Gabriel Trujillo, Doctors Without Borders/Médecins Sans Frontières' (MSF) program manager in Sudan, has returned from Darfur in September. In the western part of the province where MSF is working, displaced people continue to live without any sense of security and are still affected by ongoing violence and tensions.

WHAT IS THE STATUS OF OUR ACTIVITIES IN DARFUR?

In western Darfur, there is a continuing, and even increasing, level of insecurity both inside and outside the camps. Furthermore, the displaced persons are still subject to ongoing pressure regarding their possible return. At the same time, it's clear that there is no political solution to the conflict. In this context of sustained tension and insecurity, it is absolutely crucial that Doctors Without Borders/Médecins Sans Frontières (MSF) continues to have a presence.

In late 2003 and early 2004, when MSF's activities were getting underway in Darfur, the needs of the displaced civilians were huge, so we set up wide-ranging medical, nutritional, and sanitation activities. This was the MSF's largest emergency operation in 10 years.

The situation has changed since then. The number of humanitarian actors in the field has increased and epidemiological indicators show that the medical and nutritional needs of the displaced people are being addressed, overall. However, considering the situation by looking at numbers alone is not an adequate basis for making decisions about MSF's activities. The statistical indicators (including mortality rates, coverage of nutritional needs, and others) are below emergency levels, but the displaced people in the camps are still living in precarious conditions and disparities persist between the three states of North, South, and West Darfur.

WHAT ASSISTANCE IS MSF PROVIDING THE POPULATIONS?

In West Darfur, MSF is continuing medical activities in El Geneina, Mornay, Zalingei, and Niertiti serving 300,000 people, half of whom are displaced.

At the El Geneina hospital, MSF has restored the operating room and is working in the pediatrics department, among other activities. MSF will wind up our activities there at the end of September because this ministry of health facility can now function without MSF, as other organizations are also working inside the hospital.

However, MSF will maintain the health facility that the teams created in Mornay, a small town where nearly 70,000 displaced persons still live. MSF's medical activities are still operating at a very high level, with close to 6,000 consultations every month. MSF is continuing our medical assistance in Zalingei, where teams are working in a health center in a displaced persons camp and are working in the hospital pediatric department, as well as in Niertiti, in the Jebal Mara foothills in the heart of Darfur, where teams are managing a health center with hospital beds.

In the nutritional area in West Darfur, MSF is treating several severely malnourished children in Mornay, Zalingei and Niertiti. In Mornay, medical teams observed an increase in admissions during several weeks in July after the World Food Program (WFP) ended its food distributions, so MSF had to reopen our therapeutic feeding center. In Zalengei, however, malnutrition is linked to episodes of diarrhea during the rainy season, just like in Niertiti. There, MSF teams see children coming from the Jebel Mara, where the WFP is not conducting any food distributions, but where people can farm. Thus, apart from a few sporadic admissions, MSF is not seeing any nutritional problems for the populations.

WILL OUR PRESENCE CHANGE?

MSF has begun to deploy mobile medical services in the Jebel Mara. Once a week, MSF sets up a mobile clinic in Thur and one in Kuthrum, two completely isolated sites. The Sudanese government controls Thur and the SLA, one of the Darfur rebel movements, controls Kuthrum. Each site has around 25,000 people. It is hard to estimate the level of violence they are experiencing, but their isolation in the Jebel Mara has deprived them of access to care. MSF is going to try to increase the frequency of visits.

Last, MSF will strengthen our medical activities to better respond to violence against women carried out in Mornay, Zalingei, and Niertiti. The persistent violence in the camps for displaced persons targets primarily women. Respiratory infections are the main cause of admissions (13 percent of patients) to the emergency department in the hospital MSF manages in Mornay. But violence ranks just below that, with 11 percent of patients being victims of direct violence (wounds and burns) and 3 percent the victims of sexual violence.