Médecins Sans Frontières (MSF) has had to halt its emergency medical care in the Swat region of Pakistan and reduce activities in other areas affected by the current warfare. The international humanitarian organization was the only one supporting the hospital in Mingora and providing ambulance services in Swat. The reduction of MSF’s activities is a result of the generalized insecurity in addition to a number of direct incidents against MSF itself. “Even before this new offensive, civilians in northwestern Pakistan were already struggling to survive a terrible situation,” says Brice de le Vingne, coordinator for MSF’s work in Pakistan and Afghanistan. “Today, curfews, roadblocks and intensely fierce warfare make it virtually impossible for them to reach hospitals and clinics. They are literally locked into this situation of extreme violence. On top of that, it is largely impossible for our medical teams to assist them.” Unknown numbers of people cannot escape the warfare. Trapped in their homes, they cannot go out to buy food, get clean water, visit a doctor if they need to. MSF calls on all parties to respect the rights of injured civilians to medical treatment and to provide space for MSF to assist them without being subjected to further violence, threats and intimidation. As a priority, MSF needs to be able to evacuate wounded people and replenish Saidu Sharif hospital with urgently needed medical supplies. “This is a completely untenable situation,” says de le Vingne. “It has gone from dire to absolutely desperate. And there is every chance that things will get even worse. Right now, exactly when the risks facing people are radically increasing, we are simply not able to set up much of the necessary lifesaving activities.” Hundreds of thousands are seeking refuge in less insecure parts of Pakistan. They often stay with host families, putting extra strain on local resources including health care, or in improvised camps. In Lower Dir, MSF continues to provide clean water and basic healthcare to displaced people in two camps. And in Peshawar, MSF prepares for a possible arrival of more displaced, including injured civilians who cannot find treatment closer to home. MSF has a team on standby in Dargai to assist all those who need surgery. From December 2007 to December 2008, during curfew hours MSF ambulances transferred around 1,300 war-wounded patients and other emergencies from various parts of Swat towards Saidu Sharif and hospitals in Peshawar and Islamabad. In September, MSF treated almost 4,000 cholera patients during an outbreak of the disease. Such lifesaving assistance is no longer possible. Other activities of MSF in Pakistan — in Baluchistan, Kurram agency, and in the Peshawar area — continue uninterrupted. MSF works in three basic health units in the Peshawar neighbourhoods that are hosting families displaced by the war, has supported a camp in Charsadda and distributed essential non-food items to over 30,000 displaced people in Peshawar, Charsadda and Mardan since August.