Médecins Sans Frontières (MSF) has warned that a new outbreak of kala-azar, or visceral leishmaniasis, could wreak havoc among the population of southern Sudan, whose nutritional status is severely compromised by 20 years of war and famine. "It is overwhelming. Many of the people coming to the clinic look more dead than alive.

They resemble terminal AIDS patients", MSF Operational Director, Jose-Antonio Bastos, said at press conference in London on Nov 8. MSF believes around 100,000 people died of the disease in western Upper Nile in the early 1990s - a third of the population living in that region.

At the height of the epidemic, there were insufficient healthy people to bury the dead. The outbreak waned 10 years ago but a drastic increase in cases in recent months indicates the disease may again rage out of control.

The agency is now registering more than 100 new patients a week in one of its four clinics in Lankien. At this centre doctors are treating 333 people with a 3-week course of injections and therapeutic feeding. MSF fears a disaster could reoccur if there is further disruption to operations such as the flight ban imposed when the government temporarily walked out of peace talks in September.