The people of southern Sudan are trapped in a worsening crisis following the most violent year there since a 2005 peace agreement ended more than two decades of civil war. However, according to international medical relief organization Médecins Sans Frontières (MSF), the response to this escalating emergency is inadequate. In its report, ”Facing Up To Reality: Health crisis deepens as violence escalates in southern Sudan”, MSF calls on government authorities, international donors and relief organizations to recognize the full extent of the crisis and ensure that immediate humanitarian needs are prioritized. “ Violence is surging, plunging people from one disaster to the next. Yet, immediate needs are not being met,” said Stephan Goetghebeur, MSF director of operations for Sudan. “A better response to this growing emergency is crucial, or clinics will continue to run out of vital medicines, gunshot patients will still reach medical care many days after attacks and countless others will receive no care at all.” Over the last year MSF witnessed a disturbing deterioration in the security situation in southern Sudan, from increasing clashes in Upper Nile, Jonglei, Lakes and Central Equatoria States, to attacks by Ugandan rebel group the Lord’s Resistance Army (LRA) in the Equatoria States. The violent clashes in Jonglei and Upper Nile States suggest a more serious trend than traditional ‘cattle-rustling’. Villages, rather than cattle camps, were often attacked, with the majority of victims being women and children. In these attacks three times more people were killed than were wounded. 87 per cent of those MSF treated had gunshot wounds. MSF provided 1,426 surgeries in the first ten months of 2009 in those two states alone; more than the total 1,271 surgical interventions for six states in 2008. “The intensity of this year’s violence has severe consequences,” said Shelagh Woods, MSF Deputy Head of Mission. “We treat injured women who lost entire families, children with legs destroyed by bullets, people who fled without time to bury loved ones. People do not feel safe and live in constant fear of attacks.” The violence has displaced up to 250,000 people who now live in precarious conditions where disease thrives and malnutrition is a grave risk. In the first ten months of 2009 MSF admitted 11,129 patients with severe malnutrition to its clinics, compared to 6,139 admissions for all 2008. The rising violence aggravates the already dire medical situation in southern Sudan, where 75 percent of people have no access to even the most basic healthcare and where large-scale outbreaks of diseases threaten lives. MSF had already treated 175 patients in the first six weeks of a recent outbreak of kala-azar - a fatal, if untreated, parasitic disease – compared to 127 for the whole of 2008. However, the focus of international donors on longer term development remains disproportionate to immediate humanitarian needs. “Alarm bells must ring when only a handful of agencies are mobilizing to respond to serious needs on time. Development alone is not enough in southern Sudan. Emergency preparedness and humanitarian action must be priorities,” adds Stephan Goetghebeur. MSF has been working in Sudan since 1979 and currently has projects in southern Sudan, Kordofan, Red Sea State and in Darfur. Médecins Sans Frontières (MSF) is an independent and neutral aid agency that serves all people based on medical need, regardless of tribe, race, political or religious affiliation.