Geneva - In the last weeks, tens of thousands of displaced Somalis have fled Mogadishu following a resurgence of violence in the capital city of Somalia, already home to many displaced people. This recent spell of violence has put entire columns of people on roads attempting to move to safer areas of the country, such as Lower Shabelle region, Hiiraan region, Galguduud region and Bay region.

This massive displacement comes at a time when the health situation is deteriorating in many parts of the country, such as the Hiiraan, Bay and Lower Shabelle regions. Hundreds of watery diarrhoea cases have been reported.

There is a general lack of sanitation everywhere in the country and areas where IDPs (Internally displaced people) have gathered have no latrines and very little access to drinkable water. Other needs, which are far from being covered, include lack of shelter and basic health services. With the price of commodities available on local markets increasing sharply, there are serious concerns as well about a possible deterioration of the nutritional condition of women and children, as most people had to leave without much, or any, food at all.

In Afgooye, a former university campus west of Mogadishu, an estimated 50,000 people have been seeking refuge among the local population. Others have found shelter in the Lafolle University buildings, some 10 kilometres from Afgooye, while the most destitute stay under very precarious shelters or even under trees alongside roads.

So far, 401 cases of watery diarrhoea have been reported in local health structures, including 13 fatalities, indicating the rapidly declining health situation. A team of senior Médecins Sans Frontières (MSF) Somali staff managed to reach the area on April 17, 2007, and put in place a supply of medicines to support the already existing health structures. Non-food items have been directly distributed to more than 2,500 destitute families, including 5,000 pieces of plastic sheeting.

The MSF team is also participating with other organisations in the provision of safe drinking water to the IDPs through water trucking distributions. MSF is now able to provide 48,000 litres of clean water every day to the displaced gathered in Afgooye, but this remains insufficient compared to the needs observed. In recent weeks, the area has seen an influx of between 800 and 1,000 people a day, and more are expected to come if the violence continues in and around the Somali capital. However, due to the general insecurity and the renewed violence, assistance remains extremely difficult to provide and below the levels required.

MSF is extremely concerned about the low response aid agencies are able to provide largely due to the insecurity situation. On April 20, 2007, a rocket landed in one of the buildings of the health centre run by MSF in Yaqshid (Middle Shabelle region).

"We are very concerned with the extremely volatile context since the resumption of fighting in Mogadishu," said Hugues Robert, head of the Emergency Desk for MSF in Geneva. "It seriously complicates and limits our capacity to intervene rapidly in order to meet the immense needs of the displaced."

A large number of displaced people in Afgooye were already living under very precarious conditions around Mogadishu. "If the present situation in Afgooye was to last, we could be faced with a critical humanitarian crisis very rapidly" added Robert. As an independent and impartial emergency medical organization, MSF urges all parties involved in the fighting in Somalia to facilitate access and delivery of assistance to populations in need and to respect humanitarian workers as well as medical facilities.

MSF has been present in Somalia since 1991. It runs regular medical projects in Bay, Galguddud, Hiiraan, Lower Shabelle and Bakool regions. Since the resumption of fighting following the Ethiopian military intervention, it has been assisting displaced populations in several locations in and around the periphery of Mogadishu.