West Darfur In El Geneina, the provincial capital of West Darfur, MSF supports the emergency and surgery ward of the general hospital by providing medicines, medical materials and technical support, such as assistance with the management of the pharmacy. Access to medical care and emergency support is a constant problem for populations faced with on-going violence. Fighting to the north of El Geneina led to the displacement of several thousand people in December 2006, 5,000 of whom arrived in the nearby Aradamata and Dorti camps. In Aradamata camp, on the outskirts of town, MSF has set up a medical mobile unit to screen new arrivals, and more than 500 people were treated in less than a week. People continue to arrive in small groups, mostly at night due to the risk of attacks on the roads, and there are many reports of acts of violence perpetrated against villagers. In Habilah, a camp near the border with Chad, which has 7,000 residents and houses over 22,000 displaced people, MSF runs a medical clinic with a 30-bed inpatient ward. The clinic provides therapeutic feeding for severely malnourished children and ante-natal care and assistance with deliveries. On average 35 babies are delivered each month in the health centre. Outreach workers assist with health education and referrals. In 2006, 25,000 consultations were done in the outpatient department and 750 patients were hospitalised. Mobile clinics, which provided medical care for mostly nomadic populations have been stopped, due to increasing insecurity. In this particularly difficult context, MSF is trying to reach populations located north of El Geneina, who are receiving little if any assistance. An exploratory mission recently went to Tanjeke, 30km north of El Geneina, where there were reports of families being stranded because of insecurity. A security incident on the return journey has confirmed that the roads are not safe enough to be used regularly. So, at present, MSF is not able to provide this population with further assistance. In Seleia, in the north of the West Darfur province, fighting has been on-going. A four-person team is setting up a surgical facility to treat the wounded and assist in emergency obstetric cases. The team is also giving support to the health centre. A mobile clinic is being put into place. In Um Dukhun, near the border of Chad and the Central African Republic, MSF had been offering primary and secondary health care since January 2004. MSF's presence brought a degree of stability, improved health indicators, provided surgical care and opened up access for other agencies to intervene. MSF's services were handed over to the International Medical Corps and the Sudanese Ministry of Health in May 2007. The health and nutritional situation in the Mornay, Zalingei and Niertiti camps in West Darfur, where MSF has been working since late 2003, has also stabilised and mortality rates have long been below emergency thresholds. In 2003-2004, MSF was the only organisation working in Mornay, a camp housing 75,000 displaced people. As other medical care actors are now present, MSF gradually ended its outpatient visits and hospitalisations in mid June. MSF is able to hand over the project because the government and other organisations are taking responsibility for meeting the health care needs and the distribution of food and drinking water. MSF is continuing to provide services (outpatient visits and hospitalisations) in Niertiti, at the foot of the Jebel Mara, where the population totals 3,000 residents and 30,000 displaced people. The MSF team also has a presence in Kutrum, in the Jebel Mara. The health centre that MSF set up in Kutrum is the only medical facility in the rebel zone, serving the entire western part of the Jebel Mara. In mid-June MSF teams in Kutrum had to be evacuated. They will return as soon as the security situation improves. In Zalingei, where 90,000 displaced people are living, the MSF team is providing secondary care in all departments of the hospital. The hospital is now running smoothly, doctors from the Ministry of Health are present throughout the facility, and MSF's support appears to be less critical. Over the next few months, MSF will gradually reduce its activities and focus on working in three of the hospital departments: emergency care, paediatrics and surgical care. North Darfur In the town of Kebkabiya, just over 150 kilometres to the west of the provincial capital El Fasher, MSF is running three dispensaries and providing support to the Ministry of Health hospital for the clinical management of the cases referred. The programme serves a population of approximately 75,000, mostly displaced, people who sought refuge in the city at the beginning of the conflict in 2003. Outreach support from Kebkabiya to the town of Kaguro (in the rebel-held Jebel Si), which had been placed on stand-by in August 2006 after a number of security incidents, restarted in February. The project focuses on bringing medical care to around 37,000 people who have been cut off from assistance since 2003, when the whole area was attacked and most villages burned. Many people were killed and a large part of the population fled to the mountains around Kaguro. Unfortunately, a new security incident prompted the teams to once again stop movements and the provision of care outside of Kebkabiya, including mobile clinics that had only recently been launched to help the many marginalised and neglected Arab nomads in the southern and eastern parts of Kebkabiya district. A team of Sudanese staff continues to support the dispensary in Kaguro. An international team will soon return to the area to work on improving the functioning of the dispensary and to do further outreach to the surrounding villages. MSF will restart the mobile clinics within the areas around Kebkabiya and plans to cover more locations. Serious security incidents forced MSF to evacuate its international team