When bullets tore through the streets of Kismayu in June, leaving over 70 dead as rival militias fought twice for control of the Somali port city, many international aid agencies halted a cautious scale-up of activities.

One of the few to stay was the World Health Organisation (WHO).

“For us, conflict means casualties. We are doctors; we have to be there,” Omar Saleh, WHO Somalia’s emergency health co-ordinator, said last week.

But for most international organisations — many of which had just returned to Kismayu after militant Islamists Al Shabaab were driven out late last year — the June violence proved too dangerous.

As stability returned through July, activities slowly resumed. Still, the political and security crises that fuelled the fighting are at risk of deepening. (Read: With emerging peace and stability, the scramble for Somalia is on)

Jubaland dispute

The recent disputes over Jubaland, a state-within-a-state whose leadership and borders are not recognised by the administration in Mogadishu, constitute a test of federal principles outlined in Somalia’s provisional constitution. The central government also seeks control of, and revenue from, Kismayu — Jubaland’s de facto capital.

Jubaland, which, in its maximum extent is considered to include the regions of Gedo and Lower and Middle Juba, has 87,000km2 of mainly fertile land, and some 1.3 million people of many different clan allegiances.

The Jubaland issue is also complicating relations between the central government in Mogadishu, regional powers Kenya and Ethiopia, and the African Union (AU) mission in Somalia (Amisom). And with key players in Kismayu temporarily distracted, the crisis could be giving Al Shabaab a much-needed breather to regroup.

(Read: KDF now sucked into Somalia power struggle)

These developments threaten gains made this year by aid agencies, and risk extending an already complex humanitarian situation in the city, where 60,000 people are in need of aid, according to estimates by the UN Office for the Co-ordination of Humanitarian Affairs (OCHA).

“Whenever territory is taken by military operations, there is at least a temporary lag setting up a functioning administration. This hampers the ability of humanitarians to access people in need,” Philippe Lazzarini, the UN’s top humanitarian official for Somalia said.

“The change in power can stoke insecurity rooted in competition among rival factions, as we saw in Kismayu and the Juba regions,” he added.
For several years, Kismayu, 200km north of the Kenyan border, was a key stronghold and source of income for Al Shabaab. The militants took control of the city in August 2008, after defeating the militia of Barre Adan Shire (widely known as Hiiraale), and remained in control of it until their defeat in September 2012.

Kismayu was a key target in Amisom’s operation against Al Shabaab — the militants controlled the lucrative charcoal trade out of the port and also taxed imported goods.

While civilians reported some stability during Al Shabaab’s control of the city, there were also limited livelihood opportunities, and access to education and healthcare was often difficult. Al Shabaab also banned polio vaccination in Kismayu and elsewhere in south-central Somalia, and according to reports, the group forcibly taxed and recruited the city’s residents.

