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Maryan Muse sits with her four children in front of the closed doors of the Jaziira medical facility in Somalia's capital Mogadishu, tearful and discouraged.
“Who will now help my family?” the single mother asks, throwing up her hands as she contemplates a future without the assistance of medical charity Medicins Sans Frontieres (MSF).
Like thousands of other Somali families, Muse and her children have been relying on the free health care services provided by MSF. A public health system is as good as non-existent in the war-torn East African nation.
But on August 14, MSF closed all its operations, citing recurring attacks on its staff, including murders and kidnappings. In the 22 years the charity has been working in Somalia, 16 staff members have been killed by armed groups.
“The closure of our activities is a direct result of extreme attacks on our staff,” explained MSF President Unni Karunakara.
Insecurity continues to reign in Somalia, where the new government, formed almost a year ago, has been struggling to establish peace and stability.
A bedraggled army, supported by almost 18 000 African Union peacekeepers, has been trying to fight Islamist al-Shabaab militants and rival warlords for control over the country's south, without tangible success.
“Some of (my colleagues) were killed, wounded, harassed or being kidnapped for ransom payments,” said Ahmed Sheikh Osman, a logistics worker for MSF who lost his job this week, along with 1 500 other local staff members the charity employed in Somalia.
Osman and his colleagues will now join the masses of the jobless, with little prospect of finding new employment. More than half of all adults are without work in the country of 10 million people, according to the United Nations.
But worst affected by MSF's pullout will be the hundreds of thousands of poor Somalis who cannot afford to pay for private health care or medication at a pharmacy.
Almost three quarters of Somalia's population lives in extreme poverty, surviving on less than 2 dollars a day.
“My baby is sick. I don't know where to go for free health care services since MSF left us behind. I cannot afford to get medicine from private pharmacies or the local hospital for lack of money,” said Asho Du'alle, a mother of three, who, in despair, queued in front of the Jaziira clinic, although she knew the charity had left.
For many years, MSF provided free consultations, medicines, vaccinations and nutritional support in the poverty-stricken nation in the Horn of Africa. All that is now over.
The minute the charity announced its departure, members of the al-Qaeda linked Al-Shabaab group swooped in, seizing MSF-funded facilities in the Middle Jubba and Bay Regions, looting the remaining medical equipment and supplies, witnesses told dpa.
“The reality is, in some places there will be no medical care for the people left behind,” Karunakara admitted. “We just have to face that fact.”
For many Somalis, this could mean a death sentence. Already, 71 percent of the population is undernourished, according to the United Nations Development Programme statistics. Life expectancy is a meagre 50 years, compared to the global average of 70 years.
Children, the most vulnerable, will be worst affected. With 180 deaths per 1 000 live births, Somalia already has one of the highest under-five mortality rates in the world, according to the World Health Organisation.
Dr Ali Abdullahi Warsame, health minister of the northern Puntland state, called MSF's departure “disheartening.”
The Somali government Thursday pleaded with MSF to review its closure.
“This decision will directly affect the lives of thousands of vulnerable people,” said Maryan Qasim, minister of human development and public services.
“We fear that this decision will lead to a catastrophic humanitarian crisis.” - Sapa-dpa