Security conditions impede the operative capacity of MSF and the result is that these people do not have access to the necessary assistance. Since cholera was confirmed in Mogadishu on March 19, MSF has treated more than 800 patients.

However the worsening violence is making it increasingly difficult for patients to access MSF's cholera treatment centre (CTC), which opened two weeks ago. The violence is also preventing MSF from reaching other areas of the city. "So far we have received more than 800 patients, 40 per cent are children," says Henry RodrÃ?­guez, medical coordinator from MSF Spain in Somalia.

"This is more than the total number of cholera patients MSF has treated in the last years in Mogadishu, where MSF has worked for 15 years and responded to 12 different cholera epidemics. "The cause of this growth is mostly because other health structures which normally work in other areas of Mogadishu are not able to do so due to the violence.

It's also impossible to do the things necessary to try and control the outbreak, like supply clean water or establish points for oral rehydratation." The MSF clinic in Mogadishu, which provides care for more than 100,000 people each year, has verified that because of the fighting the population cannot access the scarce health services (hospitals, health centres...) that continue to function in the Somali capital.

The fighting has caused massive displacement as people flee towards the outskirts of the capital and other cities, like Jowhar. There are reports of tens of thousands of displaced people, who are being received by extended family or friends. Many who do are living under trees without shelter, food or water. The security conditions impede the operative capacity of MSF and the result is that these people do not have access to the necessary assistance. MSF is concerned about the security of its patients and health personnel and urges the parties involved in the conflict to respect civilians and humanitarian agencies.

"We are worried about the health situation of a population which has enormous difficulty in accessing the scarce health structures which exist in their surroundings", says Javier FernÃ?¡ndez, Head of Mission for MSF in Somalia. "We have evidence of the presence of tens of thousands of displaced people on the outskirts of Mogadishu who we simply can't access." Following the principles of neutrality and impartiality, MSF in a non-governmental organization with permanent presence of expatriates in Somalia since 1991.