Extreme and "catastrophic" violence has become part of everyday life in Somalia and is seriously hampering the efforts of humanitarian organisations in the country, says the medical aid charity Médecins Sans Frontières (MSF). The plight of the Somali people has largely been ignored by aid agencies and the international community, it says.

More than 500 people with trauma injuries resulting from violence have been treated in the charity's two hospitals in Galkayo, central Somalia, this year alone. It has to operate two separate hospitals because patients cannot cross the front line that splits the town.

In the first six months of 2005 in the north of the town the agency treated 397 patients for injuries related to violence, of which 224 were gunshot wounds, 135 were knife wounds, and 38 were the result of direct physical assault. In the first three months of the year 106 patients were treated for gunshot wounds in the southern hospital alone. Many of the victims were women and children.

"The frightening fact is that Somalia is officially not even at war," said the charity's head of mission, Colin McIlreavy. "This level of violence is simply a reflection of the brutality of everyday life for the people living in this country. Extreme violence has become a part of daily existence, and the effect on the population is catastrophic."

A retrospective study of deaths in the Lower Jubba area conducted by the charity for the three months to November 2004 estimated that daily mortality for children aged under 5 years reached 16.83 per 10 000 - a "shocking" figure, said Mr McIlreavy.

He said, "In other words, more than 15% of the young children died within this short time span. These are catastrophic disaster levels that speak to the tremendous needs in this country and would provoke a response from the aid community in most other countries."

Somalia, which has had no government for 14 years, has no functioning health system. MSF says that more than 10% of children die at birth, and of those that survive a quarter will die before their fifth birthday. Yet medical activities are often suspended because of threats against staff and patients.

"Violence seriously limits the work of MSF and that of other organisations. We know for a fact that the already huge number of violence related injuries we treat are just the tip of the iceberg. Violence severely limits people's access to our medical facilities," said Mr McIlreavy.

"There is no question about the need for humanitarian aid, because Somalia has some of the worst health indicators in the world. But the needs have to be weighed up against the risk to our staff," he added.