Sri Lanka

Medical facilities in the Sri Lankan camps are overstretched. People can wait days before they can see a doctor for treatment. Although the war has ended, suffering continues.

We now have 180 patients in Pompaimadhu and the hospital is full. A lot of our patients have chronic wounds like pressure ulcers and amputations which are healing poorly. There is a huge need for physiotherapy. Everyone has joints that don’t move well and fractures that are not healing.

More than 77,000 traumatized and exhausted civilians poured out of Sri Lanka’s conflict zone in May after being trapped for months on a narrow strip of jungle and beach under nearly constant artillery fire and bombardment.

This edition of Alert comes to you in the aftermath of major violence and upheaval for civilians in northern Sri Lanka. Many were killed and injured during the first months of this year in a war between the Liberation Tigers of Tamil Eelam and the Sri Lankan army.

Seven weeks after fighting ended between the Sri Lankan army and the Tamil Tiger rebels, fewer patients are arriving at the hospitals, but their numbers still exceed bed capacity.

While Sri Lanka’s Ministry of Health has set up a system to provide initial treatment to the wounded and sick people in displaced persons camps, the needs remain immense, requiring an around-the-clock medical presence in the camps to respond to all emergencies.

When the war between the Liberation Tigers of Tamil Eelam (LTTE) and the Sri Lankan government ended on May 16, MSF emergency coordinator Lauren Cooney and her team provided emergency medical care at the Omanthai checkpoint, where thousands of people poured out of the conflict zone.  Here, Cooney describes the situation.

MSF, Ministry of Health doctors and nurses, and Red Cross Society volunteers quietly move from patient to patient housed under six temporary structures. Most of the patients have several dressings that need to be changed regularly. In a small room in the hospital, MSF surgeons and anesthetists carry out surgical procedures such as skin grafts and wound closures.

The situation remains extremely serious inside the hospitals and for the 269,000 displaced people in Vavuniya District.

MSF teams have been providing medical services day and night at different locations in Vavuniya district, including the hospital in Vavuniya city and at the checkpoint in Omanthai, close to the former frontline.

As the Sri Lankan government declares the end of the conflict, thousands of people are leaving the Vanni, the former conflict zone, and arriving in Vavuniya district in desperate need of medical care.

Twenty-six staff of Doctors Without Borders/Médecins Sans Frontières (MSF) are working around the clock as caretakers in two wards of the Ministry of Health General hospital in Vavuniya, northern Sri Lanka. The role of caretaker is to support hospital patients' basic health needs from the moment they arrive at the hospital and throughout their treatment.

While tens of thousands of people remain trapped in the combat zone, around 200,000 people have been able to flee and settle in camps for internally displaced persons in the Vavuniya District of Sri Lanka's northeast.

Patient numbers at Vavuniya hospital stabilized this past weekend as new arrivals were diverted to other hospitals. MSF has offered to scale up its medical activities and is currently in talks with authorities to do so.

"There are simply too many people to treat them all," says an MSF surgeon. "We are not able to save some people because we need to provide more aftercare. There are simply not enough nurses."

"Our hospital has got about 450 beds, and we’ve now got more than 1,700 patients in the hospital—on the floor, in the corridors, and even outside. So the hospital is very close to being overwhelmed."

Over the last 36 hours, MSF surgeons, alongside Ministry of Health staff, have been working around the clock to treat more than 400 war-wounded patients who have arrived in Vavuniya hospital in the government-controlled area of northern Sri Lanka.

In Vavuniya, about 50 miles south of where the fighting is taking place, MSF provides food in 10 camps for displaced people and works in the area’s hospital. Two MSF surgeons provide support to the existing surgical team; in March, they carried out almost 800 operations.

During the first two weeks of March, relatively few people seem to have been able to flee from the conflict-affected Vanni area in northern Sri Lanka. Communication with people inside the Vanni remains incredibly difficult, but accounts given by people who have managed to escape in recent days confirm that civilians remain trapped by the conflict and that it is practically impossible for them to leave as they risk being shot at.

MSF is urgently calling on both parties in the conflict in the Vanni area in northern Sri Lanka to ensure the safety of civilians and to allow access to humanitarian assistance. MSF teams are still unable to enter the Vanni to evaluate the needs of the affected population and provide urgently needed medical care.

