While thousands of people flee Mogadishu the humanitarian medical organization Médecins Sans Frontières (MSF), is gravely concerned about the remaining population in the Somali capital as violence intensifies in the city.

MSF is one of the only international organizations providing health services in Mogadishu and is witnessing increasing violence in the areas near one of its clinics. Those who are able have left the city, but many more are trapped, cannot afford to flee or are too afraid to leave Mogadishu. People are fleeing into other areas of the city but are increasingly left with no safe place to seek refuge.

"People are terrified but most have little choice except to wait and hope that the violence does not come to them," said Colin McIlreavy, MSF head of mission for Somalia. "In Mogadishu now there is no safe place to go."

The high levels of insecurity often prevent wounded civilians from receiving medical assistance. MSF staff have been unable to help individuals who have been wounded by shrapnel or bullets during fighting at night. Some people have bled to death as it was too dangerous to move them to hospitals. Former residents of a densely populated suburb near MSF's clinic described armed men marching through the streets emptying houses, in some cases shooting unarmed people.

Displaced people living in Mogadishu are particularly vulnerable. Makeshift camps are found throughout the city. Residents of these camps usually have little more than ripped cloth and plastic sheeting for shelter — providing no protection from bullets, mortars and shells. There are few men in these camps; they’ve gone — leaving women struggling to feed and care for their children, vulnerable to violence and looting. Last week, MSF treated three women who had been raped in their home the night before by armed men.

In the past weeks, MSF staff in Mogadishu have reported fighting coming increasingly closer to the clinic. Some staff are not able to travel to work because of road closures due to the violence. "We've seen a massive reduction in numbers of people coming to our clinic from some neighbourhoods where fighting has been heaviest. This is consistent with the stories we hear of people fleeing these neighbourhoods to go to other parts of Mogadishu," said Dr. Fuad, an MSF doctor in the Mogadishu clinic.

Many who can afford to flee the city are doing so, but at high risk. "The checkpoints between Mogadishu and Galcayo are unlike any I have seen in my life. I managed to count 86 over 300 kilometres where they demanded money. Halfway through our journey, money was not enough and they took everything," said one man that MSF team members interviewed in Galcayo, north of Mogadishu.

MSF is struggling to provide a measure of healthcare and humanitarian assistance to the people of Mogadishu. But Mogadishu's residents need more than medical care — they need safety. MSF calls upon all warring factions to refrain from indiscriminate attacks on civilians and to respect international humanitarian law.

Blog : "Mogadishu and beyond"

Read the blog "Mogadishu and beyond" by MSF Humanitarian Affairs Officer, Tirana Hassan, as she works in Nairobi and Mogadishu examining the causes and effects of violence, and the human impacts it has for MSF patients.

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