Médecins Sans Frontières (MSF) is urgently calling on both parties in the conflict in the Vanni area in northern Sri Lanka to ensure the safety of civilians and to allow access to humanitarian assistance.

In neighbouring Vavuniya, located outside the conflict zone, MSF medical teams are working with hospital staff around the clock. Ninety percent of the injuries seen are a direct result of the fighting. People are being brought to hospitals with gun-shot and shrapnel wounds. In the past two weeks, MSF has performed over 300 operations on patients who were directly wounded in the conflict and it appears this number is just the tip of the iceberg.

An estimated 200,000 Sri Lankans living under desperate conditions are still trapped in the conflict zone in Sri Lanka's north. Patients tell MSF how people are being shelled for days on end, with the dead and wounded surrounding them. There is a severe lack of medical care and not enough food and drinking water.

The stories shared with MSF by those who have managed to escape make painfully clear the desperate situation inside the Vanni. People have been trapped in active conflict for weeks, hiding in bunkers they have dug themselves.

A few weeks ago, for the first time in months, a significant number of civilians began emerging from the Vanni. There are now a reported 35,000 people who have managed to reach Vavuniya. They are tired, hungry, and frightened, and have no information about their family members who did not manage to escape the conflict zone.

Many are injured, some with infected wounds that are weeks old. As a result, many people have been maimed for life. Even those who have made it to Vavuniya have no freedom of movement, no access to information, and no options to look for lost family members.

Only a minority of the people trapped inside the Vanni have succeeded in crossing the front line to safer territory. Most remain caught between the warring parties.

An additional 2,000 sick and wounded people have been transferred from the Vanni to Trincomalee by boat by the International Committee of the Red Cross (ICRC). Despite the authorities' efforts, the medical management of wounded people who were evacuated is becoming a major challenge.

While hospitals in Trincomalee and surrounding areas were initially able to cope with the influx of wounded, some are now reaching full capacity and are in need of additional space, as well as medicine and medical materials. MSF visited several hospitals following the arrival of the first medical evacuations and is in contact with local health authorities in order to identify support that can be provided to the hospitals.

As MSF has been denied access to the population trapped inside the Vanni, the organization is relying on the personal accounts of patients to highlight what is happening there.

One 53-year-old woman told MSF staff how her family spent days in a bunker without food and water. Out of desperation, and despite the shelling, they left their bunker to get some food when three out of her 15 family members were killed on the spot. Her daughter was seriously wounded by shrapnel and is now in Vavuniya Hospital. Some of her relatives had to stay behind in the Vanni. She does not know whether they are still alive. This is only one example and many other people tell a similar story.

MSF teams are still unable to enter the Vanni to evaluate the needs of the affected population and provide urgently needed medical care. Together with other international organizations, MSF has been denied access since September 2008.