Amsterdam - An upsurge of violence has led to displacement, injury and death of civilians in the Upper Nile and Jonglei provinces of southern Sudan. According to the international medical humanitarian organisation Médecins Sans Frontières (MSF), clashes between armed groups and direct attacks on villages have occurred in the region north and south of the river Sobat since the beginning of April. The deteriorating security situation also forced MSF to evacuate a number of its international teams from the area.

On April 10, armed militia attacked the village of Ulang, where MSF operates a clinic. Most of the patients and villagers, along with MSF's staff, fled in search of safety. Thirty-one people were reported killed and dozens injured; 15 were treated in the MSF hospital in the nearby town of Nasir.

Subsequent outbreaks and threats of violence forced MSF international staff to evacuate from Nasir as well, and from clinics in Wudier, Lankien and Pieri. In Pieri, most of the patients in the MSF clinic, among them 120 patients being treated for tuberculosis (TB), were forced to flee. Medical equipment, drugs and food for the patients were looted, leaving the clinic effectively destroyed.

"We are concerned about the growing number of violent incidents," says MSF co-ordinator Cristoph Hippchen. "This means humanitarian assistance to the people of Upper Nile and Jonglei, already far below what is needed, will be even less now."

MSF is one of the very few providers of health care in Upper Nile and Jonglei, an area where malaria, TB and the deadly tropical disease kala azar are rampant. While in some locations Sudanese staff have been able to continue treating some of the patients, access to essential medical care for the population is now severely reduced.

After decades of conflict, the signing of a peace agreement in January 2005 raised the hopes of the people living in southern Sudan. However, in parts of Upper Nile and Jonglei, renewed fighting and tension have created similar conditions to the years of war, with civilians living under the threat of violence and precarious access for humanitarian agencies. Since the signing of the agreement, little has changed in the lives of these people, and the benefits of peace seem tenuous at best.

MSF works in six locations in the Upper Nile region with 50 international and 400 Sudanese staff. In 2005 MSF conducted more than 294,000 medical consultations, of which over 40 per cent were done with children younger than five. In southern Sudan MSF runs 19 hospitals and clinics providing primary and secondary health care, and has extensive programs to treat people with TB, malaria and kala azar.