At 85, Somaliland’s first midwife still has dreams to achieve
By Annelise Jolley
Edna Adan Ismail has chased soldiers toting automatic rifles out of her operating room. She’s been imprisoned under a military dictatorship and fought off hungry hyenas while evacuating the wounded from a war zone. But ask Edna how she would describe herself and she won’t reach for the attention-grabbing stories. “I’m a nurse, I’m a midwife,” she answers immediately. “That’s what makes me do whatever else I’ve been able to add to it.”
The 2023 Templeton Prize winner for her contributions to women’s health, Edna’s life glitters with firsts: First Somali woman to study in England. First woman to drive a car in Somaliland. Somaliland’s first trained midwife, first female cabinet minister, and former First Lady. Now, the first African woman to win the Templeton Prize. But Edna isn’t resting on her remarkable achievements. At 85 years old, she’s looking to the future and the work she intends to continue.
Edna and I met in the ubiquitous Zoom chatroom. She wore a beaded head scarf and gold-framed eyeglasses that glinted in the screen’s blue light. She’s as elegant today as she was during dignitary events in the 1960s. Despite having just recovered her voice after a bout of the flu, she spoke with the same conviction that she brings to the global stage. As we talked, the gloom of a British evening seeped through the window behind her. She explained that she was staying in London, a city of her long acquaintance, after speaking at a conference in Barcelona. Next she was heading to Germany to join discussions about the current humanitarian crisis in Somaliland.
An autonomous and self-governing territory in northern Somalia, Somaliland has burned with violence in recent months. Reports describe heavy fighting between Somaliland troops and militia from a clan in northern Somalia, with civilian casualties mounting. “The entire capital city of Hargeisa is now being flattened. A lot of people are refugees,” Edna tells me. It wouldn’t be unreasonable for her to stay abroad until the dust settles. But that’s not how Edna operates. “This is certainly no time for me to run away,” she says, using the same firm tone I imagine she directs at careless nursing students and political bullies alike. “The existence of my people depends on it. In whatever little way I can help contribute to the survival of our nation, I will do it.”
So back home to Somaliland she will go, where she will be picked up from Egal International Airport (named after Mohamed Egal, former Prime Minister and Edna’s first husband) and driven to the Edna Adan Hospital. Her apartment sits one floor above the main hospital—she eats, sleeps, works, and plans to live out her days in this building—but she’ll head straight to the office without even dropping off her luggage. She’ll check in with staff and hear about any problems that cropped up in her absence. “Nobody will ever tell you, ‘Oh, by the way, the roses are blooming,’” she says. “It’s always, ‘The rose bush died.’”
At lunch, hospital staff will gather around Edna’ dining table to eat together. If a particular patient is in critical condition, she’ll tend to them, though she’s no longer physically fit enough to make regular rounds. The current violence in eastern Somaliland adds complexity to the hospital’s care. “War is a very ugly thing and it does very ugly things to the human body,” she says, explaining that the influx of wounded patients is stretching her staff’s capacity.
I ask where she draws reserves during these long and often disheartening days. “My love for my people, my love for my country,” she answers. “And my hate of injustice.”
After all of this, Edna will prepare for the day to come—or, as she puts it, preparing for battle. Finally, Somaliland’s first and most beloved midwife will go to sleep.
To understand how one woman, born in what was then the remote reaches of the British Empire, became a global icon of compassion, you need to understand the girl.
Edna’s upbringing was unusual by any metric, but particularly for a girl born in the British Somaliland Protectorate in 1937. Her father, Adan Ismail, was the country’s most senior Somali medical professional and known as Somaliland’s Father of Healthcare. He was a devout Muslim; her mother, a Catholic. The multi-faith household imbued Edna with a lifelong respect for different faith traditions. “I believe that most religions are the same,” she says. “They preach the same principles of righteousness, of charity, kindness, of honesty. I see the similarity between the Catechism and the Quran.” What religion is mainly about, she adds, is “to do right by fellow humans.”
Edna calls herself a “turbulent” child, more interested in running barefoot or chasing wild animals than learning domestic skills. By age 12, she was assisting her father on rounds in his forty-bed hospital. He enlisted her to sterilize instruments, change burn dressings, and cut sheets for bandages. “He often had no supplies, facilities were very poor, and not the kinds of places that a doctor would like to work in,” she remembers. But this didn’t stop him from caring for his patience with dignity and compassion. “It was that determination that showed me that you don’t throw in the towel. You do the best you can with what you have.”
Trace Edna’s story back to these formative years, and you’ll arrive at two inciting events. One occurred while shadowing her father in his poorly-equipped hospital. A “fantastical thought” bloomed in Edna’s mind as she watched Adan Ismail at work: one day, she would build him the kind of hospital he and his patients deserved.
