reporting was provided by Amy Schoenfeld Walker from New York.
