Fierce fighting between government troops and militias in Somalia's southwestern city of Baidoa killed dozens of combatants and at least four civilians, a hospital official said Tuesday. The conflict also left 98 people wounded, straining local health services already struggling with an influx of people displaced by drought and previous fighting.

The clashes erupted early Monday when militia groups attacked government positions on the outskirts of Baidoa, a city that hosts over half a million displaced individuals. Somali officials stated that at least 30 attackers were killed, while the number of government casualties remains unconfirmed.

Dr. Abdikafi Omar Mohamud, head of the emergencies department at Bay Regional Hospital, reported that among the wounded were 28 women and an elderly man struck by stray bullets. The hospital, with only 40 beds, established an emergency tent to manage the surge in patients. Medical workers are also contending with shortages of essential medicines.

Calm returned to Baidoa on Tuesday, with security forces patrolling damaged streets. Residents cautiously left their homes while maintaining a significant military presence in key areas.

The violence began shortly after 5 a.m. Monday with two explosions near a military base east of Baidoa. Heavy fighting ensued around another base in Bonkay, south of the city, before armed groups entered Baidoa and exchanged fire with government troops. Forces loyal to former South West state President Abdiaziz Hassan Mohamed Laftagareen reportedly displaced new administration troops from parts of the city for about six hours before being driven out.

In separate assaults, fighters affiliated with the extremist group al-Shabab targeted two Somali military positions on Baidoa's outskirts. The timing of these attacks has led to allegations of coordination between al-Shabab and Laftagareen's forces. Somalia's federal government stated that attackers included Laftagareen-aligned militias and al-Shabab fighters, claiming nearly 30 attackers were killed and several captured. South West state authorities reported approximately 50 attackers killed.

South West Internal Security Minister Isak Mohamed Korsaar confirmed that government troops recovered bodies of al-Shabab fighters and apprehended others. "The militias that attacked us were not alone. We have confirmed that they were accompanied by al-Shabab," Korsaar told reporters.

This recent violence follows months of tension surrounding leadership and electoral processes within South West state. The federal government had rejected Laftagareen's disputed indirect re-election in March. Federal troops took control of Baidoa on March 30, after which Laftagareen, who had led South West since 2018, announced his resignation.

Analysts suggest that political disputes settled through military means can create opportunities for extremist groups like al-Shabab to exploit, with civilians bearing the brunt of the consequences.