People are caught in the middle of the conflict. Even if they do not take sides they may be suspected of supporting either the government or the rebels. In a way, MSF faces the same suspicion.

It is very difficult to persuade everyone that we are neither on one side nor the other, and to keep being seen as neutral, which is our main basis for access to the population in need.

We cannot do our work in safety if this is not understood....In the end it is our neutral and impartial action that counts. So, a good medical programme is our best protection.

How has the situation evolved at the end of last year?

"At the end of October, a newly formed armed group started to take control of several key towns in the Vakaga province. In December it was announced that the government had recaptured all areas. The problem was that nobody had any information about the humanitarian situation. Attempts by humanitarian organisations to assess the needs of the population in the region were blocked by the government for over a month. In the middle of December MSF was finally granted access to the people."

What is the humanitarian situation like?

"The civilians in Vakaga are trapped in the middle of the conflict as they are suspected to support one side or the other. Violence between armed groups has led to the pillaging and torching of entire villages. We discovered more than 200 houses which have been burned. The people fear reprisals by one of the armed groups. The majority of the population have been forced to flee their village and about 10,000 to 15,000 people are hiding in the bush - where they attempt to survive in the most primitive living conditions.

"For most of the population - estimated at 35,000 to 55,000 for the whole province - there is no access to health care whatsoever. Health posts are abandoned, most of the few medical workers have fled the area, and the few medical supplies that would normally have been sent to Vakaga have not reached most parts of the province since the outbreak of fighting."

How is MSF reacting?

"As a first, short term response, a mobile medical team visits about half a dozen locations in and around the provincial capital Birao and is treating up to 100 patients per day. The main health problem is Malaria, which is particularly endemic as the wet season lasts up to ten month in the region. But the team also comes across acute respiratory infections and diarrhoeal diseases, indicators of the bad conditions people are living in.

"We also distributed emergency relief items to displaced people: blankets, as it is quite cold there at night, mosquito nets impregnated with repellant to help people protect themselves from malaria, plastic sheeting and soap to improve the shelter and personal hygiene of those who live in the bush.

"Apart from the assistance in and around the provincial capital Birao, we are currently expanding our activities to the area of Gordil, about 200 kilometres or a ten hour drive to the west. Relief items are being distributed to the population who are hiding in the bush in this area, and a mobile team is treating those in need of medical care."

Vakaga is partly government-controlled, partly rebel-held. What does that mean for the people and MSF's work?

"As I said, people are caught in the middle of the conflict. Even if they do not take sides they may be suspected of supporting either the government or the rebels. In a way, MSF faces the same suspicion. It is very difficult to persuade everyone that we are neither on one side nor the other, and to keep being seen as neutral, which is our main basis for access to the population in need. We cannot do our work in safety if this is not understood.

"Our staff therefore reiterates time and again to all sides - village chiefs, representatives of armed groups, government officials, local population - that MSF is assisting the most vulnerable first, regardless of their political, religious or ethnical affiliation, and that we help people purely on the basis of medical need. In the end it is our neutral and impartial action that counts. So, a good medical programme is our best protection."