How Somaliland’s first midwife-led the fight against FGM after traumatic childhood experience

Edna Adan Ismail tells Pascale Hughes why she built a hospital to support Somaliland’s women and the importance of education

As a child, Edna Adan Ismail’s doctor father, Adan Ismail, taught her to wash forceps and make bandages out of old bed sheets in the hospital he ran in Somaliland.

In 1950, when he went to work in a relief camp for people suffering from the drought known as the Year of Red Dust, he left notes for Ismail, then 13, telling her to ensure patients received medication and had sutures removed. “I did not know what these medicines were for but I was the boss’s daughter, so I would go to whoever was in charge and say, ‘By the way, dad wanted you to remove these.’”

She noticed the hospital never had enough instruments or supplies. “I can’t remember the exact moment when I decided I would build a hospital, but I do know I had a very clear image of how it would be run.”

Ismail went on to do more than that. Now 87, she is a former first lady of Somaliland, its first woman cabinet minister, foreign minister, and nurse-midwife, an anti-FGM campaigner and, today, the director of the maternity and teaching hospital she founded in the capital, Hargeisa. She is certain she is the only foreign minister in the world to have had to leave a meeting to deliver triplets.

Fight against FGM

Ismail’s life has been defined by her fight to improve maternal healthcare in Somaliland and the fight against FGM. Somalia, and the autonomous region of Somaliland, has the highest rate of FGM in the world, with the procedure carried out on up to 98 per cent of women. Ismail’s mother and grandmother arranged for her to be cut when she was eight and her father was away from home. It was a deeply traumatic experience she has spoken about around the world.

The problem is that the practice is “glorified” in some communities, she says. “The ones who haven’t had it say, ‘Why have we not been purified? Why am I being denied this?’ But we need to educate young people, young parents, and not glorify the procedure.”

Ismail never had children but tried for many years. She says FGM could be have been to blame because it can cause pelvic organ inflammation. As a midwife, Ismail has seen the many complications it can cause during childbirth.

Ismail says she only became a midwife because her father made sure she learned to read and write, which was almost unheard of at the time for girls in the region. When she was 17, Ismail moved to the UK to train as a nurse after winning a scholarship. She was accepted on a course at the West London Hospital in Hammersmith.

Education

The rotation she enjoyed most was in surgery. “I loved operating theatres,” she says. “They were so clean and efficient. The satisfying sense of accomplishment was like nothing I had experienced before.”

When she returned to Somaliland three years later, she was determined to become a surgical nurse. “I didn’t want to be a midwife,” she says. “But then my father asked, ‘What are you going to do for women? What will you do if there’s a woman in labour who needs you?’ My father gave me so many opportunities and never stopped me from doing anything. It felt like it was his way of asking me to do something.”

Ismail returned to London and learned to be a midwife at Hammersmith and Lewisham hospitals. When she was delivering four or five babies in a day, she understood why her father had suggested she train as a midwife. “Somaliland has the highest maternal mortality rate in the world. There are still areas where they have never had a trained midwife. I have scars of a forceps birth, my sister died after just such a delivery and someone who wasn’t medically trained dropped and killed my baby brother. I would return to Somaliland with my midwife training where it was desperately needed.”

Facing new challenges

When she returned in 1961 to the new Somali Republic, formed of British Somaliland and Somalia, she met new challenges. She was assigned to work in a hospital, but was given no position, no salary and had to fight to be allowed to drive. “The administrators had never encountered a woman with nursing and midwifery certificates.” People reacted with hostility, saying she would never marry.

In fact, she married three times. Her first marriage was to Mohamed Haji Ibrahim Ega when he was head of government in British Somaliland five days prior to Italian Somalia’s independence. They met in London and he went on to become prime minister of Somalia (1967-69) and president of Somaliland in 1993. They divorced five years later. Ismail married twice more, but says midwifery and the hospital are her most important relationships. In 2002, after stints working for the World Health Organisation (WHO), Unicef and the Ministry of Health, Ismail opened the Edna Adan Maternity Hospital. It was built on a former rubbish dump donated by the government.

Most nurses or midwives had fled or been killed during the Somali Civil War, which destroyed Somaliland’s health infrastructure and 95 per cent of its cities between 1982 and 1991.

Ismail recruited more than 30 candidates and began training them while the hospital was still under construction.

There are now 200 staff members and 1,500 students, and almost three-quarters are female. “I just did what needed to be done,” she says about her decision in 1998 to sell her home and car, and donate her UN pension, to fund the hospital. Patients come from as far away as Mogadishu, more than 800km south, and neighbouring Ethiopia, to seek treatment in the best-equipped general hospital around. More than 14,000 babies have been delivered and more than 140,000 patients have been treated.

In 2002, Ismail became Somaliland’s first female cabinet minister. She became foreign minister the following year, but continued to work in the hospital. “I am a midwife first and foremost. One day when I was meeting with a European delegation, I knew that there was a woman in the hospital who was going to have triplets. When the hospital called I had to say, ‘I’m sorry, I know we have got important things to discuss but I really have to go. I’ll talk to you tomorrow.’”

A Woman of Firsts by Edna Adan Ismail is out now, published by HQ

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