In Saiza hardly anyone sleeps at night. Campesinos (farmers) living in this small jungle enclave in the northwest of Colombia go to bed early, at sunset. But then they cannot fall asleep. When they can, it is even worse because their sleep is full of nightmares. As in many rural areas of conflict, fear has stolen Saiza's sleep.

Six years after the massacre that emptied this prosperous region of campesinos and turned Saiza into a ghost town, a few families have dared to return to their destroyed houses to face the armed groups that forced them off their land. The anxiety of surviving in a conflict area is taking its toll on the people,

One mother of five who returned a year ago said, "Sometimes I can sleep, but mostly I can't. My husband tells me, 'OK, sleep', and I close my eyes, but I can't stop thinking about when they'll come back and kill us all."

She is not alone in her fears. One of the area's long-time leaders, a key promoter of the community's return to Saiza five years after the massacre, admits that the first time he rediscovered sleep in this tormented town was in June 2005, when Médecins Sans Frontières (MSF) established a permanent presence in the town.

"Saiza, the town itself is terrifying" he agrees "There are what you might call ghosts here, because of what we had to live through. You feel afraid to spend the night here, but when the doctors are here it gives you peace of mind. You aren't leaving, are you?"

Although MSF is there to provide immediate health care to the area population, there is no denying the sense of security the team has brought to the settlers. But that in turn is a point of concern for the MSF team.

"People are frightened. But whether there is a real risk for them or they just believe they are in danger is not easy to say, " explains Steve Hide, field coordinator in the Costa Atlántica project of MSF in Colombia. "This is very difficult for us because on one hand we like the fact that we have an impact and influence among the population but also we don't want necessarily to be a security blanket or for people to think that we can provide something we can't from the security point of view."

Saiza is located in a strategic corridor used by guerrilla and paramilitary groups. In the last 15 years, the town has been the scene of killings, armed raids, and gun battles between armed groups. But what happened six years ago was different. The Saiza massacre in July 1999 caused the internal displacement of some 8,000 campesinos and Embera indigenous people. Even MSF, having just begun work in the area, was forced to leave after witnessing, along with the rest of the community, the murder of several shopkeepers.

According to one campesino, "The killers sent a direct threat to the civilians. They told us not to plant any crops or we'd end up buried next to the corn. They put the men in one line and the women in another. They started to kill people and burn the houses, and they gave us two days to leave."

For five years, what had been a social and commercial hub in the beautiful Paramillo National Park, was a wasteland. The crops failed, the forest began to creep into the streets, and trees sprung up in the patios of the burned houses. The main road, river port and airstrip deteriorated badly, and the health post and the school started to fall down. The town church remains closed to this day, because the murders were committed on its doorstep.

In spite of all this, one year ago the first seven families dared to return to Saiza, fleeing the misery of internal displacement.

"Sometimes we had to endure hunger. In the city you have to pay for everything, water, rent, food," said one of the returnees of his life as a displaced person. "It's really hard to leave everything you have, and go out looking for nothing. Borrowing everything, working without pay. Here, on the other hand, the land is really good, although people live with fear and there are always rumours that somebody or other is going to get killed. You're always stuck in the middle."

In Colombia, campesinos living in "red zones" &#– war areas &#– have to survive with the stigma of the armed group that controls the area where they live, and often are accused of belonging to that group. The constant rumours only increase their daily uncertainty. One old man explained that before the massacre he owned a big shop but he was forced to leave by threats from an armed group.

"When I was displaced, I was fat but still I had to sleep on the streets and ask for food from people passing by", he explains bitterly. A year ago he came back to Saiza and opened a small business where he sells everything from tuna fish to saddles. But he also admits to having problems sleeping.

"It is said that there are lists with names of people they are going to kill and that I'm in one of the lists," he says. "Alright, I say that if they're going to do something to me, they'll have to do it here, because I'm not leaving again. It's better to get killed in your own home."

When the first families came back to Saiza in early 2004, nothing was like before. The shocking scene of their town swallowed by the jungle and their houses destroyed was unbearable for them. One campesino describes their experience: "When we got here, we cried and we were really afraid. I couldn't stay in my house because it had been burned down. The first night, we all slept together and then nobody dared to go out and work. We stayed at home with our wives."

