Last month, two workers from Doctors Without Borders — known across Africa as Medecins Sans Frontieres (MSF) — were released after 21 months in captivity.  In the 22 years that the organization has been in operation throughout Somalia, 16 staff members have been killed. International President of Doctors Without Borders, Unni Karunakara, says the organization, doctors and volunteers have reached their breaking point, NPR reported.

“We’ve just reached our limit and [are at a point] where we can no longer continue to work the way we have been until now in Somalia,” Karunakara told NPR. “We are absolutely willing to sit across the table from any of the authorities that want to discuss meaningfully, the conditions that can lead us to perhaps one day go back and work in Somalia.”

The organization has faced criticism for speaking out against the government, Al Shabaab and other leaders who supposedly had a stake in keeping MSF workers safe. The organization’s retreat from Somalia — due to increasing security threats — is the second time in history that MSF charity efforts have been completely withdrawn.

MSF didn’t single out any authoritative group, instead Karunakara said that collectively, the government and rebel groups failed to prioritize safety for the doctors and health personnel who administered thousands of vaccines and surgeries in Somalia.

“The more troubling thing that led us to make this decision is the realization that the very authorities — whether it be the government, the Al Shabaab or it be traditional community leaders who were supposed to give us safety assurances — have at times actively supported or approved attacks, killings and abductions of humanitarian workers in Somalia, Karunakara said.

He further explained that the government does not have full control over the country. In central regions and others, Al Shabaab acts as a governing force. And although Karunakara said authoritative figures haven’t really helped to keep MSF workers safe — NPR reported that government officials said MSF’s withdrawal could ultimately be catastrophic.

“Over the last 22 years we have stayed in Somali through some really difficult times.  It’s also been difficult for us. We’ve had thousands of incidents against our staff members — attacks on staff members,  health facilities, ambulances, etc,” Karunakara said. “A withdrawal like this is never easy. It’s been 22 years. We’re all very attached to the programs that we set up and create — and the people we work with. It’s not an easy decision.”

MSF has agreed to continue offering support to the nation, however no longer via on-location missions.