Increasing violence in parts of the Somali capital Mogadishu has trapped many residents, leaving them with no safe place to go, Médecins Sans Frontières (MSF) said on 7 November.
"People are terrified but most have little choice except to wait and hope that the violence does not come to them," Colin McIlreavy, the MSF head of mission for Somalia, said in a statement.
Tens of thousands of people have already fled the city following intense fighting between insurgents and allied Ethiopian-Somali government troops.
MSF said it was struggling to provide healthcare and humanitarian aid to the people of Mogadishu. "But Mogadishu's residents need more than medical care – they need safety," the agency added. "MSF calls upon all warring factions to refrain from indiscriminate attacks on civilians and to respect international humanitarian law."
MSF said it had witnessed increasing violence in the areas near one of its clinics.
"Those who are able have left the city, but many more are trapped, cannot afford to flee or are too afraid to leave Mogadishu," MSF said. "People are fleeing into other areas of the city but are increasingly left with no safe place to seek refuge."
Local sources said on 5 November that fears of a major military offensive had sparked a further civilian exodus from the city.
Mohamed Hassan Haad, the chairman of the Hawiye (the predominant clan) elders' council, told IRIN that those fleeing were worried the arrival of thousands of Ethiopian troops would lead to a major attack on the city.
For its part, MSF said that over recent weeks its staff had reported fighting coming increasingly closer to its clinic, with some staff being unable to get to work.
"We've seen a massive reduction in numbers of people coming to our clinic from some neighbourhoods where fighting has been heaviest," MSF quoted its staff member, a Dr Fuad, as saying. "This is consistent with the stories we hear of people fleeing these neighbourhoods to go to other parts of Mogadishu."
According to MSF, a high level of insecurity has prevented wounded civilians from receiving medical aid, especially those injured by shrapnel or bullets during fighting at night.
"Some have bled to death as it was too dangerous to move them to hospitals," MSF said.
The agency said displaced people living in makeshift camps throughout the city were particularly vulnerable.
"Residents of these camps usually have little more than ripped cloth and plastic sheeting for shelter – providing no protection from bullets, mortars and shells," MSF said. "There are few men in these camps, they’ve gone, leaving women struggling to feed and care for their children, vulnerable to violence and looting."
Last week MSF treated three women who had been raped in their home by armed men.
On 30 October, a coalition of NGOs said the worsening state of security in Mogadishu had prevented them from coping with "an unfolding humanitarian catastrophe".
"International and national NGOs cannot respond effectively to the crisis because access and security are deteriorating dramatically at a time when needs are increasing," 40 NGOs said in a joint statement.
"Tens of thousands of people are currently fleeing violence in Mogadishu adding to the 335,000 people already needing immediate lifesaving assistance in Mogadishu and the Shabelle [Lower and Middle] regions," they added.