He had to battle so many odds to do what he was doing for his patients. It left a legacy with me—that if I have been educated, if I have been kept alive for 85 years, if I have been taught a profession, it was for a reason, it was for me to help humanity with it.Edna Adan Ismail
The other inciting incident was one that Edna wouldn’t speak about for decades. When she was eight years old and her father was away treating nomadic communities, her mother and grandmother arranged a circumcision ceremony. While a group of women held her down, an old woman performed the most severe form of female genital mutilation (FGM) on Edna without anesthetic, then stitched her up with acacia thorns. The psychological and physical trauma has followed her ever since: haunting her privately, galvanizing her public activism, and reminding her daily of its damage as she cares for women as a midwife.
As Somaliland’s first trained midwife, Edna transformed the landscape of maternal and infant health in the country and lowered infant mortality rates by an astonishing 75 percent. But the career was hardly love at first sight. “I didn’t really like midwifery,” Edna says, remembering her first impressions as a nursing student. “My reaction was, ‘Ahh, babies and screaming and women and, ahhh—you know…”. She trails off, gesturing at imaginary scenes of vernix-coated infants and bloody sheets and women howling in labor pains. “I didn’t have a good impression of midwifery, of childbirth.”
Her first love was surgery. But when Edna’s father asked her to consider where her medical skills would do the most good, she thought about Somaliland’s abysmal rates of maternal and infant mortality and knew that she needed midwifery training. The first delivery she attended was an emergency birth in the back of a London ambulance. The ordeal left her starched white uniform covered in blood and Edna in shock. But when she recovered, her fate had been sealed. “I thought, ‘Oh my god, this is what I should be doing.’ I never looked back.”
The relationship between midwife and expectant mother is distinct from other doctor-patient relationships. During the pregnancy, a midwife gets to know not only the woman but also her unborn child. To Edna, hearing two heartbeats—that of the woman and that of the fetus—feels like a form of communication, a sacred bond. During labor, the mother, baby, and midwife work together to deliver life from the dark sea of the womb into the bright world. They collaborate in “a beautiful partnership.”
Edna is a practicing Muslim. She’s been on pilgrimages to Mecca. She prays daily, calling her communication with God “strong and consistent.” And yet it’s the process of accompanying patients through pregnancy and birth—listening to a fetal heartbeat, palpating an abdomen, coaxing a newborn’s slippery body out into her hands—that brings her closest to her Creator. As she works she often prays, “In the name of God the Merciful.” I’m in your hands, she will say to God. You have taught and permitted me to do this.
I tell Edna that my own experience of pregnancy and birth was profoundly spiritual, a physical transformation that put me in awe of divine presence. She nods as I speak.
“It’s a very humbling experience. Each childbirth is unique. Each childbirth has its stress, its anxiety, its hope, and [at] times, failure. …The human element is there. The power of God is there.”
“Midwifery gave me that additional compassion towards people,” she adds. “A woman is at her most vulnerable when she’s having a baby. She’s totally in your hands, in your command.”
Her work with women and infants deepened her capacity for compassion, already a seemingly-boundless trait she inherited from her doctor father. The work also gave her a terrifying window into the long-lasting damage wrought by FGM. Edna treated women suffering from mutilation-caused complications, from hemorrhaging to fistulas to stillbirth. As she fought to deliver babies through heavily-scarred tissue—often leading to birth delays and occasionally brain damage—her anger and sense of injustice mounted.
In 1976, Edna stood before a crowd of women at the police academy in Mogadishu, Somalia. Riot police flanked the exterior of the buildings. The Minister of Health sat in the crowd with his head bowed, bracing himself for what she was about to say. Edna told the audience that she would be talking about a health crisis that affected all of them, as well as their daughters and granddaughters: female circumcision. Women gasped, whispered, dropped their gaze, pulled on their head coverings. But Edna raised her voice above their muttering and their shame—breaking for the first time, a “conspiracy of silence.”
FGM is thought to act as a permanent chastity belt, a ritual that preserves a girl’s virginity until marriage. It is practiced in some 30 countries across Africa, the Middle East, and Asia, mostly on girls between ages five and ten. Though FGM pre-dates Islam and is not required by the Quran, deeply entrenched religious and social pressure has cemented the practice among many Muslim communities (as well as non-Muslim) communities.
Edna has been working to dismantle the practice since that conference in 1976. “At that time, I was under the impression that [with] the campaign and education, we [would] do away with it in no time. I didn’t realize how hard a nut it is to crack.”
Now one of the world’s most prominent activists, Edna believes eradicating FGM hinges on two simultaneous efforts. The first is education. Every would-be health professional who trains under Edna must learn about FGM and commit to working against the practice—whether ophthalmologist or dermatologist or nurse-midwife. “These are the parents of tomorrow who need to be convinced not to damage their children,” she says. The second key? Involving fathers. Edna’s father was furious when he found out she had been cut; it was this outrage that first opened her eyes to the injustice of what was done to her. She believes that societies will only stop cutting girls if communities no longer view FGM as a “woman’s affair,” relegated to the domestic sphere and hidden behind closed doors.
