The reluctant pull-out of the medical aid group, Doctors Without Borders, from Somalia after many hard, dangerous years there is a sign of the circumstances that prevail in that East African region.
Doctors Without Borders -- "Medecins Sans Frontieres" in French -- is probably the hardiest and most non-political of the humanitarian groups. It is usually the first in and the last out of world disaster areas, providing care in the most difficult of circumstances to the most miserable victims of sometimes savage conflicts. Thus it has been in Somalia, where MSF has operated since 1991, when the government there collapsed.
That area on the map -- divided, without coherent government, torn by inter-clan and religion-inspired fighting since 1991 -- has been the site of deadly fighting that has claimed up to 1.5 million lives and displaced (either internally or as refugees) mostly into Kenya or Ethiopia, another 2.3 million.
Some international organizations, including the United Nations and the African Union, after having spent some $60 billion there, like to pretend that the current body seated -- sometimes -- in Mogadishu, the capital, is gaining strength and support among Somalis. In fact, the area has at least three different governments -- in Mogadishu, in Puntland, and in Somaliland, with other, more local bodies ruling in other towns and areas of what used to be Somalia, making the claim that it is coming back together after 22 years a wish or a joke.
The body in Mogadishu, which includes a president, prime minister, cabinet and other trappings of sovereignty, depends for its existence on the presence of 18,000 foreign troops from Burundi, Djibouti, Kenya, Uganda and Sierra Leone, all financed from abroad. A Somali national army is in the process of being trained by foreign troops, but the general view is that the Mogadishu government would be forced to flee the country in haste if the foreign troops were withdrawn.
The presence of some 3,000 American troops, supported by jet fighter aircraft and drones, at a base in nearby Djibouti, the former French Somaliland, also probably helps preserve the Mogadishu government.
Medecins Sans Frontieres is pulling out, not because it is no longer needed -- for example, a polio outbreak has just occurred in Somalia, with more than a hundred cases -- but because it does not feel it can continue to work there in safety. The decision to leave was made after violent attacks on the organization's staff members, who treated some 665,300 Somalis last year.