Dr Omar Saleh first came to Kismayo General Hospital in 2007, after Ethiopian forces had stepped in to help the Somali interim government of the time.

But just a year later, Dr Saleh, the World Health Organisation's emergency co-ordinator for Somalia, found himself unable to get to the hospital, as the city fell under the control of the notorious al-Shabaab armed group.

When a coalition of Kenyan troops and Somali forces - the Somali National Army allied with the Ras Kamboni armed group - ousted al-Shabaab in September 2012, hopes for humanitarian access were raised.

Dr Saleh returned to Kismayo in October 2012, his first visit since the city's days under al-Shabaab's harsh rule. He found the hospital, built in 1931 under Italian colonialism, in a sorry state. Four years without adequate maintenance and supplies had taken its toll.

The security situation in the city, held together by a precarious armed peace, is not sufficient for most humanitarian agencies to operate. Many organisations have visited the hospital and have said that they would help, but so far there have been few promises fulfilled, one of the staff told Al Jazeera.

The World Health Organisation is supplying drugs to the hospital, and training teams of medical staff, but many of the rooms here are inaccessible, as crumbling walls and ceilings threaten to collapse at any moment.