West Africa has been experiencing a sustained refugee crisis for more than a decade. Between 1990 and 1997, 235,000 people fled Liberia because of the civil war. Over the past year, the fighting between Liberian rebel groups and the army forces have intensified, forcing an additional 76,000 Liberians to seek refuge in neighbouring Guinea and Sierra Leone.

Since August 2001, and particularly over the past month of June, there has been an increase in violent clashes between armed groups in and around Lofa County in northern Liberia, prompting the exodus of thousands of people to the central and southern part of the country, and to Guinea.

"Cut off from adequate assistance and trapped between armed groups, civilians fleeing the fighting throughout West Africa are increasingly left with little or no protection or security, nor enough food", said Kostas Moschochoritis of MSF. "Since the re-opening of the border after the Guinea election, we've seen more and more people arriving from Liberia and showing distinctive signs of malnutrition".

Once across the border, most refugees from Lofa County arrive in Tékoulo transit camp (on the Liberian-Guinean border near Guekedou), which currently hosts some 902 Liberian refugees.

In this region, MSF supports 14 health structures in order to ensure health care for both refugees and resident population. MSF also provides water sanitation and organises medical screenings before and after transfer to new camps in the region of Albadaria, where the three camps of Telikoro, Boreah and Kountaya host 55,000 refugees. Another 7,000 refugees were moved to Dabola camp, in central Guinea. Mostly women and children are passing the border. Men are often forcibly recruited by the Liberian fighting groups.

MSF takes care of malnourished refugees arriving in the Tékoulo camp, while referring the most severe cases to the nearby nutritional centre run by Action against Hunger (ACF) in Macenta. "I used to be a farmer but it is too dangerous now, rebels systematically confiscate the harvest", says a 26 years-old refugee in Tékoulo. He fled the city of Kolahoun in Lofa County. "I fled with my three children because of hunger and insecurity.

I knew that, once in Guinea, my life will be saved. Everybody in Kolahoun wants to flee, but the majority doesn't do it. They are too hungry, too sick or too weak to walk".

MSF increasing field presence

MSF is currently sending specialists to Guinea to assist the field teams and to advise on humanitarian issues, in order to provide refugees and displaced with some legal protection. MSF also continues to provide nutritional and medical aid to the internally displaced Liberian people who are fleeing to the few safer parts of the country. Since the intensification of the fighting, Lofa region has been inaccessible to any media, aid organisation or UN agency.

There is no independent information on what the situation is like in the area, which has been caught for years in instability, civil war and population movements, and also subject to cross-border incursions by armed groups from Guinea and Sierra Leone.