With an estimated 200,000-300,000 displaced Liberians crowded into schools, churches, abandoned buildings and stadiums, living conditions are intolerable.

The availability of clean drinking water and proper sanitation in Monrovia, particularly in areas where displaced people are living, continues to deteriorate.With fighting continuing in and around the Liberian capital of Monrovia over the past two and a half weeks, 16 MSF international aid workers (including three surgeons and four physicians) and over 300 Liberian staff and some 600 MSF-supported public health workers have worked under extremely dangerous and difficult conditions to provide some of the only health care available to displaced persons and residents of Monrovia.

Last Saturday, MSF sent two cargo planes containing a total of 68 tons of medical and logistical materials to Monrovia for use by the MSF medical programs in Liberia.

An additional 8 tons of medical supplies, equipment, and food is scheduled to arrive in Monrovia late this week. Two make-shift hospitals built in the MSF residence compounds in the Mamba Point area of Monrovia continue to offer in- and out-patient care, maternity, pediatric, nutritional, and surgical care.

These limited facilities remain functioning today. After receiving more than 400 war wounded civilians in the two weeks of July 17 to August 1, last week the MSF Mamba Point hospitals treated over 160 war wounded civilians. Stray bullets continued to fall in, and close to, the MSF hospitals, making medical care for, and transport of, patients to the hospitals difficult. From July 28 to August 3, one compound hospital team saw 112 patients.

This number was significantly less than the preceding weeks because the danger of stray bullets meant that people had poor access to the MSF compound. There were 15 people admitted for surgery and almost all of these admissions were war-wound related. The situation has improved since this past Monday, and the number of war wounded civilians has dropped. However the decline is not necessarily an indication of improving conditions.

"In the past days, we've seen a decrease in the number of people coming to our clinics for treatment, but we don't think this is a good thing," said Dr. Chris Brasher, MSF medical coordinator in Monrovia on Sunday. "There is no question that people in Monrovia continue to suffer from malaria, cholera, difficult pregnancies, malnutrition, and other health problems, but the ongoing fighting has made the streets too unsafe for them to seek medical treatment."

This week, MSF opened an additional out-patient clinic in a convent school in the Mamba Point area of Monrovia and reopened Soniwein and New Georgia clinics. MSF continues to support two clinics on the West Point area of the city.

Duport Road clinic continued to offer medical care throughout the fighting although Redemption Hospital and the clinics in Clara Town and Logan Town remain closed. With an estimated 200,000-300,000 displaced Liberians crowded into schools, churches, abandoned buildings and stadiums, living conditions are intolerable.

The availability of clean drinking water and proper sanitation in Monrovia, particularly in areas where displaced people are living, continues to deteriorate. Cholera and malnutrition remain the biggest concerns for the current medical activity and although Redemption Hospital remains closed, MSF has been able to continue working at the cholera treatment unit (CTU) at the JFK Hospital and the teams hope to reopen two CTUs that had to be closed recently due to insecurity.

Any cases of malnutrition amongst children - always the first to suffer - are being sent to a therapeutic feeding centre run by Action Contre le Faim. Before the current round of fighting began on July 18, MSF teams had pre-positioned eight rehydration points in the city to offer access to drinking water and oral rehydration salts for those suffering from severe dehydration due to cholera.

Unfortunately, the limited movement in the city has made it impossible for MSF staff to adequately replenish these rehydration points.This past week, MSF began trucking water to centers for displaced persons in the Mamba Point area of central Monrovia, but efforts continue to be hampered by stray bullets and fighting.

Two MSF workers were lightly wounded last week. "Before the fighting restarted in mid-July, MSF was treating about 350 cholera patients a week, now we're seeing far less," continued Dr. Brasher.

"This is very worrying to us as we know that a cholera epidemic doesn't just disappear, particularly not when people are living in such cramped and unhygienic conditions without access to food, water or medical care.

"Significantly, most of the cases were coming from the "Island" area, now held by the rebels. We have no information on what is going on in terms of health on their side and need to evaluate as quickly as possible."

At the Samuel K. Doe Stadium in Monrovia, where the number of displaced persons has tripled to an estimated 50,000 persons in the past three weeks, an MSF team is carrying out over 250 consultations a day and runs a cholera treatment unit. A second MSF cholera treatment unit operates at the John F. Kennedy Hospital.

In Bong county, where MSF Liberian teams continue to offer medical care to over 60,000 displaced persons in three camps, MSF has measured a degradation in the nutritional situation over the past week.

MSF is currently starting therapeutic feeding for 65 severely malnourished children in the camps where food has not been distributed since May. On Wednesday, August 6, MSF dispatched a truck with nutritional materials, including high-protein biscuits, to the Salala camp where MSF will organize a blanket-feeding program in the coming days.

The situation in Monrovia is catastrophic enough, but access to over three-quarters of Liberia remains impossible and health care facilities are presumably all-but non-existent. MSF is gravely concerned about the health situation for all of the Liberian population.