from Serif Umra in July 2006. Sudanese staff continue to run the MSF dispensary, the only medical facility for a population of 55,000, many of whom have been displaced. In March 2007, an international team based in El Fasher was able to restart medical supervision on a weekly basis. A total of 4,000 outpatient consultations are performed every month in the dispensary, while patients in need of secondary health care are transferred to the hospital in Zalingei. In the near future MSF will bring back an international team to improve the curative care. In Shangil Tobaya, MSF is the only aid actor providing healthcare services for the 28,000 displaced people living in the Shangil and Shadat camps, as well as in Shangil Tobaya village. After several incidents in December and January, the team was withdrawn to El Fasher and for several months MSF had to operate on an in-and-out strategy. During that period the clinic was run by Sudanese staff with an international team assisting once or twice a week with consultations. After negotiations took place with all parties to the conflict, full activities - including 24 hours services - were able to restart at the beginning of April. The outpatient department is now carrying out 200 consultations per day and the inpatient department, which had to be suspended during the evacuation, is working once again. In June 2006, MSF began work in clinics in Killin, and a month later in Gorni, to assist displaced persons. However, the project was evacuated for security reasons in late July and since then the clinic, which is located in the north of the Jebel Mara, has been run primarily by Sudanese staff alone. South Darfur With a population of over 90,000 people, Kalma is one of the largest camps for displaced people in Darfur. MSF works in the camp, focusing on mother and child care and running a women's health centre with up to 200 consultations per day. The centre provides ante- and post-natal care, as well as delivery assistance for high-risk pregnancies and referrals for obstetric emergencies. Family planning is also available. MSF is one of three agencies providing full treatment for survivors of sexual gender-based violence. A mental health programme addresses the profound psychosocial stress and trauma experienced by the population as a result of the current, precarious living conditions, as well as the psychological trauma related to past conflict. Psychosocial care is given through several hundred private counseling sessions per month, workshops and support groups. The project is complemented by community outreach activities. The Kalma team is also responding to the emergency needs of new arrivals and people whose shelters have been destroyed by fires by providing plastic sheeting, blankets and jerry cans. MSF has been present in Shariya, a government enclave where originally around 27,000 people were living, since June 2004. The initial needs were medical and nutritional, but after a series of attacks MSF increased its activities to provide support to displaced people and, when security permitted, started mobile clinics to neighbouring villages. As the medical needs of the remaining population has stabilised considerably, MSF closed this project in April 2007. Muhajariya is a large town in South Darfur, which is controlled by one of the rebel factions. Approximately 32,000 people currently live in the town, including some displaced people from the surrounding area. In October 2006, fighting resulted in the new displacement of an estimated 50,000 people. Since then the violence has decreased and some of those that fled are returning, although the situation remains volatile. MSF offers surgical care and runs inpatient and outpatient departments and a laboratory, as well as providing reproductive health services with antenatal, postnatal and family planning assistance. Treatment for survivors of sexual violence is available. Because the nutritional situation is still fragile, therapeutic and supplementary feeding remain integrated into the basic health care programmes. MSF teams also provide water to displaced people in settlements around Muhajariya. Community outreach programmes and mobile clinics have been suspended due to road insecurity, but will be restarted as soon as the situation permits. In November 2006, 14,000 displaced people from Muhajariya and the surrounding area sought refuge in Sileah. Due to the strain on food and water, diarrhoea and malnutrition are common causes of morbidity. MSF offers outpatient services with 1300-1500 consultations per month, monitors malnutrition and runs a home-based feeding programme. In April, the feeding programme was extended to the nearby town of Yassin, although access is limited by insecurity. MSF also supports efforts to provide water and sanitation facilities to the displaced people in the town. For the population and the thousands of displaced people in and around Feina, access to basic health care has been restricted due to violence. Currently, the MSF clinic sees around 130 outpatients per day. An antenatal care and home-based feeding programme will be added. MSF aims to open more clinics in this area, some in locations so remote that travel is only possible on donkeys. MSF teams have conducted evaluation missions in other areas of South Darfur, specifically in Kass camp between Zalingei and Nyala. In this 75,000-person camp, displaced people are crowded inside the town, in schools, fields and public buildings. The town is overflowing and families are living in particularly unhealthy conditions. An additional 25,000 people fleeing tribal conflicts have arrived since January. Kass is located in an area with high levels of insecurity and their arrival has strained living conditions severely. The few medical organisations in the area are overwhelmed. MSF plans to start working in this new camp to address the needs of the weakened population and the new emergency.