MOGADISHU, Somalia — Hours of fierce fighting between government troops and militias that killed dozens of combatants in Somalia’s southwestern city of Baidoa also left at least four civilians dead and 98 others wounded, a hospital official said Tuesday.

The fighting erupted early Monday when militia groups attacked government positions on the outskirts of the city, which is home to more than half a million people displaced by conflict and drought. Somali officials said at least 30 attackers were killed, but did not immediately give a toll for government troops.

Dr. Abdikafi Omar Mohamud, head of the emergencies department at Bay Regional Hospital in Baidoa, said the fighting also killed at least four civilians and injured 98, including 28 women and an elderly man hit by stray bullets.

The latest violence placed additional pressure on health services already struggling to serve residents and displacement camps in Baidoa, about 245 kilometers (150 miles) northwest of Mogadishu.

Mohamud’s hospital had only 40 beds available and put up an emergency tent to accommodate the influx after the fighting erupted. Medical workers were also struggling with shortages of essential medicines, he said.

Calm returned to Baidoa on Tuesday as security forces patrolled major streets and inspected buildings and vehicles damaged in the fighting. Residents cautiously emerged from their homes, although troops maintained a heavy presence in key areas.

The violence began shortly after 5 a.m. on Monday with two explosions near a military base east of Baidoa. Heavy fighting broke out minutes later around another base in Bonkay, south of the city, before armed men entered Baidoa and exchanged fire with government troops.

Fighters loyal to former South West state President Abdiaziz Hassan Mohamed Laftagareen displaced the new administration’s troops from parts of Baidoa for about six hours before being driven from the city, said Samira Gaid, a regional security analyst at Balqiis Insights.

In separate attacks, fighters of the al-Qaida-linked extremist group al-Shabab struck two Somali military positions on Baidoa’s outskirts, Gaid said. The timing of the assaults prompted allegations that the extremist group had coordinated with Laftagareen’s forces.

Somalia’s federal government said the attackers included Laftagareen-aligned militias and fighters from al-Shabab. The government said its forces killed nearly 30 attackers and captured several others. South West state authorities reported a higher toll, saying about 50 attackers were killed.

Neither figure could be independently verified, and authorities did not explain the discrepancy.

South West Internal Security Minister Isak Mohamed Korsaar said Tuesday that government troops recovered the bodies of al-Shabab fighters and captured others alive.

“The militias that attacked us were not alone,” Korsaar told reporters. “We have confirmed that they were accompanied by al-Shabab.”

The fighting followed months of tension over South West’s leadership and its electoral process. The federal government rejected Laftagareen’s disputed indirect re-election in March.

Federal troops took control of Baidoa on March 30, prompting Laftagareen, who had governed South West since 2018, to announce his resignation.

Gaid warned that the fighting demonstrated how political disputes can create openings for extremist groups.

“When elite disputes are settled militarily, they create the conditions that the terrorist group exploits,” she said. “It is Somali civilians who pay for it.”