In May last year, when Richard Rowat arrived in the Malukus - an archipelago of more than 1,000 islands in Indonesia - he expected to have a relatively calm mission. His task was to wind down the MSF project for 30,000 internally displaced people, as the construction of essential services neared completion.

Four months later, he found himself in the middle of Christian-Muslim violence, a crisis that in the months that followed has spiralled out of control and has engulfed almost all of the islands of the Malukus. Tens of thousands more people have become displaced and more than 9,000 houses, churches and mosques were destroyed. Richard and his team are the only foreign aid workers providing medical assistance there.

"It was pretty quiet over here," said Richard over the phone from Ambon, the capital of the Malukus. "The communities were interacting, people would travel freely and there were no perceivable tensions. I was on my own and already dreaming of a nice break on one of the beautiful beaches here, after I finished my mission. Then, on July 26, I saw a crowd of at least 1,000 people outside our office with spears and swords. It took me completely by surprise. What began with a little stone-throwing in outlying parts of Ambon island had now expanded and come to the city."

In mid-January 2000, MSF now has a team of ten aid workers in this part of Indonesia. Six of the group are there to assess the situation on islands where clashes have been reported. The others provide aid to the vastly growing numbers of displaced people, supply medicines to clinics, run a pharmacy on Ambon island and lend support to the hospitals. The provision of water and sanitation facilities for those who have fled their homes continues, and MSF is setting up first-aid posts to treat clash victims close to the front.

The people fighting each other are divided along religious lines, but the basis of their conflict is primarily economic and social inequality.

Richard said, "the most important factor has been the transmigration policy of the previous government. About 100,000 people came to the Malukus, mainly from south Sulawesi. Before that, the population was more Christian. They started to complain that the new settlers, who were generally Muslim, were changing the balance and taking their jobs. The current climate in Indonesia allows people to speak out more freely than in the past. At the same time, the Muslim people feel that they have reached critical mass and that they should have more control over how things are run in the Malukus."

Richard adds that the economic crisis has added to the problems, as has the intervention of people from outside the province who gain from the destabilisation of the Malukus.

MSF brings aid to both sides, but Richard perceives that the Muslims seem to be worse off than the Christians.

"There is only one Muslim hospital here in Ambon," he said. "It was a maternity hospital which we are now helping to change into a trauma unit. That is urgently needed because for a Muslim to go to a Christian hospital would be suicidal."

The main medical problem is now clash-related injuries, and the wounds are no longer being inflicted by swords or spears but by homemade guns. The military may have control over Ambon, but not over the rest over the Malukus. And even in Ambon both populations mistrust them.

Richard has no hesitation in identifying the most difficult moment of his mission so far.

"That was on August 9. There was a clash in which the army was involved. In four cars, we were doing an ambulance run in the midst of the fighting. We were picking up wounded and dead kids from the streets of Ambon. That day will stay with me for a long time."