“Conditions for the population were precarious under Al Shabaab,” Soldan Haji Aden, director of the Alikar Centre for Peace, Human Rights and Democracy in Kismayu said. “Residents and internally displaced persons who came to Kismayu could not find healthcare, water, food, shelter or any kind of livelihood.”
Kismayu and the surrounding region were also hit hard by the 2011 food crisis. While famine was not declared in Lower Juba, the situation was classified a humanitarian emergency. Many of those displaced by the food crisis crossed the border to go to the Dadaab refugee camps in Kenya, but tens of thousands of people fled to Kismayu, where many other IDPs have gathered since the early 1990s.
“When Al Shabaab controlled Kismayu, it was very difficult to get food to feed my family,” Fadumo el Moge, a mother of five in Kismayu, said. “There was no work and Al Shabaab controlled the city and stopped humanitarian assistance. I had to rely on support from my family abroad.”
Kenyan and Somali troops — the former mostly operating as part of the AU mission — attacked Kismayu in September 2012. Supported by local militia group Ras Kamboni, the mixed force launched a combined ground, air and naval assault on September 28, and quickly ousted the militants from their last major urban stronghold.
 While there remain major concerns about access and security, UN agencies and NGOs have launched or extended a variety of programmes, directly or through partners. Several have sent in short missions involving international staff, and humanitarian needs assessments have also been carried out.
 “The challenges in Kismayu largely mirror those found throughout southern and central Somalia,” said Mr Lazzarini, who made his first visit to Kismayu as Humanitarian Co-ordinator in July 2013. “People lack sufficient health services. They need clean water, sanitation services and education.”
Key humanitarian risks include the possibility of a polio outbreak given the long ban on vaccination, the spread of waterborne and infectious diseases within densely populated urban areas and IDP camps, and the ongoing threat of conflict in the city and beyond.
“The situation in Kismayu is better than before,” said Mr Saleh of WHO, which is running polio vaccination and emergency surgery programmes. “But there are major problems. Kismayu Hospital needs total renovation. We need to establish long logistic lines for supplies and medicine, and build up the people who are there after so much capacity has been lost. We are progressing, however, slowly but surely.” 
The World Food Programme (WFP) launched two basic programmes in January through local partners: Wet feeding at five centres, reaching about 15,000 people each day, and a nutrition programme to treat high levels of malnutrition among women and young children.
Médécins Sans Frontières (MSF) — which withdrew from Kismayu in 2008 after the murder of three staff members — was also active in the city, but it recently announced plans to close all of its Somalia programmes due to “extreme attacks” on its staff. A number of other agencies are present, but are reluctant to share details of their operations.
Kismayu’s uneasy peace was shattered in June, when fighting broke out between rival militias laying claim to the presidency of Jubaland. The violence underscored the fragility of Kismayu’s early recovery and the dangers that remain.
“The tensions have been a setback — in particular, the fighting on June 28-30, which resulted in more than 70 deaths and hundreds of civilian casualties,” said Mr Lazzarini.

Clashes first broke out in early June, and then again at the end of the month, with rival factions battling for control of the city. WHO reported a 44 per cent rise in weapons-related injuries in Kismayu in June. The fighting pitted Ahmed Mohamed Islam “Madobe” — who was elected president of Jubaland in May, by a conference of clan representatives — and his Ras Kamboni militia, against other figures who also declared themselves leaders of the region.

Human Rights Watch criticised the militias for disregarding the safety of civilians, while a leaked letter from Somali Foreign Minister Fawzia Yusuf to the AU accused the Kenyan military of backing Ras Kamboni in the June clashes, and of using heavy weapons in civilian areas. Analysts say Kenya has been encouraging the creation of Jubaland, which could act as a buffer zone on its northeastern border.

On August 4, in Uganda’s capital, Kampala, regional heads of state decided in a communique that control of Kismayu’s airport and seaport should be handed back to the Federal Government — backing Mogadishu against Madobe.

The heads of state who met in Kampala included Uganda’s Yoweri Museveni, Kenya’s Uhuru Kenyatta, Ethiopian Prime Minister Hailemariam Desalegn, and Somalia President Hassan Sheikh Mohamud.

Polio spread

But the violence had already taken its toll. A critical polio vaccination campaign, which targeted tens of thousands of at-risk children, was halted. Although the effort was restarted in July, the delay is disconcerting given the 100 cases of polio confirmed in Somalia in 2013.

WFP’s food distribution activities were also disrupted, threatening recent gains in food security since the 2011 crisis. “The port has largely been inaccessible, so for essentially two months we couldn’t get food there,” Challiss McDonough, WFP’s spokesperson, told IRIN. “We did an exchange with another organisation, but had to suspend cooked meals in late July. We are in the process of getting more food there, and hope to be able to resume by mid-August."

The instability in Kismayu also threatens hopes of early refugee repatriation from Kenya. According to the UN Refugee Agency  (UNHCR), some 96,000 refugees in Dadaab — representing over 35 per cent of the camp’s population — have origins in Lower Juba, and are unlikely to agree to any negotiated return while significant violence still threatens the region’s capital and civilian population.

Despite the negative humanitarian outlook following June’s violence, some agencies remain upbeat.

“The local authorities told me that they are ready to ensure the security of humanitarian workers,” said Mr Lazzarini. “We are redeploying staff. We will continue to work hard to scale up our activities, not only in Kismayu but throughout southern Somalia.”

OCHA recognises that the situation in the city “remains tense,” and as MSF’s recent withdrawal from the country demonstrates, the conditions for humanitarian activity in Kismayu and elsewhere are likely to remain precarious for some time.