Somalia is facing its worst humanitarian crisis in a decade with malnutrition increasing drastically, aid agencies are warning.
If the international response is not more "robust", we could see scenes similar to the 1992-1993 famine in Somalia, says Pascal Hundt, the outgoing head of delegation for Somalia from the Swiss-based International Committee of the Red Cross (ICRC).
"It's an appalling crisis," Hundt told swissinfo on Monday. "I have witnessed the deterioration over the past 40 months and I keep wondering when things will stop and the Somalis will get some hope."
At least a million people – out of a population of about nine million – have been uprooted by fighting between the interim government and Islamist insurgents since early last year. Their plight has been compounded by record food prices, hyperinflation and drought.
The United Nations estimates that some 2.5-3 million Somalis now rely on humanitarian assistance.
In the Afgooye-Mogadishu corridor just outside the capital, 250,000 people are living in extremely crowded conditions and numbers are steadily increasing. Somalis have few options for escape, as the main border crossings are closed.
"It's far more difficult for them to cope today than a few years ago. The chronic nature of the crisis has exhausted their capacity to cope," said Hundt.
"Somalia is no longer on the verge of catastrophe, the disaster is happening now," said Bruno Jochum, director of operations for Médecins Sans Frontières (MSF) in Geneva.
"The situation is tragic and we are unable to provide the aid necessary to prevent further deterioration of the situation."
MSF treated more than 2,500 children suffering from acute malnutrition in towns around Mogadishu in May alone. Malnutrition rates have exceeded emergency thresholds for a year.
In the past three months, admissions to MSF clinics have quadrupled and are now doubling on a weekly basis according to Jochum.
"Last week alone, over 500 severely malnourished children were admitted to our nutritional programmes," he added.
Hundt said the malnutrition situation was alarming.
"Two months ago the ICRC spoke out about a major economic crisis that had to be urgently tackled or we would have a nutritional crisis. But now we have MSF saying we are facing the first nutritional [warning] signs," he added.
"All our efforts are to prevent a further deterioration, but if the current dynamic continues and there is no robust international response, we could have the same pictures we saw in 1992-93. But we are not there yet."
Fraught with danger
The ICRC will triple its Somalia budget this year due to the worsening humanitarian situation. Over the next four months the organisation will distribute food and non-food to 435,000 people in central Somalia, which has suffered from poor rainfall and low crop yields for over two years.
"The international response should be further expanded," Hundt told swissinfo. "But the ICRC has reached its limits in terms of capacity in Somalia."
Despite the urgent need for help in Somalia, aid work there is fraught with danger. MSF pulled its international staff out of Somalia after three of its workers were killed in a land mine explosion in January this year.
So far this year nine aid workers have been abducted, according to the UN.
Benoit Leduc, MSF's operations manager in Somalia, explained that the killing and kidnapping of aid workers have been chilling.
"Each time we go in a car we fear we will be caught in crossfire," Leduc said. "We fear to be hit by a roadside bomb. We fear to be kidnapped. So this is the frustration. We are not able to respond adequately to the needs."
The ICRC, which coordinates its operations from Nairobi, has been able to work thanks to a network of experienced Somali staff and its main partner, the Somali Red Crescent Society. But insecurity has severely restricted its scope of action.
"Three-and-a-half years ago we could work on a daily basis almost anywhere in central and southern Somalia. Now the worsening security situation and the unpredictability of the conflict have made it a lot more difficult to maintain such a high-level presence on the ground," added Hundt.
swissinfo, Simon Bradley in Geneva
Somalia has not had a functioning government since 1991, when warlords overthrew dictator Mohamed Siad Barre and turned on each other. Thousands of civilians have been killed in Somalia since 2007, caught in vicious disputes over ancient clan loyalties, religion and government.
Somalia's shaky transitional administration was formed in 2004 with the help of the United Nations, but it has failed to assert real control. After Islamic militants seized control of Mogadishu and most of southern Somalia, the government called in troops from Ethiopia in December 2006 to oust them.
An insurgency started soon afterward, and remains a potent and disruptive force. Rebels set land mines and attack police posts and the Ethiopian troops respond with deadly force, witnesses say.
Talks hosted by the United Nations in Djibouti earlier this month produced a tentative peace deal between President Abdullahi Yusuf's government and some members of the opposition. But it has had little impact on the ground.
According to the Mogadishu-based Elman Peace and Human Rights Organisation, conflict in Somalia has killed 2,136 civilians so far this year, bringing the death toll since an Islamist-led insurgency began in early 2007 to 8,636.
The organisation said it had also recorded 11,790 civilian injuries since the start of last year. As well as civilian deaths, hundreds of fighters on both sides have also died, locals say.
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