MSF is very concerned for the safety of an estimated 250,000 people trapped in heavy fighting in the Vanni. Hundreds of civilians are reported to have been wounded or killed during the last days as the LTTE-controlled area has shrunk in the face of the government of Sri Lanka’s military offensive. MSF has received reports from the region that the plight of the civilians is dire. Hospitals are coping to the best of their ability, but are running low on drugs and medical staff. Ambulances are having difficulty moving across front lines to evacuate wounded. MSF is standing by with medical staff and supplies, but has not been permitted to enter the area since the government told all NGOs and UN to leave the area in September 2008: this despite several requests for assistance from Sri Lanka Ministry of Health staff still in the Vanni . Though roughly 2,000 people have managed to cross to the relative safety of Vavuniya in the past weeks, most of the population is unable to leave. It is vital that both parties to the conflict respect the right of the civilians to seek safety, and to facilitate their movement in whatever way possible. In the Vavuniya area, MSF is prepared with mobile clinics in case of large-scale displacement and a surgeon will soon arrive to provide additional support to the Vavuniya hospital. MSF already provides mental health support by strengthening existing structures in the Vavuniya area and provides laboratory support to the hospital, as well as ambulatory feeding programmes in the area. MSF also works in Point Pedro hospital in the Jaffna Peninsula, at the North tip of Sri Lanka, providing medical and surgical activities, obstetrical and gynecological treatment and training to the hospital staff.