Introduction

In 2011-2012, drought and conflict caused widespread food shortages resulting in a malnutrition peak well above emergency levels in Médecins Sans Frontières (MSF) programs, and spurred the displacement of tens of thousands of people within south central Somalia and to Ethiopia and Kenya. Soaring prices for domestic and international food, insecurity, and the effects of denied humanitarian access by armed groups exacerbated the crisis that the United Nations declared a famine. Restrictive international donor policies including the criminalization of aid provision by some governments in some of the worst affected areas controlled by insurgents further hampered humanitarian response efforts leaving large gaps in aid provision.

In February 2012 the famine was declared over and policy makers are now more focused on development, state-building and security than humanitarian aid. While security and access to provide and receive assistance has since improved in certain areas, large numbers of Somalis carry on facing hardship and violence underscoring the crude reality that a humanitarian emergency continues in Somalia. As the Somalia government and its donors look toward a new era, humanitarian assistance - including food, water, shelter and healthcare - dissociated from political objectives and processes should remain a priority.

Over the past 15 months through a questionnaire, MSF has asked over 800 patients about the circumstances that led them to our clinics and hospitals in Somalia and the refugee camps in Ethiopia. What emerges is a mix of fear, violence including sexual assault, people uprooted, food shortages and a lack of access to the basic means of survival and adequate health care. In addition, individual testimonies were gathered1 from a number of community members, a selection of which is included in this report. The quotes from these testimonies allow Somalis to express in their own terms what it means to live under what for many are still emergency conditions.