Mudug is on the edge. Families arrive in displacement sites after walking enormous distances, having already exhausted every option they had. Many wells have dried up entirely — by December 2025, authorities reported 71 non-functional boreholes and wells across Galgaduud and Mudug — and water prices have more than doubled. Families are making impossible choices between buying water, food, or the cost of transport to reach a clinic. 

When patients finally arrive at our facilities, we can see in their condition exactly how long they waited. The crisis does not start at our door. It starts kilometres away, in a village with no clean water and no functioning health post. And an early-warning alert in December 2025 reported that another 29,142 people had been displaced across Bari, Mudug, Nugaal, and Sanaag — which means the pressure on already-stretched communities is not easing. It is growing.

The numbers are stark, but they represent real children. In 2025, MSF recorded approximately 117,840 outpatient consultations and 56,444 emergency consultations in Mudug. Malnutrition admissions surged — a 46 percent increase in outpatient cases and a 58 percent rise in inpatient cases compared to 2024. More than 3,800 children were enrolled in ambulatory therapeutic feeding centres, and 2,200 required inpatient care. We also treated over 56,000 respiratory infections, nearly 16,000 cases of acute watery diarrhoea, and 801 measles cases.

These figures are a mirror. They tell us that safe water, nutrition, and vaccination are failing outside our walls — and that illnesses which should be manageable are becoming life-threatening because families cannot reach care in time. 

It means there is simply nowhere left to go. When first-line services close, people do not stop being sick — they delay care until the illness becomes critical. Funding reductions have forced dozens of health and nutrition sites in Puntland alone to close or face severe staff and supply shortages. Antenatal and postnatal visits dropped in 2025 despite rising needs. Referral options for complicated cases are shrinking. 

Nationally, at least 4.4 million people faced high levels of acute food insecurity in late 2025, and 1.85 million children under five are projected to suffer acute malnutrition between August 2025 and July 2026 — including 421,000 severe cases. MSF can provide essential services: outpatient care, emergency treatment, maternal health, vaccination, and mobile clinics reaching displacement sites and remote villages. But MSF cannot replace a collapsing system. 

We are calling on donors and humanitarian actors to take three urgent steps. First, sustain and scale up integrated health and nutrition services close to where people live. Predictable funding prevents site closures and enables early treatment — the single most effective way to reduce complications and deaths. Second, reinforce routine vaccination and outreach so that preventable diseases like measles do not spread further in already weakened communities. Third, invest in safe water and sanitation — repair wells and expand water trucking — to reduce diarrhoeal disease and support nutrition gains. 

If these steps are delayed, the trajectory is clear: displacement will continue, more children will arrive in critical condition, outbreaks will spread, and preventable deaths will rise. There is still time to act — but the window is narrowing.