Here, Edna pretends to address the father of a young girl: “This little girl that is being mutilated is your daughter, she carries your name.” She pronounces the words carefully, emphasizing each your. “This is something that interferes with her survival, and the survival of the grandchildren you wish her to give you. So if these are important issues to you, then intervene—protect her when she’s young.”
Her tone is persuasive, compassionate, and unyielding.
There’s a word beyond tenacity, beyond stubborn—something that conjures up a resolve so solid that no amount of persecution or resistance can break it down. This is what Edna has. Her word of choice?
Edna retired from the WHO in 1997. While her colleagues made plans to sail the Caribbean or care for grandchildren, Edna made plans to return to Somaliland and build a hospital in the capital city of Hargeisa. The only available piece of land was an old military compound from the days of dictatorship, a place known for public torture and executions. People avoided it except as a dumping place for household trash and animal carcasses. The land was seen as haunted by many, hateful by all. Edna took it.
Edna Adan Hospital opened January 23, 2002, more than fifty years after the bright dream of a hospital appeared in her twelve-year-old mind. In 2011, the hospital evolved to include the Edna Adan University.
Today, Edna has no savings or home outside of her hospital. She sold her car, her valuables, and cashed in her WHO pension to fund the hospital’s construction, even “recycling” her jewels into faucets and toilet hardware. But to hear her reflect on her life, she’s the wealthiest person in the world. “I’m surrounded by love. I walk down the streets in Hargeisa and people I don’t know will come over and touch me and kiss me and kids will call my name. People will listen to my speeches and say, ‘If Edna said that, it must be okay.’”
This total trust comes at cost, and Edna feels a heavy burden of responsibility toward her people. But it’s their love, mutually given and received, that keeps her going.
What I’m doing is just simply teaching people or treating people—it’s no big miracle. But still, it’s seen, it’s appreciated. The love of my people is very strong. And through that I see my God.Edna Adan Ismail
There are times, though, when the weight threatens to pull her down. On these days, Edna leaves her hospital and heads to a nearby camel farm. “Nature gets me back on my feet. It’s a good tonic for me.” She smells the earth and watches baby camels wobble about on spindly legs. She drinks fresh camel milk, her greatest pleasure since childhood.
In 2006, the Edna Adan Hospital conducted a survey among thousands of female patients. Ninety-eight percent had undergone FGM, of which 99 percent suffered the most severe form, called infibulation. Five years later, the hospital conducted another survey. Instances of infibulation had dropped by 25 percent. Yet an overwhelming majority of women in Somaliland still undergo some degree of mutilation. “When you’re fighting a long-drawn battle, you keep going back to the drawing board and saying, ‘Why is it that we’re not winning this war? What strategy would give us bigger benefits?’”
Edna tells me that she’s become a realist about the practice, knowing it’s unlikely she’ll see its complete eradication in her lifetime. “Half a loaf is better than no bread at all,” she says, citing an old proverb. But half a loaf is still not nearly enough, which is why she continues to educate healthcare workers, families, and religious leaders, and why she doggedly persuades men that their active participation is crucial to the fight. “Whatever change, whatever progress we have made in Somaliland, it’s because of that.” These two factors—education and the involvement of men—undergird the strategy that she will follow for the rest of her days.
Once she was the only Somali girl named Edna. Today, Edna can’t walk down the street without meeting a girl or woman who bears her name. Somaliland’s first Edna: add that to her list of firsts.
While she’s something of a saint to fellow Somalilanders, Edna doesn’t credit her life’s work to individual effort or virtue. “What I’m doing is too big for a single woman to be doing,” she says. “There’s got to be a power behind me, in front of me, pushing me from the back, leading me from the front, protecting my sides. … I feel that God sent a whole army to look after me, and the best I can do is to look after His human beings, His creations.”
When I asked her what she hopes the coming years will hold, she spoke first of peace for Somaliland. “And of course, I’d like to see my institutions grow,” she added. A pause. “I’d like to see the students in our class today graduate.” Not just graduate, she clarified, but also to become doctors who radiate excellence and skill, who shine brighter than their peers. Gathering steam, she added a few more hopes to the list: “And to see the extension of my hospital, knock down the old outpatient [wing] because it’s crumbling… then rebuild it, put in new beds, put in new equipment. If God in His grace lets me see that, I’d be very grateful.”
In other words, Edna Adan Ismail still has plenty of dreams.
“I’m one of those people who sees something that needs doing and I say, ‘Well, I need to fix that.’ So I’m just trying to fix the world.” She laughs, then amends the statement: “That’s a bit too much. I’m trying to fix what I can, when I can, and as much as I can.”
Learn more about the remarkable life and legacy of Edna Adan Ismail.
Illustration by WessonArt