As intense violence once again rocks Somalia's capital, MSF teams continue working throughout the country

Scope of injuries faced after the fighting Mahmud Sheikh Mohammed Hassan, Deputy Field Coordinator for one of MSF’s projects in Mogadishu, describes what the past few days have been like. "The fighting’s still going on. Between May 22 to 27, we received 75 casualties. People couldn’t get to the hospital on Friday morning, but they came in the afternoon. "We started operating in the afternoon and didn’t finish until ten o’clock on Saturday morning. It was a long night. Unfortunately three of our patients died in the operating theatre; their injuries were too severe and they just couldn’t get to the hospital in time. There was nothing we could do. "One was a little girl, she must have been no more than 13 years old. I think she was in a minibus that was hit by a shell. "Three others had head injuries so they are in intensive care now. But there are no hospitals in Mogadishu that can do operations for this kind of injury, so we just have to make them as comfortable as possible. The other patients are in recovery and are doing well. "Near to the hospital there are a lot of displaced people. They come here because it’s on the outskirts of Mogadishu and they feel safer. There are around 18,000 living out in the open, in different areas around the hospital. In the past few days, I would say that around 5,000 to 10,000 more people have arrived. They have nothing with them when they come. We distributed plastic sheeting to around 2,000 families last week. People make some shelter for themselves. They put up the sheeting using branches and then cover it with plastic bags and rags. But it’s been raining heavily lately and people are really suffering." In Mogadishu’s Daynile district, where MSF supports a community hospital, medical teams treated 218 people suffering from trauma injuries caused by shelling and gunshots between May 7 and 22. Of these, 81 were women and children under age of 14. On May 14 MSF was forced to close its outpatient clinic in Yaqshid, northern Mogadishu, for two days to ensure its medical staff were not caught in the cross fire during the heavy fighting. The clinic has since reopened Since the fighting started on May 7, MSF staff have treated 14 people with trauma injuries. Nine patients had gunshot wounds and five had secondary injuries caused by shelling. Five of the patients were children, including one six month old baby. Another clinic in Lido has seen a sharp increase in activities as people flood to the area to try and escape the fighting. In the past two weeks 22 people with trauma wounds have been treated. The 50 bed in-patient ward in Lido has been packed, with an average admission of 120 patients per week. Over 1,200 outpatient consultations for children under five were done in the week ending May 15. In contrast, the number of consultations in MSF’s maternity and child care clinic in Jowhar, 90km north of the capital, actually decreased following fighting in the town on May 17, as people were too afraid to travel to MSF’s health centres. Admissions to the nutrition programme went down by 30 percent compared to the previous week, and 40 percent fewer women were seen in the maternity clinic in the same period. Many of those fleeing Mogadishu are seeking refuge in the ‘Afgooye corridor’, a stretch of road leading from the capital to the town of Afgooye, around 25km to the northwest of Mogadishu. Since 2007 MSF has worked in Afgooye, providing outpatient and nutritional care. On May 18, MSF teams distributed blankets, plastic sheeting, soap and buckets to 2,500 families who had recently arrived in Afgooye. MSF also supports a private clinic in nearby Hawa Abdi, which is about 15km from Mogadishu, and is working on building a permanent in-patient therapeutic feeding centre, as the tents that were previously used have been badly damaged by the rain. Elsewhere in Somalia MSF teams are seeing increasing numbers of children suffering from malnutrition. In Marere, in the Lower Juba region, admissions to the in-patient therapeutic feeding centre, where patients are admitted as they need 24 hour care, have increased from 45 to 130 in May alone. A further 400 children are being treated on an out-patient basis in nearby Jilib. In South Galcayo admissions have also increased with 75 patients currently receiving treatment in the inpatient therapeutic feeding centre compared to a monthly average of 40. In North Galcayo patient numbers have doubled since March/April, with around 300 children currently receiving treatment on an ambulatory basis and 40 children receiving in-patient care. Measles is also a concern. In Belet Weyne, which is in Hiraan region close to the border with Ethiopia, MSF teams started a measles vaccination campaign in mid-April, vaccinating 26,000 children aged between six months and 15 years. However, recently cases have been detected in other areas of central Somalia, in Adado, Guri El, Dhusa Mareb and Galcayo. MSF has set up isolation centres to treat people. In March medical staff treated five cases in South Galcayo. In April, it rose to 50 cases and 73 in May. MSF will continue to monitor the situation closely. MSF works in the Bakool, Banadir, Bay, Galgaduud, Hiraan, Lower Juba, Middle Shabelle, Lower Shabelle and Mudug regions of Somalia. All MSF’s projects are currently run by Somali staff, supported by international staff based in Nairobi who visit whenever security allows.