Dr. Guillermo Bertoletti, MSF director of operations. Photo © MSF

An increase in violence and fighting in 2006 has led Doctors Without Borders/Médecins Sans Frontières (MSF) to return to Sri Lanka to provide medical assistance to the war affected population. Since August of this year, approximately 200,000 people have been displaced by the fighting. Despite requests from the Sri Lanka's ministry of health for MSF to provide assistance to several hospitals in the north of the country, MSF has so far only been allowed to begin activities in Point Pedro Hospital on the Jaffna Peninsula. However, MSF teams have now had to suspend their medical activities and withdraw from the only hospital where it had been permitted to work. Dr. Rowan Gillies, president of the international council of MSF, and Dr. Guillermo Bertoletti, director of operations for the French section of MSF, recently went to Sri Lanka to see if it was possible to find a solution. Dr. Bertoletti explains why MSF suspended its activities and provides an update of the situation following his visit.

Why has MSF suspended its activities and withdrawn from Jaffna Peninsula?
Since the September 30, false allegations have been leveled in the Sri Lankan media accusing MSF teams of participating in the conflict. We have been cited as a "threat to national security" and have been accused of actively supporting the Tamil Tigers. Simultaneously we received a letter from the government canceling our existing visas and asking us to leave the country, followed shortly by a second official letter saying we could stay in the country until "further notice," stating we are under investigation.

Though MSF has not been officially accused of anything, the false allegations made in the media, combined with a lack of clear support from the government as a whole, have made the risk for our personnel unnecessarily high. As a result, the MSF team in Point Pedro has ceased providing medical assistance, and has left the Jaffna Peninsula.

Seeing as the government has now said MSF can stay, isn't it an overreaction to stop medical activities just because of some articles in the media?
This is not a decision we have taken lightly. It was especially hard to leave the patients and to stop collaborating with our colleagues in the hospital, knowing that the situation on the peninsula continues to deteriorate and that currently there is heavy bombing in the area. Throughout 2006 the security situation in the country has greatly degraded, creating acute needs for the civilian population as well as increasing the risk taken by humanitarian organizations. The assassination of 17 members of Action Against Hunger/Action Contre la Faim (ACF) was a terrible shock to us and illustrates how dangerous the situation can be for humanitarian workers also.

Within this context, like in any armed conflict, our independence and neutrality must be respected. If we are to help the civilian population affected by the conflict, we need the false allegations and inaccurate statements made in the media cleared up. We need a strong message that the government as a whole, and that authorities at all levels, are ready to welcome and facilitate the work of an internationally recognized, independent, and neutral medical-humanitarian organization. Without these assurances, we cannot send our teams to provide medical assistance to those in need.

Why were these accusations leveled against MSF? Maybe this is just a misunderstanding?
The accusations are absurd and completely unfounded. MSF has a long record of impartial and independent action in all the major armed conflicts of the last 30 years. We speak out on the humanitarian issues we face, but we don't take sides in a conflict. We worked in Sri Lanka during 17 years of armed conflict, and have proved that we are a medical emergency organization responding to the needs of the population. This situation is all the more puzzling taking into account that the hospitals we had proposed to support are all government hospitals, in government controlled areas, following requests made by the Ministry of Health. Yet, thousands of people living in the LTTE-controlled areas are also in desperate need of assistance.

However, there are a series of factors that may help to understand why this has happened. The accusations and restrictions on MSF, and other humanitarian organizations, are occurring in a context of increasing distrust and sometimes outright rejection of the involvement of international actors in Sri Lanka. On the one hand the general disappointment and frustration with the reconstruction efforts following the tsunami has translated into a profound disappointment and mistrust of NGOs. On the other hand, there is a strong opinion against the involvement of foreign organizations in the conflict. Many foreign entities, be them international organizations, states, or international NGOs, are all grouped together and perceived as being pro-LTTE (Tamil Tiger) or as profiting from the war. This is why it is extremely important for us to explain our action and to be publicly and officially recognized as being independent, neutral, and impartial. Finally, it may be that the government does not want an international presence in the areas where war is being waged.

Following your visit, do you think this situation will be resolved? What will MSF do if there is no progress?
We have made a commitment to work in Sri Lanka, and are prepared to honor that commitment. We have grave concerns for the population living in the war-affected areas. Fighting is increasing. Heavy bombing has displaced tens of thousands of people who are in need of assistance. Hospitals are in need of support in order to meet the demands. It is deplorable that we are not allowed to bring medical assistance to the population living in areas where heavy fighting is underway.

Following several meetings we had in Colombo, the capital of Sri Lanka, I believe there are members of the government who are concerned by the need for medical assistance in the north and east, and would like MSF to provide this assistance. However, this needs to translate into concrete actions. MSF surgeons, nurses, and other staff have been on standby for months in Colombo and in Europe, ready to provide care to Sri Lankans. Nevertheless, we cannot keep our teams on standby indefinitely. Today our name is not cleared up and we are not granted permits and authorizations to carry out our work. This means that we remain blocked, with no security for our teams and no humanitarian space to carry out our activities. If this doesn't change soon, if the government as a whole doesn't show that we are welcome to work in Sri Lanka, then I will consider this a situation that may force the French section of MSF to leave the country.