Continued from page 1

The difficulty of the job has been compounded by rumors that insurgents planned to use ambulances to attack government and African Union bases. In addition, a militant group donated two ambulances, a gift that raised government suspicions.

“The distrust of our service in the government-controlled part of the capital is high,” said Ali Muse, director of the ambulance service. When ambulance drivers are stopped at checkpoints, “the delay makes us lose people,” Mr. Muse said.

A government official did not return calls for comment, but a spokesman for the African Union troops admitted the AU force is sometimes suspicious of the ambulances.

Militants “can use anything, including ambulances, donkeys, wheelbarrows, trucks and fuel tankers, to carry out their attacks,” said Maj. Barigye Bahoku, the AU spokesman.

Not long after Mr. Mohamed drove away from the woman who criticized him for being late, another emergency call came in to his ambulance. He was to drive to the Bakara market, in a neighborhood controlled by al Shabab, a group that pledges fealty to al Qaeda and controls all but a few blocks of Mogadishu. It wants to impose harsh Islamic rule in Somalia, which hasn’t had a fully functioning government since 1991.

The al Shabab-controlled district is too dangerous for journalists, so Mr. Mohamed dropped off the AP reporter and photographer, who waited under a concrete wall while shelling boomed in the background.

A half-hour later, Mr. Mohamed was back, having been delayed again by government and militant checkpoints.

In the back of the ambulance lay a woman with blood pouring out of her clothes. She groaned in pain. A teenage boy who was with her said she had been caught in the crossfire at the market while buying food for her children.

During heavy fighting, Mr. Muse and his team sometimes work 24 hours or more, to the point of exhaustion. He wishes for more training for his staff and better facilities and equipment.

“But believe me, we still like the feeling of being able to help people when they need us,” Mr. Muse said.

When night falls, saving lives becomes almost impossible. A shoot-to-kill mentality takes over after dusk, with government troops and militants both opening fire on sight.

Driver Abdullahi Ahmed said he has a good job, “but it also traumatizes me.”

“We wash the blood off our hands and get back in the ambulance. Siren screaming, lights flashing, we huddle on the floor of the ambulance, we pack it with people with different injuries, some of them very critical,” he said.

Violence between al Shabab militants and pro-government forces spiked in September. Elmen, a human rights organization, says 185 people were killed last month. More would have died if not for the ambulance service.

“This service has helped a lot and saved many lives,” said Mohamed Yusuf, the director-general of Medina Hospital, one of three in Mogadishu. “I remember that a handcart used to be the only way to take the wounded to the hospital. Some people were using stretchers to rush the wounded to the hospital, and many died on their way because of blood loss.”