Over the past weeks, heavy fighting has been concentrated in the far north-east of Sri Lanka in an area called the Vanni. Approximately 30,000 people have been able to flee the area to Vavuniya, a town just south of the Vanni, but up to 200,000 people remain trapped and without access to assistance.

Médecins Sans Frontières (MSF) provides medical treatment and emergency assistance in Vavuniya, both in the hospital and in camps set up by the government to receive the displaced population. The organisation also continues to seek urgent access to the 200,000 people in the Vanni and urges both parties to the conflict to do their utmost to ensure the safety of civilians.

In Vavuniya, MSF is supporting the Ministry of Health providing care to many people, including children, who have been seriously wounded by the fighting. Patients have been badly hurt by shrapnel and some needed amputations. An MSF surgeon arrived earlier this week and has been operating in the Vavuniya hospital around the clock.

In addition to the health services provided by the Ministry of Health, two more MSF expatriate doctors are expected to arrive and start mobile clinics in these camp sites, pending approval of entry visas.

MSF teams have started food distribution for children under five, expectant mothers and breastfeeding women in the camps. In the first two days 3,316 children received food supplements. MSF mental health personnel are working alongside a local NGO to offer counseling. One MSF staff talked to about 25 patients immediately after they arrived in Vavuniya hospital.

"People are very distressed, having been separated from their family at check points while fleeing the fighting. They have not had news since, but could hear bombing from the hospital where they were treated. It is uncertain whether or when people could go back to their homes in the Vanni and rejoin their families."

Those who managed to flee the Vanni tell how they were constantly on the run from the fighting and heavy shelling coming from both sides. Many have spent days on end hiding in bunkers. One woman explained to MSF staff how she tried to get out of the conflict zone five times, but had to return each time because the LTTE (Liberation Tigers of Tamil Eelam) kept shooting at people. She also said that people now staying in the camps fear that the LTTE might attack the camps to "punish" people who left the Vanni.

Northern Sri Lanka's Vanni area has been a battleground for years, although recently fighting between the Sri Lankan Army (SLA) and the LTTE intensified massively. Over 70,000 people have died in the conflict since its start in 1983.

MSF has been working in Sri Lanka since 1986. The organisation left Sri Lanka in 2004, following the peace agreement, and returned in 2007 when the conflict started again.