Fighting between rebels and forces loyal to Ivory Coast President Laurent Gbagbo broke out in the region in December 2002 and left the Man hospital looted and then closed. Re-opening it was imperative for the local population, especially after the closure of the only other hospital in the region in nearby Danané.

In addition to up to 170 consultations per day, the hospital in Man is provides 33 beds which, if necessary, could be increased to 100.

Paediatrics, surgery and maternity are among the services which have been resumed. "The situation in the west of Ivory Coast is extremely volatile at the moment and there is a genuine climate of anarchy and fear," explained Christopher Stokes, MSF Operations Director in Belgium who has just returned from the region.

"The people are becoming too afraid to come even for medical consultations. Last week, after hearing about an outbreak of fighting in Bangolo, a village 25km from Man, over 60 people fled the hospital, including a mother whose child was suffering from second and third degree burns. With no care the child would probably not have survived."

Meanwhile, MSF is planning to send a surgeon to bolster the team of four expatriates currently working in the hospital. It is also aiming to give support to local health clinics, many of them pillaged by the fighters, which have been left deserted by fleeing staff.

"The people of Ivory Coast are not used to conflict," continued Stokes. "They are well-educated, comparatively well-off and used to relatively good health care. Now they are embroiled in a war which has led to a complete collapse of the institutions that underpin their lives and they can’t adapt. The state of shock among the population is striking."