Somalia's humanitarian catastrophe worsens

Already struggling to survive with little or no access to even basic health-care services, Somalis experienced some of the worst violence in over a decade in 2008, with people in the central and southern parts of the country living under increasingly deteriorating humanitarian conditions. While difficult to verify given the collapsed health-care system, Somalia has some of the worst health indicators in the world: one in ten women die during child birth and more than one in five children die before their fifth birthday. The impact of the war on childhood malnutrition was exacerbated by skyrocketing food prices and a prolonged drought in the country.

Since fighting between Transitional Federal Government forces, supported by the internationally backed Ethiopian troops, and an array of insurgent groups began in December 2006, the United Nations estimates about one million Somalis have fled their homes. Intensifying combat in one of the capital's most populated residential areas resulted in a surge of wounded civilians and once again displaced thousands of people. In Mogadishu, MSF treated nearly 2,300 patients for injuries caused by mortar rounds and bullets from January to late November, underscoring the fact that hundreds of thousands of civilians live in a war zone. To the north in Galcayo, a relatively calm city in comparison to the capital, an MSF team still operated on or treated more than 500 victims of violence in 2008.

On the road from Mogadishu to Afgooye, where many have been forced to flee from violence, there are more than 250,000 displaced people living in appalling conditions. Since January, more than 9,500 children were treated for malnutrition by MSF medical teams. The population is largely dependent on external food aid, but assistance is provided intermittently, and families fleeing violence are met with a lack of shelter, food, and health care. 

Somalis are taking extreme risks to leave the country, mainly heading south into Kenya. There are currently 200,000 refugees, according to the UN High Commissioner for Refugees, in three camps in Kenya. Recently, an additional 35,000 arrived at these camps. Those who are unable to seek refuge in Kenya make their way north, where many have risked their lives boarding smugglers' boats to cross the Gulf of Aden to reach Yemen. According to UN figures, more than 43,500 people - mostly Somalis, but also Ethiopians fleeing hunger and persecution - attempted the journey in 2008.  Passengers say that more than 100 people are routinely packed into the 30- to 40-person vessels. Many suffocate while others drown before they can reach the shore.  Since the beginning of 2008, MSF teams in southern Yemen have treated more than 8,000 people who have arrived by boat.

This appalling humanitarian situation has unfolded amid a stark increase in targeted attacks, including assassinations and kidnappings, against aid workers, deeming Somalia - a country with seemingly limitless humanitarian needs - an almost impossible place to deliver and administer aid. In early 2008, MSF was forced to withdraw its 97 international staff members after three colleagues were killed in a roadside bomb attack in the southern port town of Kismayo. The kidnapping, and subsequent release of two staff members in Bossasso, in Somalia's autonomous Puntland region, forced the closure of a health and nutritional program in the city. In August, MSF ceased medical activities in one of its clinics, based in the Wardigley/Hodan area of Mogadishu, due to increased fighting and security risks for patients and staff.

MSF currently has no international staff permanently based in Somalia and the organisation's lifesaving humanitarian work continues thanks to the national staff members who keep the programs running. In 2008, MSF continued to work in 9 regions in the country, providing primary health care, malnutrition treatment, health care and support to the displaced people, surgery, water and relief supply distributions in an attempt to meet some of the massive needs of the Somali population.