The medical program Doctors Without Borders (DWB) announced on Wednesday that they are pulling out of Somalia due to violence towards their staff working in the country.

The decision will leave hundreds of thousands of Somalis without medical care, Reuters reports, as the organization is one of the main, and in some regions one of the only, providers of medical help in the country.

According to a statement released by the charity, DWB has been working in Somalia since 1991 and was forced to close its programs there due to “extreme attacks on its staff,” such as the brutal murder of two of its doctors in Mogadishu in December 2011.

Dr. Unni Karunakara, international president of DWB, stated in the press release, “We are ending our programs in Somalia because the situation in the country has created an untenable imbalance between the risks and compromises our staff must make, and our ability to provide assistance to the Somali people.”

Karunakara added that “[u]ltimately, civilians in Somalia will pay the highest cost.”