Following the recent outbreak of cholera in Mogadishu, Somalia, MSF has implemented a Cholera Treatment Centre (CTC) which will be up and running later in January.

Initial data for this year was collected in co-ordination with Action Contre la Faim (ACF) who have a CTC in South Mogadishu and the ICRC who run four rehydration corners also in the south of the city. MSF has set up a CTC in North Mogadishu every year since 1994.

"The incidence of diahhroea tends to rise every November with confirmed outbreaks starting around January," said Andre Le Sage, the MSF Head of Mission for North Mogadishu on the coast and Jowhar and Aden Yabal in Middle Shabelle. "Though establishing a consistent pattern is difficult; it seems to change every year, with the timing of the peaks being hard to predict," he added.

"Part of the problem is that, while oral hydration salts are effective in treating early-stage cholera, Somali common sense dictates that the only effective treatment is ringer lactate [isotonic solution administered intravenously], which is only used when there are no other alternatives," said Le Sage. "Having an IVU plugged into your arm is more impressive to the Somalis than drinking ORS, I guess, so they think it must be more effective.

But it also means a delay in treatment." He anticipates that the CTC will continue for around five months - "Although if it's anything like last year, we'll be there for nine months," he said. MSF runs primary health programmes in North Mogadishu and Middle Shabelle with out-patient dispensaries, mother and child health clinics, mobile vaccination teams and emergency monitoring and response.

Somalia plunged headlong into civil war in 1991 when the central government of Siad Barre collapsed and the country has been war-torn ever since. Access to basic health care is often extremely limited, while maintaining security for the teams in Mogadishu, Middle Shabelle and Kismayo - where MSF provides support to the only hospital in South Somalia - is a recurrent problem.

One NGO worker for the organisation Care International was ambushed and shot dead recently in Middle Shabelle region. Even in the northern provinces of Puntland and Somaliland, which have seen something of a return to stability and civil government, security can still be uncertain.

Despite this, however, MSF continues to work in the region. This week the MSF team has re-occupied the mission in Mudug General Hospital, Galkayo, Puntland, after they were forced to evacuate following an armed robbery late last year.