Médecins Sans Frontières, or Doctors Without Borders as they are called by many, go into places where no one else will go, they were born out of an exhaustion of complacency and work to bring health care to people who have no other option.

With that as the background, you can imagine how bad a situation has to be for the organization to leave somewhere.

Today MSF announced the closure of all its programs in Somalia, where it has been set up since 1991. This comes after extreme attacks on staff “an environment where armed groups and civilian leaders increasingly support, tolerate, or condone the killing, assaulting, and abducting of humanitarian aid workers.”

The most recent incidents include the brutal killing of two MSF staff in Mogadishu in December 2011 and the subsequent early release of the conviceted killer; and the violent abduction of two staff in the Dadaab refugee camps in Kenya that only ended last month after a 21-month captivity in south, central Somalia. These two incidents are just the latest in a series of extreme abuses. Fourteen other MSF staff members have been killed, and the organization has experienced dozens of attacks on its staff, ambulances, and medical facilities.

In some cases, the same actors—particularly but not exclusively in south central Somalia—with whom MSF must negotiate minimum guarantees to respect its medical humanitarian mission, have played a role in the abuses against MSF staff, either through direct involvement or tacit approval. Their actions and tolerance of this environment effectively cuts off hundreds of thousands of Somali civilians from humanitarian aid.

The only good part to it all is that MSF isn’t just going to leave. They are going to make a big fuss about going. Dr. Unni Karunakara, MSF’s international president is calling out the government, armed groups and other leadership in Somalia for what a lack of medical services will do to the citizens.

“Ultimately, civilians in Somalia will pay the highest cost,” he said, during a media event in Kenya this morning.

MSF in Somalia by the numbers (from 2012 alone):

• 1,500 staff
• 624,000 medical consultations,
• 41,100 patients admitted to hospitals,
• 30,090 malnourished children cared for,
• 58,620 people vaccinated,
• 7,300 babies delivered

Learn more about MSF.