- Location of MSF Project in Sri Lanka

Shortly after midnight, the Doctors Without Borders/Médecins Sans Frontières (MSF) team in the city Vavuniya was awoken by the telephone. A night bus full of passengers was hit by a bomb explosion on the provincial road 30 kilometers outside the city. Some passengers were killed, and dozens were wounded. As soon as the security situation allowed, ambulances would try to pick them up. Could the anesthetist, the two surgeons, and the nurse from MSF report to the hospital immediately?

Full of projectiles
The team knew they would not be getting any more sleep. This was the second time in a month that a bus had been hit by a claymore mine: a remotely-triggered bomb full of metal ball bearings hidden on the side of the road. Within a short time, the ambulances brought 33 people to the hospital, including nine women and three children. For one woman, the help came too late; she passed away en route. Most were suffering from multiple wounds from the many small metal bullets. Some were lucky, and had only suffered superficial wounds; others had internal bleeding and broken bones. Still others were so badly hurt that the doctors could do little to help them.

Acute blood loss
The MSF team had earlier drawn up a disaster plan for the hospital in Vavuniya for just such an incident. There had been no time to practice, but the relief measures went according to plan. At the door, the anesthetist selected the wounded who could not wait one more minute for help. First, the wounded with respiratory problems and serious bleeding were stabilized and treated, and only then those with wounded extremities and broken bones. Everyone did their part. Thanks to the Sri Lankan doctors and nurses, who are often used to treating war victims, all of the wounded were treated in a short time. As the victims of a previous bomb explosion had not yet been discharged from the hospital, there was a shortage of beds and some patients had to be laid on the floor.

Human tragedy
"As a surgeon, you treat injuries," says Jim Balz, MD, who began working for MSF in Sri Lanka a short time ago and has worked with MSF in southern Sudan and Liberia. "The scale of the human tragedy only hits you later, when you go to intensive care and see the family standing around the bed of a man with metal bullet lodged in his brain who has little chance of survival. Those things affect you. Blowing up an ordinary passenger bus is not a way to fight a war – not that there is a good way to do it – but this is really not as it should be."

Tension and fear
Vavuniya has been in the grip of violence since last year. The city, controlled by the Sri Lankan government, is only17 kilometers south of the frontline. Tamils, Singhalese, and Moslems live alongside each other, but occasionally tensions flare between the different ethnic groups. Since the end of January, when MSF began working in Vavuniya, the hospital has treated many dozens of wounded people. Project coordinator Megan Hunter feels the tension and fear that hang in the air. "The violence reminds people here of the 1990s. The hope that peace will ever come is fading." Almost every day, the people in the streets can hear the sound of artillery, bomb explosions, and small-arms fire. Everyone waits for the attacks and fire fights that could break out in the city at any time.

Quick treatment
Due to the violence, many medical specialists have left the front areas like Vavuniya. The hospital sometimes went months without a surgeon. Wounded and other patients had to be brought to the south for treatment. The arrival of MSF helps many of the war wounded find quicker treatment. Dr. Balz is often impressed by his Sri Lankan patients. "The way they succeed in surviving their wounds, is a revelation for me. They are much better at dealing with wounds than we are, even though their medical care is less sophisticated than in the West. Maybe they are used to the violence surrounding them, but maybe we are just too spoiled."