Madina hospital struggle to cope with the growing number of injured civilians as they continue to stream in due to the ongoing fighting in Mogadishu. Explosions and gunfire shook Mogadishu overnight and into Sunday (April 22) during a fifth day of battles between insurgents and allied Somali-Ethiopian troops that have killed more than 200 people, residents said. Dragging and carrying belongings on their head, hundreds of Somalis trudged out of the city on foot in an exodus some local groups say is now nearing half a million people. With an insurgency simmering since the ouster of militant Islamist rulers from Mogadishu over the New Year, this week's violence has been one of the worst sustained flare-ups. A previous four-day spike in battles at the end of March killed at least 1,000 people, mainly civilians. A small African Union peacekeeping force of 1,500 Ugandan soldiers has failed to stem the conflict and remains hunkered down around the airport, presidential palace and port. Madina, the only functioning hospital is stretched to capacity and forced to set up some makeshift tents to cater for the growing number of injured civilians. Most of the injured are not even able to get to the hospital as the roads have been barricaded and end up dying on the streets. Insurgents are barricaded behind makeshift sandbanks and race through streets on pickups turned into battle-wagons, while Ethiopian and Somali troops fire heavy artillery and make forays into their strongholds with armoured cars. The Islamists ruled most of south Somalia for the second half of 2006, before being defeated by the interim government and its Ethiopian military backers in a war over the New Year. But Islamist fighters -- backed by some disgruntled Hawiye clan elements and foreign jihadists -- have regrouped to rise up against President Abdullahi Yusuf's administration and his Ethiopian backers whom they regard as hated foreign invaders. Illustrating regional divisions many say are fomenting the escalating war, Eritrea pulled out of the east African group IGAD after a rift with Ethiopia over Somalia. The feuding neighbours each accuse the other of stirring the conflict. Ethiopia accuses Eritrea of sending arms and men to support the Islamists, while Asmara says Addis Ababa is occupying Somalia illegally at the behest of the United States.