I first arrived in Panthou in May 1998 to a horrific scene. We came in to land over the vast parched desert and as we touched down hundreds of tall, skeletal people slowly, quietly moved towards the plane and surrounded it. In the MSF therapeutic feeding centre, desperate women sat under the trees holding their listless, hollow-eyed children, just skin and bone.

In our supplementary feeding centre, long lines of women and children sat patiently waiting to collect their food rations. We were fighting a losing the battle. The general food distribution being supplied by the UN`s World Food Programme fell way short of what was needed and the entire population was slowly starving. It was becoming horrifyingly obvious that the food shortage normally endured by the people of southern Sudan at that time of year (the so-called `hunger gap` between the end of last year`s food stocks and the next harvest) was far worse than usual.

The latest phase of the civil war had been going on for 15 years and there had been several years of drought and inadequate harvests. In January 1998 fighting erupted in Bahr el Ghazal, southern Sudan, and the consequent population displacement tipped an already fragile situation over the edge into full-scale famine. MSF scaled up its operations in Bahr el Ghazal from February onwards and by the height of the famine in July and August we were feeding well over 12,000 children in nine sites across the province.

A year later I returned to Panthou, but to a different world. The people who greeted the plane were smiling, noisy and energetic. As we walked past their homes, there was a sense of normal life – fields being ploughed and planted, women cooking food, children playing. In our therapeutic feeding centre, a couple of dozen almost chubby children sat in a corner of the huge structure that had accommodated hundreds the summer before. The few severely malnourished children were those few with a causal illness such as TB.

Our supplementary feeding centre was mobbed but happily fewer than 400 were found to be malnourished, mostly formerly displaced people who had just returned to the area. The dramatic difference from my last visit constituted one of those precious moments working for MSF when you realise we`ve made a real difference. Thousands died in the famine last year, some of whom might have been saved but for the faults and weaknesses of the international relief effort. Everyone has since been conducting evaluations to try to learn the terrible lessons of last year. Nevertheless, as a direct result of MSF`s nutrition programmes last year, around 50,000 children did not die.

The situation in southern Sudan remains fragile and the people vulnerable. Although MSF`s feeding centres are now working at a much reduced level of operation, the turn-around in the nutritional status of the population does not reflect a real change in their ability to support themselves. It is an artificial situation in a war zone where the population is largely dependent on international humanitarian assistance.

West of Panthou, in Aweil county, conditions have deteriorated again in the last few months. Violence and looting is forcing communities away from their villages in the middle of the cultivation period, leaving them without food reserves. Numbers in our feeding centres in Ajak are rising once again. It is clear that MSF must remain prepared to respond again in Bahr el Ghazal, rapidly and massively if need be.