Access to medical care for civilians and displaced persons in and around the Somali capital of Mogadishu has decreased alarmingly in the past months, according to the international medical charity Médecins Sans Frontières (MSF).

"With bombings and shootings nearly daily, people in need of medical care are terrified to leave their homes, medical personnel are fleeing the city, and hospitals are closed or barely functioning," said Christophe Fournier, MSF International Council President, at a press conference on 20 August in the Kenyan capital, Nairobi.

"People are not being treated for basic ailments, let alone emergency needs. The lack of respect for doctors [at] work, the sick and wounded is shocking and absolutely unacceptable," he added.

Other health workers spoke of armed men snatching patients from hospitals.

"For the first time since the civil war started 16 years ago 'technicals' [battlewagons] are coming into hospital compounds," said a doctor who requested anonymity.

On three different occasions, he added, government forces had taken people from their beds in Madina hospital, Shifo hospital (south Mogadishu) and Keysaney hospital (north Mogadishu). "They not only took the patients but also any relative who happened to be there at the time. We don’t know where they were taken or what happened to them," he said.

Government spokesman Abdi Haji Gobdon said there was only one incident of security forces taking a patient from a hospital. "It was a regrettable incident and never happened again." The government, he added, was committed to adhering to international law and respected the sanctity of hospitals.

According to MSF estimates, less than 250 of the 800 hospital beds available in Mogadishu in January are still in service. Since then, three quarters of the staff in several of these hospitals have also left.

MSF has treated nearly 60,000 people in its out-patient facilities in and around the city since January, but insecurity has prevented the organisation from offering more services.

"We should be able to open emergency and surgical services in Mogadishu, send out ambulances to reach the sick and wounded, and bring them back for treatment," said Fournier. "But after months of trying, we still can’t even move about the city freely to assess the needs and provide the care that is needed. We want to do more, as do the Somali doctors remaining in the city, but we are increasingly outraged that not enough is being done by all parties to ensure safe access to medical care in Mogadishu."

People in the camps outside the city are living in miserable conditions with little assistance, inadequate water and shelter, and no stable source of food, said MSF. A rapid health assessment in June at Hawa Abdi IDP camp, 17 kilometres west of Mogadishu, indicated a global malnutrition rate of 21.5 percent among children under the age of five and a severe acute malnutrition rate of 3 percent – a nutritional emergency, according to World Health Organization standards.

"The increasing rates of malnutrition and a deteriorating trend in the nutritional status of children among families who have fled Mogadishu is of extreme concern," said Fournier. "Without a dramatic increase in humanitarian assistance and access to medical care, the health situation will further deteriorate. Immediate action must be taken to assure that children, the sick and the wounded do not suffer or die needlessly because they cannot receive medical care."

Meanwhile, violence rocked the Somali capital on 18 and 19 August, when dozens of explosions targeted government forces, a local source said. "People almost expect these things to happen. They have become part of life in Mogadishu."

Among those killed was Moalim Haaruun Moalim Yusuf, a prominent Haiwye clan elder who died on 18 August outside his house, said the source.