Op-ed on Somalia by MSF international president, Dr. Unni Karunakara who states: "We may have to live with the reality that we may never be able to reach the communities most in need of help".
This article by MSF's international president, Dr Unni Karunakara, first appeared on the Guardian website on 2nd September 2011.
The current emergency unfolding in and around Somalia is being portrayed by many aid organisations and the media in one-dimensional terms, such as “famine in the Horn of Africa” or “worst drought in 60 years”.
But only blaming natural causes ignores the complex geopolitical realities exacerbating the situation and suggests that the solution lies in merely finding funds and shipping enough food to the Horn of Africa.
Unfortunately, glossing over the man-made causes of hunger and starvation in the region and the difficulties in addressing them will not help resolve the crisis.
"Profoundly distressing situation"
I just returned from Kenya and Somalia and what I and my colleagues from Médecins Sans Frontières MSF (Doctors Without Borders) are seeing on the ground indicates a profoundly distressing situation.
In Mogadishu, I met a young woman from the southern region of Lower Shabelle who is now living in one of the many makeshift camps appearing all over the city.
She left home with her husband and seven children because of a bad harvest and because they could not afford food and water.
Somewhere along her trek, she had to leave her husband and three children behind, as they were too weak to complete the five-day walk.
Sadly, her story echoes those of thousands of other families in southern and central Somalia who have been ravaged by conflict for years and tipped over the edge by drought.
Malnutrition is chronic in many parts of the Horn of Africa and there needs to be a long-term international effort to ensure that nutritious foods are reaching the people who need them.
Today, however, the most urgent needs are concentrated in southern and central Somalia. Even if we do not have a full picture, we know the situation is dire from the large numbers of Somalis arriving in a weak condition in the capital city, Mogadishu, and at camps across the border in Kenya and Ethiopia.
"Failed harvests exacerbated what was already a catastrophe"
The failed harvests exacerbated what was already a catastrophe. Somalia is the theatre for a brutal war between the Transitional Federal Government, strongly backed by Western nations and supported by African Union troops, and armed opposition groups, most notably Al Shabaab.
In a failed political landscape, it is this war, combined with the internecine rivalries of the various Somali clans, that has kept independent international assistance away from many communities.
"Virtually no access to healthcare"
The Somali people are trapped between various forces who are depriving them of assistance, either for their own political reasons, or in an effort to weaken their opponents.There is virtually no access to healthcare in vast tracts of land across the country.
Against the backdrop of conflict, where many agendas are at play, it is difficult for a medical humanitarian organisation like MSF to expand health services and have an impact.
MSF has been working in Somalia for two decades and has projects in nine locations on both sides of the front lines – in areas under the control of the Transitional Federal Government and Al Shabaab.
"Many children are not just suffering from malnutrition"
We are doing everything we can to scale up our activities to meet the growing needs. We already have more than 8,000 acutely malnourished children in our feeding programmes, and many children are not just suffering from malnutrition.
All four of the children I met who made it from Lower Shabelle have measles in addition to malnutrition.
They live with their mother and thousands of other displaced people in crowded, unsanitary conditions.
Others from these camps complain of skin and eye infections, watery diarrhoea and respiratory tract infections. Some are too weak even to seek food or healthcare.
"Scaling up operations inside Somalia is slow and difficult"
In refugee camps in Kenya and Ethiopia we have been able to provide medical and nutritional care for tens of thousands people.
But scaling up operations inside Somalia is slow and difficult. MSF is constantly being forced to make tough choices in deploying or expanding our activities.
Without the ability to carry out independent assessments and provide assistance in what we believe to be the hardest hit areas, we will not be able to prevent the worst consequences of this emergency.
Humanitarian aid has come to be seen by all sides in the conflict as either an opportunity or a threat.
In areas considered to be the epicentre of this crisis, Al Shabaab, already suspicious of western agendas, has placed bans on foreign staff, on the supply of medicines and materials by air, and on vaccination activities.
Even the temporary lifting of US restrictions on the provision of aid in areas controlled by Al Shabaab is unlikely to improve access.
Elsewhere, seemingly endless negotiations turn simple procedures like hiring a nurse or renting a car into projects that take up precious time at the expense of the rapid response that is needed.
"We may not be able to reach the communities most in need of help"
The reality of providing aid in Somalia today is about as grim as it gets. Our staff run a constant risk of being shot or abducted while they provide lifesaving medical assistance.
In spite of our constant negotiations with all parties to the conflict to gain access, we may have to live with the reality that we may never be able to reach the communities most in need of help or that we will have to compromise some of our independence when we do reach them.
It is amid this hostile climate that slogans like “Famine in the Horn of Africa” are being used to raise impressive amounts of money for food and other supplies being sent to the region.
But I am concerned with the last mile: getting assistance and supplies from the ports of Mogadishu to the people who need it urgently.
Unless all parties remove the barriers that stand between organisations with the capacity to save lives and the people who rely on them for their survival, thousands more may continue dying preventable deaths.
Dr Unni Karunakara
International president, Médecins Sans Frontières