Five people have been killed and dozens wounded in Yemen’s third city of Taez, Doctors Without Borders (MSF) said Tuesday after clashes erupted between various pro-government factions.

“Heavy fighting has once again resumed inside Taez,” a city just inland from the Red Sea port of Mokha, MSF wrote on Twitter.

“MSF supported facilities have received some 91 wounded and recorded five deaths directly related to the fighting,” since April 19, it added. The medical charity added the clashes are preventing patients from reaching an MSF supported hospital in the city — the only facility providing maternal healthcare to Taez residents.

Rights group estimate the toll could be much higher.