Increased fighting inside Somalia’s capital, Mogadishu has led to another exodus of the local population, adding to hundreds of thousands of internally displaced people who have already fled the conflict area since January 2007. West of Mogadishu, on the road to Afgooye, where Médecins Sans Frontières (MSF) has been providing emergency medical and nutritional care since April 2007, the number of IDPs has nearly doubled in just a few weeks, reaching an estimated 200,000 people. Most live by the roadside under makeshift shelters and are fully dependent on external assistance.

People are facing unacceptable sanitary conditions and their vulnerability has only increased in the face of months-long food shortage. In Afgooye and Hawa Abdi, a large majority of the 1,700 weekly medical consultations carried out by MSF teams are linked to precarious living conditions: severe malnutrition, diarrhea and acute respiratory tract infections. Children arriving from Mogadishu today, especially under five years of age, are extremely weak. In the past two weeks, more than 250 severely malnourished children, including 80 who had to be hospitalized in intensive care. Faced with this deteriorating situation, MSF teams have doubled their capacity from 20 to 40 beds in Afgooye and are setting up a 50-bed pediatric unit in Hawa Abdi. The intensive nutritional care centre in Hawa Abdi has increased its capacity from 20 beds in September to 80 today, and needs are increasing by the day.

Mortality rates are extremely worrying. In Hawa Abdi, a camp with 32,000 internally displaced people and where humanitarian assistance is available, the mortality rate of children under five is more than twice the emergency threshold: 4.2 deaths per 10,000 people per day ; the global mortality rate is 2.3 deaths per 10,000 people per day. Diarrhea is the main cause of death in the camp (over 50 per cent) due to disastrous sanitary conditions.

Needs for water, food, shelter and medical care are rapidly increasing. However, increasing humanitarian assistance is extremely difficult in this conflict. Despite the mobilization of international aid over the past weeks, it is still largely inadequate. Living conditions in the estimated 100 improvised camps along the Mogadishu-Afgooye axis are significantly below commonly accepted standards for emergency humanitarian assistance, and the risk of epidemic is high.

The number of internally displaced people is increasing every day. Without a significant increase in neutral and independent assistance, this emergency situation could deteriorate even further.

MSF has worked continuously in southern and central Somalia for over sixteen years and is currently providing medical care in nine regions - Bakool, Bay, Galgadud, Hiraan, Lower Juba, Middle Juba, Mudug, Middle Shabelle and Lower Shabelle. Today we have around 60 international staff and over 800 national staff working in Somalia.

In Afgooye, an MSF team of 80 Somali and five international staff has set up several feeding centres work in the hospital and perform more than 1,700 consultations per week. Between mid-August and end of November 2007, 614 severely malnourished children under five were admitted to MSF feeding centres, among which 222 were admitted to the MSF intensive care unit. Since April 2007, MSF teams have also distributed basic relief items (plastic sheeting, jerrycans, soaps, blankets, mosquito nets) to more than 17,000 newly displaced families. The last distribution took place at the end of November, reaching more than 3,000 families. Each day, 90,000 litres of drinkable water are distributed to the displaced people by our teams.

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