Meet the people running Somalia's only public ambulance service

old center of Mogadishu, Somalia. Photo / 123RF

For the first hour after the blast, the smoke was so thick it was almost impossible to breathe. But even as volunteer medics struggled to see survivors to rescue, Dr Abdulkadir Abdirahman Adan knew it would be the worst day of his 12 years running ambulances in one of the world's most violent cities.

"I got there in about 15 minutes. The first thing I saw was a truck burning. Cars, trucks, motorcycles - all of them burning," the 44-year-old dentist said. "Wherever you looked, there was a part of a body. I remember someone screaming ... I saw a man in a burning car, and we couldn't do anything for him - there were no fire fighters. We did what we could. We transported almost 250 people."

At least 512 people were killed in the suicide truck bombing that ripped through Mogadishu's busiest street on the afternoon of October 14. The blast was Africa's worst ever terrorist attack, and it dealt a shattering blow to a fragile but tangible sense of optimism that Somalia was leaving nearly three decades of war and insurgency behind it. It also cast a critical light on the international community's claims to have al-Shabaab, the al-Qaeda-aligned group believed to be behind the blast, on the run.

Stretched along a perfect sandy beach and blessed with a historic old town and port, Mogadishu once liked to call itself the Pearl of the Indian Ocean.

But today al-Shabaab remains so deeply embedded that it is impossible to describe it as anything other than a city at war, despite being nominally controlled by an internationally recognised government heavily backed by the UN and African Union troops. Roadside bombs, grenade attacks, and shootings shake the city with monotonous regularity.

The city centre is a chaotic and heavily militarised maze of Hesco barriers, concrete blast walls, and police checkpoints. The legion of foreign diplomats, aid workers, and soldiers dispatched to help rebuild Somalia are confined to the heavily fortified airport. Nobody can leave without armoured vehicles and a small platoon of gunmen to protect them.

Despite the deployment of an increasingly internationalised effort to crush them - including a supposedly clandestine US campaign of drone strikes and special forces raids - al-Shabaab retains control of large areas of the countryside. Somalia has been in a near-constant state of war since an uprising ousted Mohamed Said Barre, the dictator who had ruled the country since 1969, in early 1991. A succession of battling warlords, would-be presidents, Islamists and foreign powers left the capital in ruins and destroyed any sense of a municipal - let alone national - state. "In other words, al-Shabaab isn't the problem," said one Western military officer advising the Somali Army. "The problem is the complete collapse of the state."

Aamin ambulance, the tiny bunch of volunteers who rode into the smoke and attempted to triage a catastrophe, are the only first responders available to ordinary Mogadishu residents.

The group began in 2006, when Adan returned from six years abroad to find the district where he chose to open a dental practice was a battlefield, and any semblance of a functioning state had vanished - including the emergency services.

"More people were getting killed and wounded in that market than anywhere else, but people had to be pushed to hospital on wheelbarrows. So if you had catastrophic bleeding, you'd die before you got there. And even if you had a car there were checkpoints, and they'd question you, and if you answered the wrong way you might be arrested."

Inspired by a similar project he'd come across while studying in Pakistan, he spent his $3245 savings on a second-hand Toyota minivan, wrote the world 'Ambulance' on it, and began ferrying casualties across the city. Twelve years on, the service has grown to 10 ageing second-hand Japanese ambulances and 35 volunteer staff including paramedics, drivers, and logistics managers.

It even has a 999 telephone number that connects to a bare-bones operations room, consisting of one man and a laptop - the only free, first-response ambulance service available in the entire city. "We respond to any emergency - women in labour, children with diarrhoea, hypertension..." said driver Abdulkadir, 23. "It's still mostly bombs though. It used to be about two a month, but there are a few less these days."

Adan called his DIY ambulance service Aamin - the Somali word for trust. But it is dangerous work. An ambulance was destroyed by an Ethiopian tank shell in 2008. Abdulkadir said he has twice been nearly caught by secondary explosions when responding to bombings.

Adan says he dreams of expanding the network across the country. He is frank about the shortcomings. The staff are few, their ambulances sparsely equipped, and their expertise not always equal to their remarkable commitment. He guesses "many more" lives could have been saved on October 14 if they'd had basic items such as tourniquets.

"The idea is there. But this is a city of up to three million people. I've got 20 paramedics and 10 drivers."