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Qaali Hussein's life began with the Qur'an.
Before she learned to read or write, she attended dugsi, a Qur'anic school, her family's priority clear: Qur’an first.
She had just begun school in Somalia when war erupted. She was eight years old, and her education was about to become brutally practical.
The family fled in a truck toward a tiny Somali airstrip to catch a flight to Kenya when shots rang out. A bullet tore through both of her grandmother's legs. The truck screeched to a halt. In the chaos, Qaali's mother ripped off her own garbasaar, a piece of cloth Somali women wear, and fashioned tourniquets, a desperate act of battlefield medicine.
They faced an impossible choice.
They could continue to the airstrip, an unknown distance away, and watch her grandmother bleed to death. Or they could turn back, driving through the same streets where attackers had just fired on them, hoping against hope to find a hospital.
The decision they made in that moment would save a life and create a surgeon.
* * *
A year later, at nine, Qaali arrived in Houston, Texas, speaking Somali and a little Swahili.
Her grandmother, after months of care in Kenya and rehabilitation in America, was learning to walk again. Watching the medical system piece her beloved grandmother back together revealed a new world.
"The impact it had on her, that it saved her life and gave her back to us to learn from her, influenced me enormously," she says.
In school, Qaali became a nerd. She loved learning, devouring books with a dictionary by her side, memorizing English tests before she could properly speak the language.
By sixth grade, she was taking honors classes.
But as she moved into adolescence, the pressure to conform overwhelmed her.
She witnessed the painful compromises Muslim women faced, like the woman who, unable to find work, had to ask an imam if wearing a wig to hide her hair was a permissible workaround to get a job.
An advisor told her that to become a surgeon, something had to give. She couldn't have a family, a faith, and a dream, not all three.
Then a Muslim woman physician, someone who should have been a role model, gave her the most chilling advice of all. After listening to Qaali's ambitions, the woman looked at her hijab and said flatly, "Not with that. Don't waste your time."
The dream felt impossibly distant.
As she pushed through college, she discovered her white peers were miles ahead, their lives mapped out for decades while she was still learning the acronyms for the next exam.
Then, in her final year, a professor she had worked for nearly two years threatened her.
Upset that she was choosing medicine over a PhD in his lab, he rescinded his letter of recommendation, telling her, "You're lucky I'm not calling every single medical school and telling them how unreliable you are."
* * *
"I remember going home, back to Houston. I call it my crying couch," she says. "I completely lost it."
The threats, the weight of an MCAT score she wasn't happy with, the racist medical school interview where a woman spent half the time critiquing her hijab, it all confirmed what she'd been told.
It was impossible.
Then she remembered the conversation that had changed everything.
She was 16, struggling with the decision to wear the hijab full-time. She sat with her grandmother, who told her a story.
In the 1970s, defying all Somali cultural norms, her grandmother had sent her daughters abroad for their education, enduring the community's backlash. When war broke out, those educated daughters, now with professional connections, secured the family's passage to America.
"She got all this backlash," Qaali says, "but she didn't fight with anybody. She just did what she needed to do for her household and for her children."
Then her grandmother asked her a question that would become the bedrock of her life.
"Who are you waiting to give you permission?" she asked. "To wear your hijab, to have kids, to become a surgeon? Who do you need to come and say, 'Good job, Qaali, now you can go do it?’"
The question was a revelation. "I was like, nobody," Qaali recalls. "She says, 'Do you trust in Allah?' 'Yes, I do.' 'Then what's the problem?'"
Lying on her crying couch years later, the professor's threat ringing in her ears, that question returned.
She got up, filled with new resolve. Her future was in Allah's hands, not this man's. She would apply, and if she didn't get in, she would apply again.
She waited in silence for the results, expecting nothing. Then, in the middle of the night, an email arrived. She had been accepted to medical school. With a scholarship.
She had made it.
But she was about to discover that getting into the institution was only the first battle. Surviving it would be the real war.
* * *
Medical school was like "drinking from a fire hose," Qaali says.
Residency at a prestigious Texas program was worse. The program prided itself on being "malignant," boasting a near-hundred percent divorce rate.
When Qaali, now married, became pregnant during her intern year, the program director told her she had chosen motherhood over surgery and should find another specialty.
That was the year her colleagues debated whether they should ask her to remove her hijab.
She refused to quit.
In an act of profound defiance, she had five children during her residency—including twins—and a sixth during her fellowship, all while navigating a system openly hostile to her presence.
She finished her training, completed a fellowship, and finally landed her first job as an attending surgeon in Florida.
She thought she had finally paid her dues. The reality shocked her.
The hospital was a decade behind in its practices, and her attempts to implement evidence-based medicine met a wall of resistance.
Nurses wrote her up for asking questions. Colleagues changed her orders behind her back. In one life-or-death moment, with a patient bleeding out, the team moved at a snail's pace, their resentment palpable in the room.
Her competence, her hard work, her double-board certification—none of it mattered.
She was trapped in a hostile workplace, and a patient's life hung in the balance. She realized she didn't just need to be a good surgeon; she needed to learn how to lead in a system that refused to listen.
* * *
The final straw came at a women in medicine conference. She stood up and asked the keynote speaker, a Harvard expert on diversity and inclusion, how to navigate the racism and Islamophobia she faced.
The speaker's response was a stunning dismissal. She ended the Q&A, and when Qaali approached her afterward, she looked her in the face and said, "I don't do race."
Her sister's words over the phone later that day delivered a cold, clarifying truth.
"No white woman is going to tell you how to navigate racism and Islamophobia," her sister told her. "You have to figure it out yourself."
And so she did.
She came home and began a year of intense journaling, a deliberate excavation of the pain and the lessons from every trial she had endured: the nurse in medical school who told her she couldn't be in the operating room "with that thing on your head"; the resident who abandoned her in that moment; the countless patients who looked past her to a white male colleague and asked, "Wait, you're the surgeon?"
She realized that her hard work and competence, which she believed would shield her, would never be enough.
A system built without you in mind will not automatically make space for you. You have to learn how to lead, how to set boundaries, and how to command respect in a hostile environment. She saw that every obstacle she had overcome, she had overcome alone. There were no resources, no guides, no mentors for the unique intersection of challenges she faced.
That realization birthed a new mission. In 2020, she founded the Defiance Academy, a platform to create the strategies and solutions for Muslim women that she never had.
At the core of her teaching is the same transformative question her grandmother asked her all those years ago: "Who are you waiting to give you permission?"
At the core of her teaching is the answer to that powerful question. She urges Muslim women to stop seeking permission from the world—from a boss, a colleague, or a culture—and to find it instead in their unshakeable trust in Allah.
She teaches them that their future is not in the hands of a professor who threatens them or a program director who dismisses them.
It is written by Allah, and their role is to put in the work with unwavering trust and reliance on Allah.
The girl who was told she couldn't, the student who was told she was unreliable, the resident who was told she had to choose, and the surgeon who was told she didn't belong had finally found her answer.
It was never about getting permission for herself. It was about becoming the one who could finally give it to others.