MSF is preparing to scale up its assistance to displaced people in camps in and around the city of Vavuniya, in Northern Province, Sri Lanka. MSF is already distributing food and basic relief items in 10 camps and plans to work in five more.

MSF provides mental health counseling in Vavuniya for traumatized patients.

Yesterday, 226 sick and wounded civilians, 51 of them children, were evacuated by the International Committee of the Red Cross (ICRC) and the UN from the Vanni district of Sri Lanka's Northern Province after being wounded during fighting between government forces and rebel group the Liberation Tigers of Tamil Eelam (LTTE).

MSF is very concerned for the safety of an estimated 250,000 people trapped in heavy fighting in the Vanni in northern Sri Lanka. Hundreds of civilians are reported to have been wounded and killed during the last days as the LTTE-controlled area has shrunk in the face of the government of Sri Lanka’s military offensive.

Following a directive from the government of Sri Lanka earlier this week, MSF withdrew its staff yesterday from Kilinochchi town, in the Liberation Tigers of Tamil Eelam (LTTE)-controlled Vanni area. MSF is very concerned about the possible consequences of ongoing hostilities for the people still living in the area, and the impact of displacement on the health of the population.

Shortly after midnight, the 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. The team worked through the night to treat the victims of the bombing.

Throughout 2006, tens of thousands of people have been displaced by the armed conflict in Sri Lanka while at least 15,000 people have fled to India. For the past nine months, Doctors Without Borders/Médecins Sans Frontières (MSF) has been pushing to provide medical assistance to the population living in the conflict affected areas of Sri Lanka.

New York, January 9, 2007 — The staggering human toll taken by tuberculosis and malnutrition as well as the devastation caused by wars in the Central African Republic (CAR), Sri Lanka, and Democratic Republic of Congo (DRC), are among the "Top Ten" Most Underreported Humanitarian Stories of 2006, according to the year-end list released today by the international humanitarian medical aid organization Doctors Without Borders/Médecins Sans Frontières (MSF). The ninth annual list also highlights the lack of media attention paid to the plight of people affected by the consequences of conflict in Haiti, Somalia, Colombia, Chechnya, and central India.

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.

Since August, major fighting in northeastern Sri Lanka has forced more than 200,000 persons to leave their homes. It has become increasingly difficult to deliver aid to populations affected by the conflict and several regions have been cut off entirely from outside aid. Judith Soussan, Doctors Without Borders / Médecins Sans Frontières (MSF) head of mission in Sri Lanka, elaborates.

Doctors Without Borders/Médecins Sans Frontières (MSF) is deeply shocked and outraged by the announcement of the killing of 17 members of Action Contra la Faim/Action Against Hunger in Sri Lanka. MSF is concerned about the turn this conflict is taking. Since hostilities resumed, the level of violence directed at civilian populations and humanitarian aid workers has increased. Gabriel Trujillo and Denis Lemasson, MSF program officers for Sri Lanka, react to the news.

Paris/New York, August 9, 2006 – Deeply shocked by the killing of 17 Sri Lankan colleagues working with Action Against Hunger in Sri Lanka, Doctors Without Borders/Médecins Sans Frontières (MSF) demands that access to victims of the conflict there and security of humanitarian aid workers be guaranteed.

31 January 2005 - A little over one month after the tsunami hit Southeast Asia, Doctors Without Borders/Médecins Sans Frontières (MSF) is publishing a detailed report of its emergency relief activities to assist the victims of the disaster. Since the beginning of the crisis, over 200 international MSF volunteers and 2,000 metric tons of supplies have been sent to the region. Today, 127 international volunteers are helping in Aceh, Indonesia, 36 in Sri Lanka, and 6 in India, working side by side with national staff.

Tonia Marquardt, MD, was dispatched on December 31, 2004 to Sri Lanka, where she served as a field coordinator for the Trincomalee emergency on the eastern coast of Sri Lanka.

December 28, 2004 - Doctors Without Borders/Médecins Sans Frontières (MSF) emergency medical teams are assessing the needs of populations in the areas hit hardest by the earthquake and tsunami in South Asia. MSF is airlifting more than 60 tons of medical, surgical, and water-and-sanitation equipment to Sri Lanka and Indonesia. Currently, MSF teams are on the ground in India, Indonesia, Malaysia, Myanmar, Sri Lanka, and Thailand.

by Kaz de Jong, Maureen Mulhern, Nathan Ford, Isabel Simpson, Alison Swan, and Saskia van der Kam