In 2009, the Somali population continued to fall victim to indiscriminate violence and the consequences of the collapse of the public health system in the country. A severe drought plagued parts of the country, leaving thousands of children severely malnourished, while abductions and killings of international and Somali aid workers increased the already enormous gap between the needs of Somalis and the humanitarian response on the ground.

In the capital, Mogadishu, fighting raged between the African Union- and UN-backed Transitional Federal Government forces and militant opposition groups. Human rights groups and United Nations agencies have estimated that between 20,000 and 25,000 people have been killed from the fighting and countless others wounded since 2007. The UN estimated that over the last twelve months, more than 1.5 million people have fled the renewed heavy fighting in Mogadishu and other parts of South Central Somalia.

Somalis also suffer from a general lack of access to basic and lifesaving medical care. One of the main challenges for MSF has been to recruit doctors and nurses with so many health workers among those who have fled the violence and no medical universities open.

A drought and the death of important livestock precipitated a nutritional emergency in Galcayo and its surrounding areas, where 1,300 severely malnourished children enrolled in the MSF nutrition program in early December, representing nearly half of all the cases treated in the program in 2008.

Somalis have continued to flee by the tens of thousands to the neighboring Djibouti, Kenya and Yemen. MSF provides assistance to the refugees in these three countries as well as in Malta and until recently Italy.

Jamaame hospital in southern Somalia. The patient is burnt in a conflict and the MSF staff is doing the consultation. It was opened in March 2007. 55 beds hospital, located nearly 30 kms North of Kismayo. Activities include Nutrition, maternity, general medicine and emergency care. [? Javier Roldan/MSF]

Jamaame hospital in southern Somalia. In terms of nutrition an average of 260 kids have been treated every month in ambulatory while 90 more sever cases had to be admitted every month.

A child with malnutrition in Jamaame hospital. [Somalia 2009 ? Javier Roldan/MSF]