Last week MSF, working with the Somalia Medical Association, has opened a cholera treatment centre and an outpatient clinic for children under five in Mogadishu. MSF's Project Coordinator, Jelle Pentinga, and the chairman of the Somalia Medical Association, Dr. Abdirisak Ahmed Dalmar, describe the humanitarian situation in Somalia's capital. You've just returned from Mogadishu, what impact has the conflict had on people living there? Dr. D: It's sad to say, but in some ways the people living in Mogadishu are used to conflict. For the past 16 years Somalia has been without a government and the Somali people have experienced a great deal of fighting and violence. But no matter what was happening, Mogadishu never stopped working. Universities, schools and hospitals always stayed open. The violence of the last month was different. The fighting was intense. Those who could afford to fled. Some had enough money to leave the country or travel to cities like Galcayo. But they were in the minority. Even before this conflict, Mogadishu was home to thousands of displaced people. Over the past 16 years people from all over Somalia have arrived in the capital, fleeing violence and famine, or perhaps just searching for a better life. They live in terrible conditions, in makeshift shelters in public buildings and empty compounds. During the conflict these people didn't have the option of leaving the country or fleeing to other cities, so when the fighting displaced them for the second or third time in their lives they moved to other, safer parts of Mogadishu or to just outside the city, to places like Afgooye or Jowhar. Now that the fighting seems to have stopped, many Somalis are returning to the capital. Universities and hospitals are starting to reopen and people are trying to rebuild their lives. But there are many displaced people who haven't come back, either because they have no money for the journey or because the places where they were living have been destroyed or taken over. I don't know what will happen to them. How has the conflict affected the health needs in Mogadishu? JP: The health needs in Somalia are enormous and have been for a long time, but they are especially acute in Mogadishu. Every time I go to Mogadishu I'm shocked to see so many people living in such extreme poverty. Every public building or compound you see is filled with displaced people. The shelters they have built themselves are so basic and flimsy that you think they must have only been there for a few days, but the truth is that many of them have been living like that for ten years or more. In the past Mogadishu was a beautiful city on the coast, but now when you drive through the city, almost all you see is misery. The happy few have cars and jobs, but there are literally thousands of people living hand to mouth. They have nothing. Years of violence have left them with no education, jobs, healthcare, and sometimes no hope. Somalia has some of the worst health indicators in the world. Malnutrition is chronic and tuberculosis widespread. Rare, fatal diseases like kala azar are endemic in certain areas. Sixteen years without a centralized government has left Somalia with very little free, public healthcare. There are lots of private clinics and health centres, but you have to pay for them. And most Somalis can't afford to. So people die every day from easily treatable diseases like malaria or respiratory infections. As you would imagine, the recent conflict has made the health situation in Mogadishu much worse. A lot of people were wounded in the fighting, many of them civilians. Most of the hospitals and clinics were damaged or shut down. For example, the only free paediatric hospital in Mogadishu is still closed, but we hope that it's going to reopen very soon. And, of course, many health staff fled. Water points were also damaged in the fighting, which has increased the spread of diarrhoea and other diseases. Cholera is endemic in Somalia. The

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