While tens of thousands of people remain trapped in the fighting zone and almost 200,000 are displaced in Vavuniya district alone, Médecins Sans Frontières (MSF) teams continue to provide surgical support in Vavuniya hospital and deliver supplementary food in Vavuniya and Manik Farm internally displaced people’s (IDP) camps. In addition, MSF has signed an agreement with the Sri Lankan authorities to set up an emergency field hospital which will act as the main referral hospital for the 120,000 displaced people living in Manik Farm.  MSF has also obtained the agreement s to start post-operative care in Paimpamadhu Ayurvedic hospital, for patients discharged from Vavuniya hospital. The number of wounded arriving directly from the conflict zone to Vavuniya hospital has decreased to barely a trickle: for this last week 16 wounded patients have come directly from the conflict zone to Vavuniya hospital. The reasons are that fewer people are able to leave the conflict zone and those who do are being transferred to other hospitals or straight to the camps. The number of sick and wounded patients being admitted to Vavuniya hospital, coming from the displaced people’s camps, has increased compared to previous weeks, with a total of 1,179 wounded and sick patients admitted to the hospital from the IDP camps in the last week.  The MSF surgical team working in Vavuniya hospital now has three surgeons and one operating room nurse. Together with the Ministry of Health staff, they have performed a total of 212 surgeries in the past week. Most of the surgical operations are related to wound infection, amputations that need further surgery, skin grafts and occasional reconstructive surgery. The Ministry of Health has increased the number of staff working in the Vavuniya hospital and 84 MSF caretakers continue to work round the clock, helping patients with basic needs like getting to the toilet, eating, getting dressed and wound care. MSF caretakers continue to visit all the wards on a daily basis and distribute items such as sheets, travel bags, flasks, plates, clothes, diapers and a single cash donation, according to the needs of the patients. MSF teams continue to distribute supplementary feeding (high energy porridge) to children under five, lactating mothers, pregnant women and vulnerable groups such as elderly and handicapped people, in Manik Farm camps and in five transit camps in and around Vavuniya town. In the past week, MSF distributed a total of 110,402 portions of supplementary food. This coming week, MSF will also start providing therapeutic ready-to-use food for malnourished children under five, pregnant and lactating mothers in the camps in zone 2 of Manik Farm. Hundreds of patients are in need of post-operative care and some of these patients are discharged to secondary level hospitals or to the camps and are therefore unable to receive the full post-operative medical care they need. Over the coming days, an MSF team will start post-operative care in the Paimpamadhu Ayurvedic hospital, near the town of Vavuniya. Patients in Vavuniya hospital who need post-operative care will be transferred there, where MSF medical staff will do minor surgery, wound care and physiotherapy. As well as the medical activities in Vavuniya district, an MSF surgical team continues to provide surgical support in the Ministry of Health Point Pedro hospital in the Jaffna peninsula. MSF has a total of 27 international staff and 343 national staff (contract and temporary staff) currently working in Sri Lanka.