Little by little, the return to the community was organized and the rest of the campesinos began to come back. Currently the area has almost reached its original population of 1,000 families, although no more than 40 live in the town itself. About 70% of the returnees are originally from Saiza, the rest are mostly single men from other regions attracted by the rich land here. People plant corn and yucca root, raise pigs and harvest precious woods like cedar, teak and mahogany. According to the leaders, coca crops are not welcome.

However the living conditions are not easy., For now there is no running water or electricity. Most of the children live too far away to attend the school and to get to the nearest hospital people have to walk four hours and take a truck (and pay an impossible amount of US$2, enough to feed a family of six for two days).

A local leader says "We went back to the Stone Age. We grind our corn by hand with a stone mortar, we bring our drinking water from the river, we cook with charcoal. But when Saiza was Saiza, airplanes came here!"

For the first year and a half, MSF supported the returnees with mobile health brigades that came every six weeks. But since the end of June 2005, the health post has been completely renovated and MSF has established an ongoing presence with an innovative project in the region.

Based out of a health post in a fixed location, the project aims to provide basic medical care and psychological support for an area of almost 1,000 square kilometers, in the hub of a fertile jungle region dotted with small rural settlements and isolated homesteads.

According to Hide, "When we saw the number of returned people increasing and the health problems they were facing, the physical distance from the nearest hospital could be days walking. Our goal is to build up services on the ground as quickly as we can and provide wider health services. Basically the kind of health services you might find in a rural health post."

On regular rotations, a team of a doctor, psychologist, dentist, bacteriological specialist, logistician and nurses settle into Saiza to provide basic health care for the 38 small rural settlements in the area.

The health post is manned by three rotating MSF teams, each one staying in Saiza for two weeks until the replacement team arrives.

It takes seven hours in a 4x4 MSF car and then three hours walking, with a train of mules carrying the medical equipment, often through heavy terrain, for the MSF team to reach Saiza.

The second option is no easier and it is only feasible in summertime. After four hours driving, and only when the rains and dangerous river rapids allow, the team crosses Embera indigenous territory, traveling along the furious Río Verde by canoe where rapids and fast running currents are frequent.

"If you fall in the river it's not necessary to swim, you'd better pray", smiles Hide.

Medical needs run the gamut from malaria to parasitosis, leishmaniasis, problems related to reproduction, complicated births, machete wounds, snake bites... and the list is getting longer.

"Since we started being permanent, every team has seen many more health problems than we realized before. Because when you go only every six weeks you are not really there if there is an accident. When you are there permanently, you realize that people do have real problems," said Hide.

But if the MSF teams endure some hardships traveling to the region, the local population endures far more. Every two days a 20-year old woman walks four hours each way in her muddy boots to treat an abcess that appeared on her chest after the birth of her youngest child. She has not missed a single day.

"Nobody dies if they can't get to the doctor, you have to put up with a lot of pain and suffer a lot," she says.

Emergencies are also part of the job. In every one of the two-week health care shifts, the MSF team has had to work together to bring the seriously ill patients to the nearest hospital, either by river or by foot. These patients have included an Embera baby with pneumonia, another indigenous child with facial burns, a campesina woman with a botched abortion she attempted at home - emergencies that could be taken care of in a city, but that in a hard to reach rural area have become serious health problems.

Another price of the war in Colombia is distrust and a weakened social cohesion. In a year and a half, Saiza has had several presidents of the Community Action Committee, the local governing body, but all of them have resigned or left.

"There are two reasons for avoiding being in these structures. One is conflict obviously. Anyone who is a leader, especially in Colombia, can be easily killed by armed groups, so this is purely survival. But also, the community itself seems to be not that cohesive in terms of community spirit," said Hide.

"We believe that these communities lose their social cohesion in the displacement period. We have to accept that we are working in a dysfunctional community. So we don't regard a lack of social cohesion as a problem for our work, we see it as an indicator that this conflict affects people."

But during the last few months, the local football championship is gathering the community every weekend in the Saiza football pitch - located just in front of the church where the massacre took place. Every Saturday, the men's team play against other campesino or Embera communities. On Sundays, women use the same blue Saiza t-shirts to play in the female league. As a permanent resident in the area, MSF has already been asked to referee the games on occasion.

MSF's permanent presence in Saiza has created many expectations.

"Everyone knows that MSF is an institution respected by both groups," explains one campesino.

But in this town that is struggling to come back to life, there is one question most often asked in the first weeks of this permanent presence in the health post: "But you aren't leaving, are you?"