"What MSF witnesses in Mount Elgon district is a dire situation," said Carrier. "People are suffering and their human needs are not being met. The current situation has deteriorated below human dignity. It is therefore of utmost importance that actors who have the mandate and the responsibility to protect these civilians step in and focus their attention to the plight of this population. Now more than ever."

The conflict in the mountainous and volcanic region of Mount Elgon in western Kenya sparked about a year ago. It is often referred to as a dispute between two clans - the Soy and the Ndorobo - over land sharing. Yet, reducing this complex situation to such a dichotomy, as is often the case when it comes to conflicts, is not only simplistic but very misleading.

Beyond the clan division, other factors have to be taken into consideration. These include elements of pastoral versus agricultural habits, land right issues, settling of old scores, revenge and counter revenge, as well as the long lasting political sensitivity surrounding land division in that part of Kenya.

Today, the civilian population is trapped between the violence of a group called the Sabaot Land Defence Force (or SDLF) which rebelled against the land allocation schemes of the central government; a strong police operation trying to address the violence and lawlessness within Mount Elgon's district; and criminal groups profiting from the current chaos.

The resident and displaced populations are facing a deteriorating humanitarian crisis. Yet little attention has arisen in response to their increasingly urgent situation.

MSF is one of the very few aid organizations helping the people touched by the conflict in the area. It is the only international aid actor on the ground on a permanent basis. Dealing with the consequences of the violence against the civilians, MSF activities focus primarily on providing access to free medical care through support to primary health care structures and immunisation activities but also mobile clinics in more remote or sensitive areas.

In Kopsiro for example, an area close to the separation line between the two communities, people have fled, fearing for their lives. The medical civil servants were no exception to this. Too scared to come and work, they had all fled the area. MSF reopened the health structure and started facilitating the transportation of Ministry of Health staff, helped by some additional medical staff supplied by the organization.

Living in fear

Since April, more than 14,000 consultations have been carried out in the Kopsiro dispensary, together with the Kapsokwany health centre and the MSF tents erected for consultations during mobile clinics. Relief items such as blankets and clothes are also distributed to families, as temperatures in the highlands of the volcano are low and can drop significantly at night. But beyond medical care, many of the inhabitants come to seek safety and refuge in the health centres.

"People are terrified," explained Rémi Carrier, who coordinates the MSF programs in Kenya. "As a recent example, heavy gunfighting outside the Kopsiro dispensary on August 27 pushed some 150 terrorised people to come find shelter and safety in the health structure. Lack of protection is the core problem at the moment."

The number of physical trauma (such as broken ankles due to beatings, sexual violence, etc.), as well as psychological trauma, is on the rise and malnutrition linked to hampered access to food or to crops is another consequence of the insecurity.

M. is a woman in her thirties. She tells how families are scattered everywhere because of the violence between the different parties.

"People are afraid and run away. They beat everyone: even the young kids they beat. They beat you with sticks. They slap you. They take your money from you and they kick you. Sometimes they do bad things to women. So people hide in the bush or in the maize fields. Sometimes, people stay there for one month. We just eat from the hands of others".

Another man explains his flight: "I moved down because people were fighting. People were being slaughtered. I had death threats. Our belongings were taken out of our houses. Houses were being burnt. We could not stay there. My mother and my brother were killed. They were together taking vegetables and they got killed. They were just going up to get some vegetables and were attacked on the way. This happened last month."

At a time of increased violence and needs linked to insecurity, the limited presence on the ground of aid actors (MSF and the Kenyan Red Cross at the moment) is not sufficient anymore.

"What MSF witnesses in Mount Elgon district is a dire situation," said Carrier. "People are suffering and their human needs are not being met. The current situation has deteriorated below human dignity. It is therefore of utmost importance that actors who have the mandate and the responsibility to protect these civilians step in and focus their attention to the plight of this population. Now more than ever."