Mogadishu, Somalia ? Heavy fighting Saturday between Islamic insurgents and Ethiopian troops backing the government left at least 52 civilians dead in the capital, a human rights official said, describing the violence as the worst in years. One of the city’s main hospitals pitched tents outside to care for the wounded.

Refugees fleeing the city carried cooking utensils, linens and clothes wrapped in sheets. Some looked weak and said they had not eaten for days.

The U.N. refugee agency said hundreds of thousands of Mogadishu residents had fled in recent days – out of the city’s total population of about 2 million – and Saturday hundreds of women, children and men joined them.

“It is better to die in a safe place hungry and thirsty than to wait for mortar shells,” said a mother of eight who only gave her name as Faduma. She said that she had not eaten for two days and during March battles between the insurgents and Ethiopians, her husband and oldest daughter were killed.

On Friday, the U.N. refugee agency revised its estimate of the number of people who fled Mogadishu since February to 321,000, up from 218,000, saying the additional figures were from new information about Mogadishu residents who had fled to central Somalia towns.

Somalia’s Elman Human Rights Organization said Mogadishu residents, hospital workers and human rights workers reported at least 52 civilian deaths and many wounded Saturday. Fighting from Wednesday to Friday killed at least 113, according to Elman.