A Somali Hospital Closed After U.S. Aid Cuts. Fired Employees Reopened It Without Pay.

In the first week of July, staff members at the Suuqa Xoolaha Center for Mothers and Children, a hospital in southern Somalia, closed its doors and locked its high front gate.

Funding from the United States, which paid for salaries and medical supplies, had been cut by the Trump administration, and the aid organization that managed the hospital fired the doctors, midwives and other workers.

But word of the closure didn’t reach everyone who needed to know. Khadija Ali, 25, arrived at the hospital a few days later, from a camp for displaced people outside the city. She was in the late stage of labor, accompanied by her aunt.

She pounded on the door, crying and saying she was afraid she might die if she could not deliver her child inside. Somalia has one of the highest rates of maternal mortality in the world.

Her labor was too far progressed for them to go anywhere else, her aunt, Habiba Ali, said. And they had no money; this was the only hospital they knew that offered free maternal care. Ms. Ali began to give birth outside the hospital door. The commotion woke neighbors, who carried her into their home, where she delivered a healthy baby girl.

Word of Ms. Ali’s traumatic midnight birth spread quickly among the fired hospital workers.

Khadija Noor Adan, a nurse-midwife at the hospital, was aghast when she heard the story. She resolved that she wasn’t going to sit at home any longer, job or no job, when women were giving birth in the street.

Many of her colleagues felt the same way — and they resolved to reopen the hospital.

“We decided, now it is time to work for the community,” she said. “Despite the fact we have no salary, we feel a responsibility to come to work.”

Word spread, and within days, the employees had reopened the hospital: doctors, mental health counselors, cleaners and the pharmacist. None of them are being paid.

“Whether you get something or nothing, you have to do what you can for your society,” said Abdikadir Hassan, the pharmacist.

The medical center is next to a bustling livestock market on the outskirts of Baidoa, a city of 750,000 that has absorbed an additional 770,000 people displaced by drought and war into makeshift camps scattered around the town.

The hospital is nominally run by the state government. Officials could unlock the doors and welcome staff members back to work. But like nearly all other health facilities in the country, this one depended on foreign assistance to staff and equip it.

Until January, the United States was the largest donor to Somalia, spending hundreds of millions of dollars each year on health, nutrition, shelter and sanitation projects. Most of that funding was channeled through the United Nations and nongovernmental organizations that provided those services.

Since the Trump administration took office, much of the assistance that flowed to Somalia through the United States Agency for International Development, or U.S.A.I.D., has been cut off, either through terminated grants or through annual awards that were not renewed.

For each of the past eight years, International Medical Corps had received a U.S.A.I.D. grant worth about $10 million to staff and equip the medical center and ones like it in three other districts of Somalia. When that grant ended in July, it was not renewed.

In a statement, the State Department said that both military and humanitarian assistance to Somalia continued but that the administration was “significantly enhancing the efficiency and strategic impact of foreign assistance programs and ensuring that foreign assistance reaches those in need.”

The Trump administration has said that much of the funding that went through U.S.A.I.D. in the past was wasted and that the United States was covering an unfair share of the burden of foreign aid. The United States was by far the largest donor to Somalia.

The volunteer staffing arrangement has led to some changes at the hospital: Teams of nurses don’t do mobile outreach any more so that they can cover the 10-bed maternity ward 24 hours a day, and everyone takes an extra day or two off each week.

Some of that time is spent looking for a new job, Ms. Adan said. The reality is that she needs to find a job that can pay her. “If I find a job, I will go,” she said.

She said she supported 10 people on her $536 monthly salary. Dr. Adan said he was supporting 20 people on his, including paying school fees for four siblings. Without his paycheck, they have had to leave school.

“My family is always asking, are you going to get paid?” Mr. Hassan, the pharmacist, said.

The hospital’s director and one nurse have already been hired away to Baidoa’s regional hospital, which is now struggling with an influx of patients who were previously cared for at primary health centers in camps for the displaced, half of which have closed since the U.S.A.I.D. cuts began.

What happens to their medical center when most or all of the staff members are gone?

“That is a difficult question,” Dr. Adan said, standing in a corridor crowded with patients. “It will close. But we hope to continue our work.”

Amy Schoenfeld Walker contributed reporting from New York.