International medical charity Medecins Sans Frontieres (MSF) has announced it will pull out of Somalia saying the threat of deadly violence had become intolerable.
The withdrawal of MSF, or Doctors Without Borders, is a blow to the government's effort to persuade Somalis and foreign donors that security is improving and a stubborn insurgency is on the wane.
"The closure of our activities is a direct result of extreme attacks on our staff, in an environment where armed groups and civilian leaders increasingly support, tolerate or condone the killing, assaulting and abducting of humanitarian aid workers," Unni Karunakara, MSF's international president, told reporters in the Kenyan capital, Nairobi, on Wednesday.
Sixteen MSF staff members have been killed in Somalia since 1991 when civil war erupted, but the charity stayed on, negotiating with fighter groups and resorting to hiring armed guards, something it does not do in any other country.
"But we have reached our limit," Karunakara said, fighting back tears.
Hundreds of thousands deprived
Within hours of the announcement, al Qaeda-linked al-Shabab fighters raided one MSF hospital in southern Somalia, forcing patients out before ransacking it.
"They have ordered the patients in the hospital out and... taken computers, hospital beds, and other valuable equipment," Ibrahim Mohamed Adan, district commissioner of the town of Diinsor in southern Somalia's Bay region, told Reuters.
We have reached our limit
MSF's departure will deprive hundreds of thousands of Somalis of medical help, Karunakara acknowledged. MSF treated about 300,000 Somalis in the first half of 2013.
Dozens of foreign MSF staff had pulled out of Somalia in past weeks, the charity said, while some 1,500 local doctors, nurses and assistants will now be jobless.
There was no immediate comment from the Somali government, which is struggling to pull the nation out of two decades of conflict and is unable to provide basic public services including health and education.
The pullout came a month after two female Spanish MSF workers were freed by their Somali kidnappers after almost two years in captivity.
In early 2012, MSF closed two major medical centres in the capital Mogadishu after two international staff were shot dead by a former colleague.